Support Staff Dental Coverage Policy

Support Staff Policies & Procedures

Support Staff Dental Coverage Policy

(Revised 1/16)

Policy

The University provides access to dental coverage for eligible employees.

Eligibility: Regular full-time and part-time (50-89.9%) faculty, academic staff and University support staff with appointments of nine months or more.

Effective Date
Faculty, Academic Staff and Executive Management: Coverage is immediately available upon hire, provided enrollment occurs within 30 days of employment. If enrollment occurs within the first 30 days of employment, coverage will be retroactive to the date of hire.
Support Staff: Coverage will become effective the first day of the month following date of hire, provided enrollment occurs within 30 days of employment.

Summary of Benefits:

Dental coverage is available through one of the following dental plans:
- Delta Dental Plan, a traditional dental plan, or
- Aetna, a dental maintenance organization (DMO).
Delta Dental Plan pays 50% of usual, customary and reasonable charges for most dental services, as defined in the Master Policy (available from MSU Human Resources).
- There is no deductible that the employee is responsible for.
- Benefit payments are limited each calendar year to $600 for each covered person.
- Orthodontic services are covered for persons under age 19 and are limited to a separate lifetime maximum of $600.
- If employee and spouse or Other Eligible Individual are both enrolled University employees, the plan provides up to 100% of usual, customary and reasonable charges for most dental services, as defined in the Master Policy (available from MSU Human Resources).
Aetna DMO utilizes primary care dentists to lower the cost -- it is a managed-care dental plan. Members select a primary care dentist (PCD) from the provider network and visit their PCD as needed for treatment and care. Highlights of the plan include:
- Fixed co-pays for services
- No annual or lifetime benefit maximums
- No annual or lifetime deductibles
- Orthodontia is available for adults and children

Premium contribution: The University contributes the following percentages towards dental coverage:

Full-time Employees (90-100%): The University contributes 100% of the monthly premium towards single, two person, or family coverage for full-time employees and employees on flexible appointments.
3/4-time Employees (65-89.9%): The University contributes up to 75% of the full-time family University contribution towards the cost of single, two person, or family coverage for 3/4-time employees.
Half-time Employees (50-64.9%): The University contributes up to 50% of the full-time family University contribution towards the cost of single, two person, or family coverage for half-time employees.

The employee's partial premium (if any) will automatically be payroll deducted for eligible part-time employees. Official retirees and employees not receiving a payroll check will be billed. Retirees and LTD recipients may continue participation based on their employee group and status during their active employment (VARIES: Employees on a Family Medical Leave [FMLA] will continue to receive the University premium contribution - see Policy and Procedure for Family Medical Leave Act [FMLA]).

Termination date of benefit:

Dental coverage will terminate when one of the following occurs:
- last day of the month of employment, or
- date of transfer to an ineligible status unless the employee is an official Michigan State University retiree or elects COBRA continuation of coverage.
This benefit continues for faculty on layoff or approved leave of absence for up to 24 months. Part-time employees will be billed for their portion of the premium.
Dependent coverage terminates as above. In addition, certain changes in dependent status terminate coverage for dependents as defined in the Master Policy (available from MSU Human Resources).

COBRA continuation of coverage: In accordance with the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA), group dental coverage for eligible employees and their dependents may be continued in the following situations:

Upon termination of employment or transfer to an ineligible status, employees and/or covered dependents may elect to continue group dental coverage for a period of up to 18 months (29 months if disabled and receiving Social Security Disability) on a cash basis.
In the event of the employee's death, divorce, legal separation, termination of an Other Eligible Individual relationship, or a dependent's loss of coverage due to age or loss of IRS dependency, dependents may elect to continue group dental coverage for a period of up to 36 months on a cash basis.

COBRA coverage must be elected in writing to MSU Human Resources by the eligible employee or dependent within 60 days of the qualifying event.

Conversion of coverage: No conversion possible.

Procedure

Application for enrollment:
Employee:

Enroll within 30 days of initial employment or appointment to an eligible status by accessing the EBS Portal with your MSU NetID and password.
If enrollment does not occur within 30 days of initial enrollment or appointment to an eligible status it is necessary to wait for an annual open enrollment period.
During annual open enrollment eligible employees and retirees may:
- enroll,
- change carriers or
- add eligible dependents.
Dependent unmarried children incapable of self-support due to mental or physical disability may remain covered under the contract under Michigan Public Acts 274 and 275, however the disability must be identified by a physician prior to age 19.

Changes in coverage or personal information:
Employee:

To make the following changes, access the EBS Portal using your MSU NetID and password.
- the addition of dependent(s) within 30 days of acquiring the dependent through birth, marriage or Other Eligible Individual relationship, adoption, etc. (action not taken within 30 days will require waiting for an open enrollment period),
- a deletion of dependent(s) when no longer eligible for coverage due to death, divorce, marriage, change of dependent status, graduation from college, termination of an Other Eligible Individual relationship, etc.,
- dependents who turn age 19 and are attending school full-time or
- cancellation of coverage.
Contact MSU Human Resources whenever the status of a dependent changes.
Contact MSU Human Resources to elect continuation of dental coverage, under COBRA provisions, within 60 days of any qualifying event (see "Continuation Coverage Rights Under COBRA" for applicable qualifying events).

Processing claims:
Employee:

Delta Dental: Obtain dental claim forms from the dentist's office (if in Michigan), MSU Human Resources, or Delta Dental. If services proposed by the dentist exceed $200, the completed claim form should be submitted to Delta Dental by the dentist for predetermination prior to providing services. Delta Dental will return form to dentist indicating amount covered under plan.
Aetna DMO: No claim form is needed by employee/retiree.

Premium payment (part-time employees on unpaid leave of absence, COBRA participants, and some retirees):

MSU Human Resources: Sends premium notice to individual's home address for payment of premiums due.

Refer questions to: MSU Human Resources (telephone 517-353-4434 or email solutionscenter@hr.msu.edu)

Revision history:

8/12/16 - Updated EBS Portal references.

1/14/2016 - Updated enrollment period for new hires from 60 days to 30 days.

7/1/2015 - verbiage change for dental termination of coverage

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