Crowns, onlays, and substructures are payable once per tooth in any three-year period. Veneers are payable on incisors, cuspids, and first bicuspids once per tooth in any three-year period without age limitations. Composite resin (white) restorations are payable on posterior teeth. Porcelain and resin facings on crowns are optional treatment on posterior teeth. Vestibuloplasty is a Covered Service. TMD treatment is a Covered Service. Benefits for Temporomandibular Disorders (TMD) are limited to those services normally provided by a dentist to relieve oral symptoms associated with malfunctioning of the temporomandibular joint. This does not include services that would normally be provided under medical care. Full and partial dentures are covered once in any three-year period. Reline and rebase of dentures, and tissue conditioning are covered once in any two-year period. Bridges are payable once in any three-year period. Implants are payable once per tooth in any three-year period. Implant related services are Covered Services. Crowns over implants are payable once per tooth in any three-year period. Services related to crowns over implants are Covered Services. General anesthesia and IV sedation are payable when administered for single extractions. Inhalation of nitrous oxide and therapeutic parenteral drugs are Covered Services. Professional diagnostic consultation provided by a dentist or physician other than the requesting dentist or physician is covered twice per calendar year. Occlusal guards and repair and/or reline of occlusal guards are payable once in any five-year period. Having Delta Dental coverage makes it easy for you to get dental care almost everywhere in the world! You can now receive expert dental care when you are outside of the United States through our Passport Dental program. This program gives you access to a worldwide network of dentists and dental clinics. English-speaking operators are available around the clock to answer questions and help you schedule care. For more information, check our Web site or contact your benefits representative to get a copy of our Passport Dental information sheet. Maximum Payment – Unlimited per person total per Benefit Year on all services. Deductible – $50 Deductible per person total per Benefit Year limited to a maximum Deductible of $100 per family per Benefit Year. The Deductible does not apply to oral surgery services.
Waiting Period – Enrollees who are eligible for Benefits are covered on the date of hire.
Eligible People – All benefit-eligible AAUP employees of the University of Cincinnati (0001) and COBRA (1099).
Also eligible are your Spouse or Domestic partner and your Children to the end of the month in which they turn 26, including your Children who are married, who no longer live with you, who are not your Dependents for Federal income tax purposes, and/or who are not permanently disabled. Enrollees and dependents choosing this dental plan are required to remain enrolled for a minimum of 12 months. Should an Enrollee or Dependent choose to drop coverage after that time, he or she may not re-enroll prior to the date on which 12 months have elapsed. Dependents may only enroll if the Enrollee is enrolled (except under COBRA) and must be enrolled in the same plan as the Enrollee. An election may be revoked or changed at any time if the change is the result of a qualifying event as defined under Internal Revenue Code Section 125. Coordination of Benefits – If you and your Spouse or Domestic partner are both eligible to enroll in This Plan as Enrollees, you may be enrolled together on one application or separately on individual applications, but not both. Your Dependent Children may only be enrolled on one application. Delta Dental will not coordinate benefits between your coverage and your Spouse's coverage if you and your Spouse are both covered as Enrollees under This Plan.
Benefits will cease Benefits will cease on the last day of the month in which employment ends.
Customer Service Toll-Free Number: 800-524-0149 (TTY users call 711) https://www.DeltaDentalOH.com Contract Start Date: January 1, 2021 Document Creation Date: April 28, 2021
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