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Pensions and Benefits

New Jersey Division of Pensions and Benefits

RETIREE DENTAL EXPENSE PLAN

Frequently Asked Questions

(Updated April 2009)


1. Q - Who is eligible for the Retiree Dental Expense Plan?

A - Any retiree eligible to enroll in a medical plan in the Retired Group of the State Health Benefits Program (SHBP) or School Employees' Health Benefits Program (SEHBP) is eligible to participate in the Retiree Dental Expense Plan.

2. Q - Do I have to live in New Jersey to join the Plan?

A - No, eligible retirees may participate in the Retiree Dental Expense Plan regardless of where they live.

3. Q - When can I enroll?

A - New retirees must enroll in the Retiree Dental Expense Plan when they become eligible for SHBP/SEHBP Retired Group health plan coverage (usually at the time of retirement, unless enrollment is waived for other employer group dental coverage).

4. Q - I'm still working. Will I be eligible to join the Retiree Dental Expense Plan when I retire?

A - When you become eligible for SHBP/SEHBP Retired Group enrollment, you will be eligible to join the Retiree Dental Expense Plan.

If you will not be eligible for SHBP or SEHBP coverage in retirement, you will not be able to join the Retiree Dental Expense Plan.

5. Q - I am currently covered under my spouse's dental plan at his/her place of work (or through my other employment). Do I have to enroll in the Retiree Dental Expense Plan now or can I wait until my coverage under my spouse's (or my own) group dental plan ends?

A - You are permitted at the time you first become eligible for SHBP/SEHBP Retired Group coverage to waive your Retiree Dental Expense Plan enrollment provided that you have other dental coverage through an employer group plan as either a dependent of a spouse/eligible partner or through other employment of your own.

If your other group dental coverage ends, you must request enrollment within 60 days from the loss of the other coverage by contacting the Division of Pensions and Benefits to request enrollment in the Retiree Dental Expense Plan. Proof of the other group dental plan termination must be submitted in the form of a HIPPA Certification of Coverage document or a letter from the employer or dental administrator along with the Retired Change of Status Application

6. Q - If I retire, should I continue my dental coverage from my former employer through COBRA* or should I enroll in the Retiree Dental Expense Plan?

A - When you retire you must make a decision whether to enroll in the Retiree Dental Expense Plan or to continue SHBP or SEHBP dental coverage under the provisions of COBRA.* However, retirees need to be aware that they cannot waive Retiree Dental Expense Plan enrollment because of COBRA coverage. Therefore, if you elect to continue with dental coverage through COBRA, once your COBRA eligibility period ends you will not be given any other opportunity to enroll in the Retiree Dental Expense Plan.

*The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).

7. Q - What does the Retiree Dental Expense Plan cover?

A - The Retiree Dental Expense Plan covers diagnostic and preventive dental services such as examinations, X-rays, cleanings, and topical fluoride application for children under the age of 19; basic services such as palliative emergency treatment, space maintainers, simple extractions, surgical extractions, oral surgery, anesthesia services, basic restorations (amalgam and resin-based composite), endodontics (treatment of diseases of the dental pulp including root canal and associated services), and repairs to removable and fixed dentures; and major restorative services such as inlays, onlays, crowns, periodontal services, and prosthodontics.

8. Q - Why does the Retiree Dental Expense Plan not cover orthodontia treatments?

A - The Retiree Dental Expense Plan was designed for retirees. Orthodontia services are not normally needed by the vast majority of retirees so they were not included to keep costs as low as possible.

9. Q - How much will the Retiree Dental Expense Plan pay towards my dental care?

A - The Retiree Dental Expense Plan has a $50 per person deductible, maximum of $150 per family, which must be met before reimbursements are made.  The deductible is waived for preventive services. The Retiree Dental Expense Plan reimburses covered services provided by any licensed dental provider at a percentage of reasonable and customary fees at differing levels of reimbursement, depending on the length of time you have had dental coverage.  The maximum possible benefit in any calendar year is $1,500 per person.  The Retiree Dental Expense Plan has a network of dentists who have agreed to accept a discounted fee for services.  If you choose to use a network provider, the fee for the service will probably be lower than that charged by an out-of-network dentist, so your costs will be lower.

10. Q - I understand that there are three progressive benefit tiers of coverage in the Retiree Dental Expense Plan.  What benefit tier of coverage will I get when I enroll?

A - If you were covered by a group dental plan for a minimum of 12 months within 60 days of your enrollment in the Retiree Dental Expense Plan, you will be placed in Tier 3, the highest benefit tier. If you were not covered by a group dental plan for a minimum of 12 months within 60 days of your enrollment in the Retiree Dental Expense Plan, you will be placed in Tier 1, the lowest benefit tier. After a year in the Plan, you will be placed in Tier 2, and after another year, to Tier 3.

11. Q - Why are there three benefit tiers of coverage in the Retiree Dental Expense Plan?

A - The three tiers are designed to protect the Retiree Dental Expense Plan, and the participants who must pay for the entire cost of coverage, from the effects of what is termed "adverse selection". An individual who has not been receiving regular dental treatment is likely to need more services and generate more dental costs than someone who has been receiving regular dental treatment. This would cause rates to rise. The creation of the three benefit tiers lessens the impact of this adverse selection.

