Lake Superior State University
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Section: Employee/Labor Relations Section Number: 4.3.3
Subject: Fringe Benefits: Dental Insurance Date of Present Issue: 09/01/91
  Date of Previous Issues:
07/84, 07/86, 03/87, 06/89, 09/89

POLICY:
  1. Eligibility for Group Coverage

    All faculty bargaining unit members, full-time administrative/professional employees and full-time hourly bargaining unit members (employed over 26 hours per week) are eligible to enroll in the group dental plan*. Employees (and/or their spouses) reaching age 65, who elect to remain in the group health insurance plan (see Section 4.3.2.A) will have dental insurance continued under the same conditions as other employees during the term of their employment.

  2. Enrollment

    New employees may enroll before the 26th of the month in which hired or rehired for coverage effective on the first day of the following month. New employees hired or rehired between the 26th and the last day of the month may enroll at time of hire, but coverage will become effective one month later. EXAMPLE: an employee hired between January 26 and February 25 will be covered March 1. An employee hired on February 26 will be covered on April 1. Employees who fail to apply for group coverage at the time of hire may sign up only during the yearly re-opening period in November with coverage effective on December 1.

    Newly hired, full-time faculty who have signed a letter of appointment may complete enrollment procedures in the month prior to being initially placed on payroll so that coverage will be effective on the first day of the month in which they are to be placed on payroll. Usually this will be September 1. Faculty may complete the enrollment process by mail in the month preceding coverage, but the enrollment card must be received in the Employee Relations Office by the 20th of the month in order for coverage to become effective on the first.

  3. Transfer

    A new employee who has been enrolled under a Blue Cross-Blue Shield plan of any state in the United States may transfer membership to the University group plan without interruption of coverage. Membership between spouses may be transferred in the same or to another group without interruption of coverage.

  4. Contributions*

    The University pays the basic rate of the one-person, two-person, or family premium for dental insurance, Class I, II, and III coverage for eligible full-time employees (employed over 26 hours per week), at 70% payment of reasonable charges, with a $1,000 maximum benefit per contract year.

    Effective September 1, 1992, faculty bargaining unit members and eligible A/P employees will also be eligible for Class IV, orthodontic benefits with a 50% co-pay and a lifetime maximum of $1,500.

    Part-time members of the faculty bargaining unit may enroll in the group plan, and will sign a payroll deduction form at the time of enrollment to have the pro-rated premium deducted from their paychecks; or they will sign a waiver card if already covered under another dental insurance policy (i.e. spouse's) and do not wish to enroll in the University plan. If payroll deductions are stopped by the enrollee, coverage will be automatically terminated.

    Children reaching age 19 may continue on the family coverage through the year in which they become 19. Reduced rider coverage may be provided for a child past age 19, at the employee's expense, by completing a Family Continuation Rider application form and a payroll deduction form for payment of premiums, if the child is:

    1. Unmarried
    2. Between nineteen (19) and twenty-five (25) years of age
    3. Legally residing with and dependent on the subscriber for more than half of his or her support as defined by the U.S. Internal Revenue Code.

    The cost of the Family Continuation Riders is paid by the employee and is deducted each month from the last paycheck of the month for coverage for the following month. The cost of Family Continuation Riders for faculty bargaining unit members and A/P employees is paid 100% by the University.

  5. Changes in Coverage

    Any changes in coverage (i.e. birth, death, marriage, or divorce) must be reported to the Employee Relations Office within 30 days of occurrence, and reported to the underwriter on a Change of Record form. Forms are available in the Employee Relations Office.

    Failure by the subscriber to report these changes places liability for loss of coverage, or additional costs, on the individual.

  6. Termination of University-Paid Coverage

    University-paid coverage terminates on the last day of the same month if employment terminates on or before the 15th of any month. University-paid coverage will be continued to the last day of the following month if employment terminates on or after the 16th of any month.

    University-paid coverage for faculty members on academic year appointment terminating at the end of the academic year (May) will be extended through August 31 of their year of termination.

  7. Cash Payment and Election of Continuation of Coverage

    1. Cash payments may be accepted for employees on unpaid medical leave, or on unpaid leave of absence of up to one year, if payment is made prior to the 20th of the preceding month for each month of coverage.

    2. Beginning July 1, 1986, for non-union employees, and January 1, 1987, for union employees, the option to continue coverage in the group is available, with identical coverage, without proof of insurability, under the same conditions as other group members, by paying the group premium rate, for the following: (COBRA Law)

      If elected by employees, for 18 months, if loss of coverage is due to:

      1. reduction in work hours
      2. voluntary termination (quit or retire)
      3. lay-off due to economic reasons
      4. discharge for misconduct (other than gross misconduct)

      If elected by dependents, for 36 months, for:

      1. surviving spouses and their children (deceased employee)
      2. children of deceased employees (i.e. single parent) and children of deceased surviving spouses
      3. separated, divorced, or Medicare ineligible spouses, and affected children of current employees
      4. children of current employees who would lose coverage because of their age (i.e. FC and SD rider)

      Election to remain in the group plan must be made within 60 days of notification of the right to elect this option. Premiums must be paid by the 20th of the prior month, for continuous coverage, and retroactive payments made within 45 days of election of continuous coverage.

    3. Persons desiring to make cash payments should contact the Employee Relations Office for assistance before making payment at the Cashier's window.

  8. Termination of Subscriber-Paid Coverage

    The University will terminate Continuation Coverage prior to expiration of 36- or 18-month optional period if:

    1. the dental plan provided to any employee is abolished
    2. the beneficiary fails to pay the premium
    3. the beneficiary becomes eligible for another dental plan upon re-employment, remarriage, or attainment of medicare eligibility.

    Forms are available in the Employee Relations Office.

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