UVa Dental Plan
The UVa Dental Plan offers two options: Basic Dental and Enhanced Dental. Both options are administered by United Concordia and provide a broad scope of dental services offered by a carefully selected network of dentists. When United Concordia participating dentists are used, participants receive the maximum benefits available. Members may be balance-billed and incur more expenses if non-participating dentists are used. A current listing of network dental providers can be found at United Concordia's website.
The Basic Dental option provides $1,000 per person each calendar year for dental benefits. In-network coverage is 100% of the allowable charge for diagnostic and preventive services including two cleanings annually. After a $50 deductible is satisfied annually, in-network coverage for primary and periodontal services is 80% of the allowable charge and 50% for complex restorative services.
The Enhanced Dental option provides $2,000 per person each calendar year for dental benefits. In-network coverage is 100% of the allowable charge for diagnostic and preventive services including two cleanings annually. After a $50 deductible is satisfied annually, in-network coverage for primary and periodontal services is 80% of the allowable charge and 60% for complex restorative services. Coverage for orthodontia services is 50% of the allowable charge. The lifetime orthodontia maximum is $1,000 per person. The orthodontia benefit is separate from the annual maximum dental benefit.
In order to be covered under the UVa Dental Plan, an employee must be a salaried employee of the University of Virginia who is either regularly scheduled to work at least twenty hours per week (50% effort), or a Health System employee who works 40 hours a week or who has signed a Medical Center Flexible Staffing Contract. Those persons eligible to be dependents on the plan are legally recognized spouses in the Commonwealth of Virginia and children through December 31st of the year in which they turn 26. Children include biological children, step children, adopted children, and foster children. Other children for whom you are the legal guardian with permanent custody who are unmarried, live with you 100% of the time in a parent-child relationship, and are declared as a dependent on your federal tax return can remain on the health plan through December 31st of the year in which they turn 26.
Coverage for dependent children who are incapable of self-support due to a mental or physical handicap may continue beyond age 26 if proof of the handicap is furnished to and approved by the Claims Administrator PRIOR to the dependent’s 26th birthday and they are unmarried, live with you 100% in a parent-child relationship, and are declared as a dependent on your federal tax return.
Enrollment Rules and Coverage Effective Date
Coverage begins on the first day of the first full month of employment, if an application is filed within 60 days of employment. If an employee’s first day of work is the first working day of the month, coverage begins that day when the employee’s application is received within 60 days of employment. Changes in membership may only be made at the annual Open Enrollment, or subsequent to a valid mid-year qualifying event. Events that constitute a mid-year qualifying event include:
marriage, divorce, or annulment
birth or adoption/placement for adoption
loss of dependent eligibility (only acceptable reason is when employee loses permanent custody of “other child”)
employment status of employee, dependent, or spouse which affect eligibility to participate in the employer’s health or dental plan
commencement of or returning from an unpaid leave of absence
judgment, decree, or order changing legal custody
cost and/or coverage changes in employee’s, dependent’s or spouse’s health and dental plan
entitlement to or loss of eligibility for Government-sponsored dental programs; or
death of spouse or dependent
Changes in membership must be received in the University Human Resources Benefits Division within 60 days of the qualifying event or within the same plan year as the mid-year qualifying event and are effective the first of the month following receipt of the form (on-line or paper) unless they are terminating due to ineligibility. Those enrollment changes are effective the first of the month following the qualifying event. Applications for changes due to birth or adoption of a child that are received within 60 days of the event are applicable for the newborn or adopted child on the date the birth or adoption occurs. The premium change, if appropriate, is effective the first of the month in which the birth or adoption occurs. Changes to other family members are effective the first of the month following receipt of the form. If submitting an application more than 60 days after the date of birth or adoption but within the same plan year, the coverage will be effective the first of the month following receipt of the application. Supporting documentation for Medical Center employees requesting changes due to mid-year qualifying events must accompany applications submitted to the UHR Benefits Division. Supporting documentation for Academic employees requesting changes in Benefits@ due to mid-year qualifying events must be faxed to the UVA Benefits Division at 434-924-4486 within 24 hours of the request being entered in Benefits@. Applications not submitted on a timely basis will be processed when the next open enrollment period occurs if crossed over into the next plan year.
Any ineligible dependents found on the UVa Dental Plan will be terminated on the last day of the month in which they became ineligible. Changes in the employee’s coverage category to match this termination of dependent’s coverage are subject to IRS Section 125 Regulations. Employee-participants with ineligible dependents enrolled on their policy will be responsible for the costs of incurred claims and may be suspended from the Plan for up to three (3) years.
Terminating employees and dependents who lose eligibility for coverage may have the option to extend continuous health care coverage through enrollment in Extended Coverage under the provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA). See COBRA Eligibility, Rates and Enrollment.
UVa Dental Plan Monthly Premiums 2014
These rates apply only to full-time salaried UVa Academic Division and Medical Center employees. Postdoctoral fellows, COBRA enrollees, and retirees have different premium rates.
|Coverage Level||Basic Dental||Enhanced Dental|
|Employee + Child(ren)||$2||$17|
|Employee + Spouse||$3||$19|
Part-time salaried Faculty, University Staff and Research Associates who participate in the Dental Insurance Program are entitled to receive a 50% subsidy toward the cost of the employer portion of the Dental Insurance premium.
For more information on the two plans, you can view the dental options comparison chart.
Dental Insurance Summary Information
United Concordia Web Site - United Concordia
United Concordia Customer Service - 1.866.215.2354
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