12. Q - Will the Retiree Dental Expense Plan coordinate coverage with another dental plan?

A - There is no coordination of benefits under the SHBP or SEHBP between any two Dental Plans because no member is eligible for coverage in more than one Dental Plan. An individual enrolled in the Retiree Dental Expense Plan may be covered through the SHBP or SEHBP as a retiree or as a dependent (of another retiree or of an employee) but not as both a retiree and a dependent. Dependent children may only be covered through the Dental Plans by one parent.

If you are covered by another (non-SHBP or non-SEHBP) group dental plan through a former employer or through other active employment of your own or that of a spouse or domestic partner, the Retiree Dental Expense Plan would be the secondary plan.

13. Q - I understand that if my dentist participates in the Plan Network that I will get a discount on my service. How can I find a dentist that participates in the Plan Network?

A - You can access a list of participating providers on Aetna's Web site (www.aetna.com/docfind) or contact Aetna Dental at 1-877-238-6200 (select the Aetna member prompt).

14. Q - Who can I cover as a dependent under my coverage?

A - The dependent eligibility rules for the Retiree Dental Expense Plan are the same as those for any plan in the SHBP or SEHBP. You may enroll your spouse, civil union partner, or an eligible same-sex domestic partner* and any of your children who are under age 26. The definition of children includes step-children, adopted children, foster children, legal wards, and children of your eligible partner, if applicable.   

If you have a child who is disabled and is therefore unable to support himself or herself, that child may be continued on your coverage (medical and dental) beyond the age of 26 with the approval of the SHBP. You must file a Continuance for Dependent with Disabilities form before January 31st of the year following the year in which the dependent turned 26 to apply for the extension.

Please note that duplicate coverage within the Retiree Dental Expense Plan is not permitted; an individual may be covered as a retiree or as a dependent but not as both a retiree and a dependent. Dependent children may be covered by only one parent.

15. Q - Can I cover my opposite-sex domestic partner under the Retiree Dental Expense Plan?

A - No. Opposite sex coverage is only available to a spouse through marraige. Under the provisions of the Domestic Partnership Act, opposite sex domestic partners are not eligible for SHBP or SEHBP coverage. For more information, see Fact Sheet #71, Benefits Under the Domestic Partnership Act Adobe PDF (56K).

16. Q - If I die or I terminate my Retiree Dental Expense Plan coverage, can my dependents continue the coverage?

A - If you die, a covered surviving spouse, civil union partner, or eligible same-sex domestic partner would be eligible to continue the Retiree Dental Expense Plan coverage at their own expense - and may cover any eligible dependents.

If you terminate coverage or a dependent turns age 26 (unless the dependent child qualifies for continuance of coverage due to disability - see Question #14) the dependent's coverage will end. There is no provision for the continuation of coverage through COBRA under the Retiree Dental Expense Plan.

17. Q - How much will the Retiree Dental Expense Plan cost?

A - The costs of the Retiree Dental Expense Plan are the same for both State and Local retirees. Current rates are available in the Division's health benefits Web site.

18. Q - How are the premium rates determined?

A - The cost of the insurance is calculated by the Actuary to the State Health Benefits Commission. The State Health Benefits Commission reviews and approves the rates every year.

19. Q - Who pays for the Retiree Dental Expense Plan?

A - Most retirees will pay the full cost of the insurance plan. The State does not pay anything toward the cost of the coverage. Under certain circumstances, a local public employer that participates in the SHBP or SEHBP may elect to share in the cost of coverage for their retirees through the adoption of the provisions of Chapter 48, P.L.1999.

20. Q - How will premium payments be made?

A - If you are receiving a monthly pension check from the Division of Pensions and Benefits and that check is large enough to cover the cost of your dental coverage, the monthly premiums will be deducted from your check. If you do not receive a pension check from the Division, or your check is not large enough to cover the cost of the dental coverage, the Division will bill you for your coverage each month.

21. Q - Where can I get answers to specific benefit questions about the Retiree Dental Expense Plan coverage?

A - You can access a summary of the dental plans in Fact Sheet #73, Retiree Dental Expense Plan Adobe PDF (38K), or call Aetna at 1-877-238-6200 (select the Aetna Member prompt).  As a member of the Retiree Dental Expense Plan, you can register for access to Aetna Navigator on the Aetna Web site (www.aetna.com). Aetna Navigator is your online resource for personalized benefits information and is available 24 hours a day, 7 days a week.

22. Q - Whom can I talk with to get answers about eligibility for enrollment?

A - Contact Aetna Dental first at the number listed above (see question #21). If Aetna cannot answer your questions, call the Division of Pensions and Benefits, Office of Client Services at (609) 292-7524 or e-mail the Division.

23. Q - Where can I get a summary of the Retiree Dental Expense Plan benefits?

A - A brief summary of the Retiree Dental Expense Plan can be seen in Fact Sheet #73, Retiree Dental Expense Plan Adobe PDF (38K). You can also find additional information in the Retiree Dental Plans Member Handbook. Both publications are available on the Division of Pensions and Benefits Web site.

 
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