Full-time team members are offered the option of selecting Dental Benefits for themselves, their spouse and/or dependent children upon meeting eligibility requirements. Team members can select this coverage during their initial enrollment period (within 30 days of hire), effective on the first day of the month following 30 days of employment or during the annual open enrollment period (effective the 1st of the following year.) In addition, coverage may be modified within 30 days of a qualified event.
The Dental PPO plan is administered by Excellus BlueCross Blue Shield. Coverage includes preventative, basic and major services, including limited coverage for orthodontia expenses for dependents under age 19. The Dental plan offers team members dental benefit coverage with reasonable cost-sharing to include affordable deductibles and co-insurance. Please refer to the Dental Plan Summary of Coverage below or the Summary Plan Description (SPD).
| Type of Service | Important Provisions | In & Out-Of-Network Benefits |
|---|---|---|
| Diagnostic/Preventative Type I Dental Services | Not subject to annual deductible | 100% |
| Basic Restorative Type II Dental Services | Subject to annual deductible | 85% |
| Major Restorative Type III Dental Services | Subject to annual deductible – see separate benefit for dental implants below | 55% |
| Dental Implants | Subject to annual deductible not subject to annual dental maximum | 80% |
| Annual Deductible | Applies to Types II and III services only | $50 Individual $150 Family |
| Annual Dental Maximum | Types I, II, and III combined | $1,500 per individual |
| Lifetime Dental Implant Maximum | $5,000 per individual | |
| Orthodontic Services Type IV Dental Services | Not subject to annual deductible for dependent children under age 19 only | 50% |
| Orthodontia Lifetime Maximum | $1,500 per individual |
Turning Stone Enterprises pays a generous portion of the cost for this coverage. The team member’s share of the cost is paid through a convenient pre-tax payroll deduction. To review the Dental Rates, please click on the link below.
What is a Qualifying Event?
Answer: An event that allows you to make a change to your health plan, such as:
- Change in marital status (including divorce)
- Birth or adoption of a child
- Dependent child who reached the age limit of 26
- Loss of coverage elsewhere by an eligible family member
Forms
- Health and Dental Rates
- Dental Plan Summary of Coverage
- Dental Claim Form (Excellus)
- HIPAA Consent Authorization Form (Excellus)
- HIPAA Notice of Privacy Practices
- How To Find A Participating Dentist
Excellus BlueCross BlueShield
Visit excellusBCBS.com/onellc to:
- View Eligibility Information
- Order ID and Print out Temporary ID cards
- Review Explanation of Benefits
- Search Claims History
- Print Claim Forms
- View Frequently Asked Questions
- Search for Providers
To find out more, please visit the Benefits Office located on the second floor of the Turning Stone, or call 315-356-1800. Office hours are Monday – Friday, 8:30am – 5:00pm.
