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. The dental decision an employee makes upon enrollment in CMU CHOICES is effective for up to two years (through June 30, 2014). After two years (effective July 1, 2014) the employee can change their dental decision during the plan's new enrollment period.
Q. When is the benefit year for the dental plans?
A. It is from July 1 through June 30. This means that dental expenses incurred on and after July 1 must meet the appropriate deductible before further dental expenses can be claimed.
Q. Why am I making a decision that will last two years (unless I have a Status Change)
A. This two-year rule helps stabilize the cost of the dental plan. The dental coverage is up to a two-year commitment because if employees opt in and out annually, the cost for this coverage is likely to increase more quickly for everyone. The two year decision is in effect no matter what option you choose; even if you elect "No Coverage".
Q. What exactly does the dental plan's $50 deductible per person or $150 per family mean?
A. In a single person policy, one (1) person has to reach a $50.00 deductible before reimbursement. Each person in a two (2) person policy must reach a $50.00 deductible before reimbursement. With a family policy (three(3) or more people), 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 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 not 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 Orthodontia Plan 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). Your spouse is not eligible for
CMU CHOICES coverage in the dental plan as a dependent if he or she is a retiree of another company and is eligible for an available plan but is NOT enrolled or is already covered as an employee under a CMU plan.