General Information

Introduction

HIPAA Regulations

Dental

Flexible Spending Accounts

Term Life Insurance

Long Term Disability (LTD) Insurance

Supplemental LTD Insurance

Employee Assistance Program

Early Retiree Benefits

Retiree Benefits

Holiday Schedule

Appendices:

Health Insurance Rate Sheet

Comparison of the College-Sponsored Health Insurance Plans

Application for Health Insurance Premium Subsidy

Campus Map

Dental Insurance rates:

*College contribution is 75% of single plan premium with same dollar contribution to family premium. For less than full-time employees, College contribution is based on a sliding scale (similar to health insurance).

Diagnostic:

• Comprehensive Evaluation - 1 every 60 months per dentist
• Periodic Oral Exams - 1 every 6 months
• Full Mouth X-rays - 1 every 60 months
• Bitewing X-rays - 1 every 6 months
• Single tooth X-rays - As needed

  --- General Care Information ---
  --- Early Childhood Information ---
  --- Preventing Cavities ---
  --- Xylitol Information ---

Preventative:

• Teeth Cleaning - 1 every 6 months
• Periodontal Cleaning - 1 every 3 months following active periodontal treatment, not to exceed 2 in a calendar year if combined with preventive cleanings.
• Fluoride Treatments - 1 every 6 months for members under the age of 19
• Space Maintainers (required due to premature loss of teeth) - For members under age 14 and not for the replacement of primary or permanent anterior teeth.
• Sealants - Unrestored permanent molars, once per tooth for members through age 15. Sealants are also covered for members aged 16 up to age 19 for those who have had recent cavity and are at risk for decay.
• Chlorhexidine Mouthrinse - This is a covered benefit only when administered and dispensed in your dentist's office following scaling and root planing.
• Fluoride Toothpaste - This is a covered benefit only when administered in your dentist's office following periodontal surgery.

• Silver Fillings - Once every 24 months per surface per tooth
• White Fillings - Once every 24 months per surface per tooth on front teeth; single surface only on back teeth.
• Temporary Fillings - Once per tooth
• Stainless Steel Crowns - Once every 24 months per tooth.

Oral Surgery:

• Oral surgical benefits not provided when rendered in a surgical day care or hospital setting.
• Simple Extractions
• Surgical Extractions

Periodontics:

• Periodontal Surgery - Periodontal benefits not provided when rendered in a surgical day care or hospital setting
• Scaling & Root Planing - Once in 24 months, per quadrant

  --- Managing Gum Disease Information ---

• Root Canal Treatment - Once per tooth
• Vital Pulpotomy - Limited to deciduous teeth

Prosthetic Maintenance:

• Bridge or denture repair - Once within 12 months, same repair
• Rebase or Reline of Dentures - Once within 36 months
• Recement of Crowns or Onlays - Once per tooth

Emergency Dental Care:

• Minor Treatment for Pain Relief - Three occurences in 12 months
• General Anesthesia - Allowed with covered surgical services only

Prosthodontics:

• Dentures - Once within 60 months
• Fixed Bridges & Crowns (when part of a bridge) - Once within 60 months

• Crowns (when teeth cannot be restored with regular fillings) - Once within 60 months per tooth

  --- Implant Information ---

	There is a $1000 calendar year maximum for all coverages combined.
	Rollover Max Available - Up to $350 of unused benefit may be rolled over to the next calendar year provided the member has used at least one preventative service. Max rollover per person accrued is $1000 in additional benefit. Current benefit is used before rollover benefits are accessed.
	Annual Deductible $50 single and $150 family
	*Deductible is waived for Preventitive services. 3 individual deductibles per family.
	Eligible dependents are covered up to age 26 or for two years past the loss of dependent status, whichever occurs first.
	There are no waiting periods for any services.
	There will be an annual open enrollment every May 1st – May 31st each year.
	All out of network services are based on usual, reasonable, and customary rates for given area.
	Access to a network access plan – a listing of dentists contracted with Delta Dental to provide additional discounts off services and procedures to Guardian dental plan members. Locate these dentists on the web at www.deltadentalma.com
	Dental claims – Delta Dental, P.O. Box 9695, Boston, MA 02114. Phone: 1-800-872-0500
	You may want to ask your dentist to submit a pre-treatment estimate to Delta Dental for any procedure that exceeds $300. this will enable us to help you estimate any out-of-pocket expenses you may incur.
	All claims must be submitted within one year.