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Chittenden Central Supervisory Union
Serving the Essex Junction, Essex Union #46, and Westford Schools

Dental Insurance

Table of Contents

Plan and Cost Information

Our group dental insurance is provided through Northeast Delta Dental.  For information about the plan, please refer to the following documents:

Below are the annual dental insurance premiums for our group plan for the 2008-09 contract year. Employees should refer to their master agreement or individual contract agreement to determine their portion of the premium cost, if any.

Coverage Annual Premiums
Single $ 517.20
2-Person $ 874.92
Family $ 1,182.72

Membership and Eligibility Information

Eligibility

New hires/rehires are eligible to enroll on our group plan the first of the month following his/her first day of employment as an eligible employee.  In order to enroll, a Dental Enrollment Form needs to be completed within 30 days of the employee's date of hire.  Coverage will begin the first of the month following receipt of the completed enrollment form if received within 31 to 60 days.  If the enrollment form is received after 60 days, coverage will begin on the next open enrollment date.

Eligible Persons

Employees and their dependents may enroll on our group plan.  Eligible dependents include:

  • Employee's Spouse/Civil Union Partner
  • Employee's unwed children between the ages of 2 and 19 who lives with the employee
  • Employee's unwed children between the ages of 19 and 23 who is a full-time student (taking 12 or more credits)
  • Employee's Spouse's/Civil Union Partner's unwed children between the ages of 2 and 19 who lives with the employee
  • Employee's Spouse's/Civil Union Partner's unwed child between the ages of 19 and 23 who is a full-time student (taking 12 or more credits)
  • Employee's dependent who is incapacitated

Delta Dental will provide automatically coverage for newborn children of participating employees for the first thirty-one (31) days following birth.  Upon receipt of an enrollment form to add a new child, coverage will resume on the first day of the month following the date of the child's second birthday. 

Full-time Student

The employee's dependent who is between the ages of 19 and 23 and is a full-time student is considered an eligible dependent.  In order to be considered a full-time student, the following requirements must be met:

  • The student earns at least 12 credits per semester.
  • The employee submits a Student Certification Form along with proof of the student's full-time status. Acceptable proof of full-time status shall include:
    • tuition bills, and
    • copies of valid identification from the institution

Student Certification must be completed at the following times:

  • When the student turns 19 and would otherwise be ineligible for coverage
  • Every year as long as the student remains a full-time student
  • When the dependent stops being a full-time student
  • When the student turns 23

If a dependent turns 19 and is removed from covered then later becomes a full-time student, s/he can be added as a dependent.  To do so, a completed Student Certification and Dental Enrollment Form would need to be received within 60 days of the date the dependent becomes a full-time student.  Coverage for the student will begin the first of the month following receipt of the required forms

Open Enrollment

Our group dental insurance open enrollment date is July 1 each year. 

During open enrollment, eligible employees may elect to:

  • Enroll in on our group dental insurance plan if s/he is not currently enrolled; or
  • Add eligible dependents who are not currently enrolled.

Employees who wish to take advantage of an open enrollment date should complete and submit a Dental Enrollment Form (and Student Certification if dependent being added is a full-time student between the age of 19 and 23).  Completed enrollment forms must be returned to Human Resources for processing prior to July 1st of the corresponding benefit year.  Late enrollments will not be processed until the next available open enrollment date.  

Adding Eligible Dependents (prior to Open Enrollment)

In order to add a dependent to your insurance policy after initial enrollment, participating employees must complete and submit a Dental Enrollment Form and corresponding paperwork to the Human Resource Department within 30-days of the following events: 

  • Birth/Placement or Adoption

  • Marriage/Civil Union;

  • Spouse/Civil Union Partner's involuntarily loss of benefits through his/her employer; or

  • Child over the age of 18 becomes a full-time student or qualifies as an "incapacitated" child.

If the completed enrollment form is received within 30 days of the event, coverage will begin the first of the month following the event. 

Removing an Ineligible Dependent

In order to remove an ineligible dependent to your insurance policy after initial enrollment, participating employees must complete and submit a Dental Enrollment Form and corresponding paperwork to the Human Resource Department within 30-days of the following events: 

  • Divorce/Legal Separation

  • Child loses Dependent Status (i.e., dependent turns age 19 and is not a full-time student, or full-time student over age 18 graduates, etc.…)

  • Death of a dependent

Coverage will end the first of the month following the date of the event.  The employee may be responsible for the full premium cost of the ineligible dependent's coverage if s/he fails to complete and submit the required paperwork within the time frame indicated.

 

Terminating Coverage

Separation of Employment

When an employee separates from employment, s/he is no longer eligible for coverage on our group plans effective the first of the month following his/her last day of work.  However the employee has the right to continue coverage at his/her own expense under COBRA for up to 18 months (or 29 months in the case of a disability). A COBRA Notification letter will be issued to employees upon separation explaining this option.

Leave of Absence

With the exception of approved leave under the Family Medical Leave Act (FMLA) or the Vermont Parental and Family Leave Law (VPFL), an employee who is on an unpaid leave of absence for longer than two weeks is no longer eligible for coverage on our group plans effective the first of the month following the date the unpaid leave began.  The employee has the right to continue coverage at his/her own expense under COBRA for up to 18 months (or 29 months in the case of disability).  The employee can re-enroll on our group plan effective the first of the month following return from his/her approved unpaid leave.  To re-enroll, the employee must complete and submit a Dental Enrollment Form prior to the effective date of coverage. If the unpaid leave begins and ends during the same month, coverage is unaffected.

Voluntary Cancellation

An employee can elect to voluntarily cancel his/her coverage between open enrollment periods.  To do so, the employee must complete and submit a Dental Enrollment Form.  Coverage will terminate the first of the month following receipt of the required form.

Outline of Benefits

Benefit Year

The benefit year for determining annual deductibles and maximum benefit amounts is the calendar year from January 1 through December 31.

 

Benefit Coverage Summary

Claim Type Benefit % Maximum Benefit Annual Deductible
Coverage A - Diagnostic & Preventative 100% $1000 per calendar year combined for Coverage A, B, and C No deductible
Coverage B - Basic 80% $25 per person or $75 per family
Coverage C - Major 60%
Coverage D - Orthodontics 60% Lifetime maximum of $1000 per person No Deductible

Benefit percentages shown are based upon the actual charge submitted to a maximum of the Participating Dentist's approved fees or Northeast Delta Dental's allowance for Non-Participating Dentists.

Coverage Exceptions:

Coverage A:

  • Emergency palliative treatment and periodontal cleanings will be covered under Coverage A
  • Two oral evaluations and cleanings are covered per calendar year. 
  • Bite wing x-rays are covered twice per calendar year. 
  • Complete series or panoramic films are covered once in any three consecutive calendar years.
  • Full-time, dependent students are covered to the end of the month of their 23rd birthdays.
  • Fluoride treatments are covered once per calendar year to the end of the month of an eligible subscriber's or dependent's 19th birthday.
  • A prophylaxis, routine or periodontal maintenance procedure, is covered twice in a calendar year. 
  • Sealants are covered once per tooth every three (3) consecutive calendar years to the end of the month of an eligible dependent's 14th birthday (limited to posterior teeth).

Coverage B:

  • Recementing of bridgework is included under Coverage B

Coverage D:

  • Appliances to control harmful habits are covered once per lifetime.  When performed, these services will be paid and are applied toward the orthodontic lifetime maximum.

Additional Information

 

Related Forms

Click here for the following forms:

  • Dental Student Certification Form
  • Dental Enrollment Form
  • Dental Claim Form
  • Authorization to Release Information