Dental Benefits FAQ
This information is summary in nature and does not supersede your plan documents. Consult your plan documents for full eligibility and coverage details.
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.
As outlined in the Summary Plan Descriptions, all regularly budgeted full- and half-time individuals are eligible for benefits.
Your dental coverage offers a discount program at select locations, but it cannot be used at the same time as the Cigna vision insurance plan (if you elect vision coverage). Additional information about your EyeMed discounts can be viewed here.
If you have a change in your mailing address, please contact Human Resources immediately. We will need to update your address in our system with the health, vision, and dental insurance carriers. If you previously participated in our TIAA-CREF retirement plan, you will need to contact TIAA-CREF directly; their number is (800) 842-2252.
Yes, children may remain on your health, vision, and dental insurance plans until the end of the month they turn 26. This is also true if they are working or are married.
Yes, you are free to choose any Dentist or Denturist.
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.
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.
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.
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.
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.
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.