This information is summary in nature and does not supersede your plan documents. Consult your plan documents for full eligibility and coverage details.
Q: I am a new hire. When do my benefits start?
A: At UNE your benefits start on the first day of the month after your hire date (the first day you worked); if your hire date is the first day of the month, then your benefits begin on your first day of work. Only dental services received after you become eligible will be covered.
Q: How do I know if I am eligible for benefits?
A: As outlined in the Summary Plan Descriptions, all regularly budgeted full-time and half-time individuals are eligible for benefits.
Q: I purchased UNE’s dental insurance. Do I have vision coverage?
A: Your dental coverage offers a discount program at select locations, but it cannot be used at the same time as the CIGNA vision benefit that comes with your elected medical coverage. Additional information about your EyeMed discounts can be viewed here.
Q: I recently moved and want to update my address with my health insurance carrier. What do I do?
A: If you have a change in your mailing address, please contact Human Resources immediately. We will need to update your address in our system and with the health and dental insurance carriers. If you participate in our retirement plan, you will need to contact TIAA-CREF directly; their number is (800) 842-2252.
Q: My child is over age 18. Can they remain on my health and dental insurance plans?
A: Yes, children may remain on your health and dental insurance plans until the end of the month they turn 26. This is also true if they are working or are married.
Q: May I choose any Dentist or Denturist?
A: Yes, You are free to choose any Dentist or Denturist.
Q: Will Northeast Delta Dental Make Payment Directly to The Dentist or Will I Receive Payment?
A: If the Dentist is participating, Northeast Delta Dental will make payment directly to the Dentist. If the Dentist does not participate, or if you obtain services from a Denturist, then payment for services rendered will be made directly to you unless state law requires that payment sent to the Dentist.
Q: What Difference Does It Make If I Go to A Participating Dentist or A Non-Participating Dentist?
A: Northeast Delta Dental does not restrict you from visiting any Dentist. However, if you go to a Participating Dentist reimbursement may result in a lower out-of-pocket expense for you. Northeast Delta Dental will pay to such Participating Dentist the applicable selected Co-payment percentage of the allowable fee (as such fees are filed with and/ or accepted by Northeast Delta Dental), or the billed fee, whichever is less. Such payment, together with the Subscriber’s Co-payment, will satisfy in full the claim of the Participating Dentist for the Dental Care provided.
If you are treated by a Non-Participating Dentist, or by a Denturist, Northeast Delta Dental will make payment directly to you on the basis of the Dentist’s or Denturist’s fee up to the maximum amount allowed Non-Participating Dentists unless state law requires that payment be sent to the Dentist. Otherwise, it will be your responsibility to make full payment to Dentist or Denturist.
Q: How Much of the Dental Bill Do I Pay?
A: You are responsible for the amount shown on your Explanation of Benefits form that will include any charges for optional treatment or specific exclusions of your program. Your Dentist may request your Co-payment, Deductible, and payment for non-covered services, at the time services are rendered.
Q: Am I Covered for All Dental Services?
A: Not necessarily. Your Coverage is described in this document and in the Outline of Benefits. These covered benefits are governed by the Exclusions, Limitations, and Northeast Delta Dental’s current Processing Policies.
Q: What If My Spouse is Covered by Another Dental Plan?
A: You may be entitled to as much as (but not more than) 100% of your Dentist’s or Denturist’s charges for covered benefits. It is important that you inform your Dentist or Denturist or any dual coverage so that the proper claim filing procedures may be followed and that you get the maximum benefit from your dental program.
Q: Is It Necessary for Me to Have My Dentist or Denturist Get a Predetermination for My Dental Services?
A: Northeast Delta Dental strongly encourages Predetermination of cases involving or extensive treatment plans. Although it’s not required, Predetermination helps avoid any potential confusion regarding Northeast Delta Dental’s payment and your financial obligation to your Dentist or Denturist.