Staff Handbook

The NYU Dental Assistance Plan

The NYU Dental Assistance Plan, administered by the Metropolitan Life Insurance Company, provides full-time office and technical staff members with benefits for preventive dental care and other services necessary for the proper care of the teeth.

You are eligible to participate in this program after you have completed three months of continuous, full-time service. The plan is provided at no cost to you. You many not waive individual (self-only) coverage. You may enroll your spouse, registered domestic partner, and/or dependent children for a fee.

Highlights of Coverage

Diagnostic and Preventive Services

The plan reimburses 100% of reasonable and customary charges, with no deductible, for covered diagnostic and preventive services, including:

• Routine oral examinations twice each calendar year
• Regular teeth cleaning twice each calendar year
• Full mouth x-rays once in any consecutive 36-month period
• Supplemental x-rays twice each calendar year
• Fluoride treatments

Details, including exclusions and plan limits, are provided in the Summary Plan Description booklet which describes dental benefits.

Corrective and Restorative Services

Before becoming eligible for reimbursement for the procedures listed below, each insured individual must pay the first $50 of covered charges during each calendar year (the deductible). For family coverage, after your family has paid three individual deductibles in a calendar year, no further deductible payments are required for that year.

After deductible(s) are met, corrective and restorative services, such as those listed below, are reimbursed at a scheduled amount (a flat rate).

• Fillings and inlays
• Tooth extraction
• Oral surgery
• Root canal therapy
• Crowns and fixed bridgework
• Partial removable or full dentures to replace teeth lost after the patient was enrolled in the plan
• Denture repair, under certain circumstances
• Periodontics, subject to a lifetime maximum
• Orthodontics at 50%, subject to a lifetime maximum

Details, including exclusions, plan limits, and scheduled amounts, are provided in the Summary Plan Description booklet, available from the Benefits Office.

Maximum Dental Assistance Benefits

There is a maximum benefit under the Dental Assistance Plan per person each calendar year. This includes any charges incurred during the year for periodontal or orthodontic treatment, which have lifetime maximums. Maximum amounts can be found on the Dental Schedule.

Pre-Treatment Estimate

The Dental Assistance Plan bases its reimbursement on the scheduled allowances for the procedures given in the Summary Plan Description booklet, available from the Benefits Office. You may want to provide your dentist with the schedule prior to treatment. If you wish, you may request a predetermination of benefits (an estimate of reimbursement) from Metropolitan Life before any course of treatment which will cost over $250.00. Have your dentist fill out a pre-treatment plan on the Metropolitan Life claim form, and check the Pre-treatment Estimate box.

Claims Procedure

For most dental work, you must first pay the provider for services rendered, then submit a completed dental claim form directly to Metropolitan Life for reimbursement of covered charges. Claim forms can be downloaded from the Human Resources Web site. You can also pick up claim forms at the NYU Benefits Office.

You may request a predetermination of benefits (an estimate of reimbursement) from Metropolitan Life before any course of treatment (see Pre-Treatment Estimate, above).

Enrollment and Effective Date

Individual coverage is provided at no cost to you; you share the cost of spouse or registered domestic partner and dependent coverage with NYU through payroll deductions. Current costs are included in your new employee kit and in your annual open enrollment packet. Coverage becomes effective after you complete three months of employment at NYU. New dependents may be enrolled in the Dental Assistance plan within 31 days of marriage, registration of a same-sex domestic partner, birth, adoption, or legal placement of a child. Coverage will be effective as of the date of the event.

Each fall, during the designated annual open enrollment period, you have the opportunity to add or drop your spouse or registered domestic partner or dependents from the dental plan.

Dental Treatment at NYU

You and your family can receive comprehensive dental care provided by senior honors students or post-doctoral students under faculty supervision. If you and your dependents participate in the NYU Dental Assistance Plan (Metropolitan Life), the Kriser Dental Center may accept assignment of Metropolitan Life dental insurance benefits as full payment, up to the yearly maximum. Deductibles and copayments may apply. For more information see Dental Services at NYU.

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