- New employees and their dependents are eligible for dental insurance on the first of the month following 3 months of continuous employment.
- During the year, if you have a qualifying event (marriage/divorce/new child/etc.), you will have 30 days from the date of the qualifying event to make a change to your benefit election. If you do not request the change within 30 days, the next opportunity you will have to make changes to your benefit will be at the next Open Enrollment period.
- Newborns must be added within 31 days of their birth, or within 31 days of their 2nd birthday. If not added within those times, the child will have to wait to be added at the next Open Enrollment period.
- Dependent children ages 19 up to age 25 qualify for continued coverage in the employees dental plan if they are unmarried, primarily supported by the employee, and enrolled in a secondary school, college or university as a full time student. Student Verification paperwork will have to be completed.
It is the employees' responsibility to notify HR when their child is no longer a full time student. The child must be removed from your Dental Insurance effective the last day of the month of graduation or date child left school.
BENEFIT COVERAGES & PERCENTAGES PAID BY DELTA DENTAL
|Diagnostic & Preventative
|Major - includes implant services
- The maximum amount which your plan will pay is $1,500 per person per calendar Year for Diagnostic & Preventative, Basic and Major benefits.
HEALTH THROUGH ORAL WELLNESS (HOW) PROGRAM
This program extends additional preventive benefits to those who are at greater risk for oral disease. Benefit enhancements may include sealants for children and adults, greater frequency of cleanings (up to 4 cleanings per year), periodontal maintenance, fluoride treatments, oral health counseling and tooth decay susceptibility testing.
Read the HOW Brochure to get more information! You can also go to the HOW web site for more information.
If you have any questions or concerns regarding the program call Delta Dental Customer service at 603-223-1000 or 1-800-537-1715.
(Please know, any additional preventive benefits you may qualify for through the HOW program are subject to the City’s dental benefit plan design. These benefits are subject to the $1,500 calendar year maximum. Also, if your qualify for additional periodontal maintenance services under “Basic Restorative”, you will be responsible for the 40% coinsurance).
- Authorization Form
Fill out this form if you want to authorize another person to provide, or receive dental information on your behalf.
- Dental Enrollment/Change Form
This form is for All Employees EXCEPT Aldermen and Department Heads.
Use this form to add dental insurance as a new employee, or when you have a qualifying event and need to add or cancel your dental insurance or add or remove a dependent.
- Dental Enrollment/Change Form 80%/ 20%
This form is for Aldermen and Department Heads ONLY.
Use this form to add dental insurance as a new Aldermen or Department Head, or when you have a qualifying event and need to add or cancel your dental insurance or add or remove a dependent.
- Student Verification Form for New Employees
If you are a new employee or first time member with Delta Dental, please complete this form and send to HR/Benefits to enroll any dependent between the age of 19 and 25 onto your Delta Dental Plan. They must be full time students and you must submit backup of their student status.
Delta Student Verification Form
If you are a current member with Delta Dental and you need to verify your dependents student status, please complete this form and send to HR/Benefits. Also include backup that your dependent is a full time student.