CMU CHOICES offers employees the ability to select one of two dental programs or to elect "No Coverage" in addition to choosing between the two plans, employees decide who in the family will have the dental coverage.
Q. When is the benefit year for the dental plans?
A. The plan year for the deductible and annual plan maximum is July 1 through June 30.
Q. What exactly does the dental plan's $50 deductible per person or $150 per family mean?
A. The annual deductible applies to basic and major care services. In a single person policy (or employee only coverage), one person has to reach a $50.00 deductible before benefits are paid on basic and major services. Each person in a two-person policy (or employee + one dependent) must reach a $50.00 deductible before benefits are paid. With a family policy (or employee + 2 or more dependents), the $150.00 family deductible may be reached by summing the deductible amounts paid by each family member up to the $150.00 maximum amount. No one person contributes more than $50.00 towards the deductible.
Q. What are the rules for covering my children?
A. Your children are eligible for coverage from birth through the end of the calendar year of the child's 26th birthday regardless of the child's residency, marital status, student or financial dependency status. Your children are eligible to be covered under the buy up plan that includes orthodontia until the age of 19. When a program of orthodontic treatment begins prior to reaching the age of 19, coverage will continue past the 19th birthday until:
- the treatment plan submitted prior to start of treatment is completed;
- the dependent is no longer eligible;
- the lifetime maximum is exhausted.
If one or more of your children is receiving orthodontia treatment as of the beginning of the Plan Year, the dental buy up plan that includes Orthodontia coverage in CMU CHOICES will pay 50% of the remaining treatment charges, up to a lifetime maximum of $2,000 per individual.
Q. How do we know when it is necessary to have pre-authorization before a dentist can perform a service, and how is it obtained?
A. Dentists know when pre-authorization is required since they have a standard list of such procedures. They will initiate the process, which may take up to four weeks. Usually for services for $100 or more.
Q. Are the requirements for my employed spouse to be eligible as a dependent in the dental plan of CMU CHOICES the same as for the medical coverage?
A. Yes. Your spouse
must elect to take their employer sponsored dental coverage through his/her place of employment if he or she is eligible, and the employer makes a contribution toward coverage costs. However,
CMU CHOICES may serve as a secondary source for a working spouse, (through two-person or family coverage). Further details are available on the Working Spouse / OEI Rule FAQ webpage.