benefitsFOCUS: Open Enrollment Essentials – Dental Benefit Options

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Open Enrollment (November 1-15) starts next week! When was the last time you compared our dental plan options to see whether your current plan still meets your needs? Open Enrollment is the only time during the year when you can change plans and dependents on your plan, unless you have an eligible mid-year qualifying event that allows you to make changes to your pre-tax benefits (like the dental plan). We encourage you to take a few minutes to assess whether you might want to make a change to your dental coverage during Open Enrollment.

What You Should Know About Our Dental Plan Options

Both of our plans cover basic dental services like exams, cleanings, fillings, and root canals. Here’s a quick look at how they compare:

Low plan:

  • 100% of allowable costs for diagnostic and preventive care (including oral exams, scheduled x-rays, and two cleanings in a 12-month period)
  • 80% of allowable costs for other basic services (after meeting a deductible of $25/person)
  • Annual plan year maximum benefit: $1,500/person

High plan:

  • 100% of allowable costs for diagnostic and preventive care (including oral exams, scheduled x-rays, and two cleanings in a 12-month period)
  • 80% of allowable costs for other basic services (after meeting a deductible of $50/person)
  • Sealants: 80% of allowable costs (for dependents through age 15)
  • Crowns and implants: 60% of allowable costs (for enrollees over age 12)
  • Orthodontics: 50% of allowable costs (for dependents under age 19); lifetime limit applies
  • Annual plan year maximum benefit: $2,000/person

Which plan should I choose?

If you don’t have dependents on the plan who might need orthodontia or sealants, and if you don’t foresee the need for a crown next year, the Low plan may suit your needs perfectly! Want to compare our plans and rates? Head over to our Open Enrollment info page.

What You Should Know About Networks

It’s important to understand that you get the best value from your dental coverage when you use in-network providers, versus out-of-network providers. Here’s why:

  • In-network providers have agreed to accept a negotiated, discounted rate for goods and services in order to join the network. Out-of-network providers have not agreed to accept discounted rates.
  • While an out-of-network provider may submit a claim to Anthem on your behalf, the provider can (and will!) charge you for the amount not covered by the insurance company reimbursement; in-network providers cannot do this.
  • If you’re on the dental plan and you use an out-of-network provider, you will not get the benefit of the two $0 cost annual exams and applicable screening x-rays.

Updated Out-of-Network Reimbursement for 2024

We are aware that a few of the larger dental practices that our employees use left the Anthem dental network in 2023. This is a situation that we’re seeing across the country, and it is not unique to our plan. In order to ease the impact on our employees, we are increasing the out-of-network reimbursement rate for 2024. Here’s what this means for you:

  • If you go to an out-of-network provider, the plan will pay more toward the cost of your services next year.
  • The provider can still charge higher rates than an in-network provider.
  • The provider likely will not accept Anthem’s payment as payment-in-full and will charge YOU for the remaining amount due.
  • You will not get the free cleanings and screening x-rays that you would if you went to an in-network provider.

Eligibility

The following are eligible for coverage on our dental plans:

  • Employees in regular positions who work at least 50% part-time
  • Eligible dependents:
    • Your spouse (to whom you are currently and legally married)
    • Your natural children, children of your current spouse, legally adopted children, or those for whom you have legal custody/guardianship (including eligible foster children) under the age of 26
    • Certain disabled dependents over the age of 26 (subject to eligibility criteria)

Please review the eligibility criteria thoroughly before adding new dependents onto your plan. If any dependent you currently have on the dental plan does not meet the eligibility criteria, you are required to remove that dependent from the dental plan during the Open Enrollment window (or as soon as that dependent becomes ineligible). Dependents on the dental plan are subject to a dependent eligibility review. Important: Failure to comply with an eligibility review will result in the removal of your dependent from the dental plan.

Need Help?

Whether you have a quick question or you’d like to schedule a virtual consultation with a member of our benefits team, we’re here to help! You can reach us by email at benefits@k12albemarle.org or give us a call at 434-296-5827.

For your convenience, here are links to previous articles in our Open Enrollment Essentials series: