DELTA DENTAL PLAN
EFFECTIVE 1-1-2022
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The SPD summarizes the key provisions of the Plan and includes important information about your benefits from the Plan.
Non-Supplemental Plans A and B Summary Plan Description (SPD)
Supplemental Plans A and B Summary Plan Description (SPD)
Doorstaff Summary Plan Description (SPD)
To enroll your dependent child for coverage under the Plan, submit a completed Dependent Enrollment Form along with a copy of the birth certificate or adoption papers to the Fund Office. You must enroll your child for coverage before the Fund pays any benefits for that child.
With respect to an adoption, placement for adoption, or placement of a foster child, if you notify the Fund Office, in writing, within 30 days of your dependent becoming eligible, benefits will be paid retroactively to the date your dependent became eligible. If you do not notify the Fund Office, in writing, within 30 days, your dependents coverage will not begin until the first day of the month following the month in which you notify the Fund Office.
With respect to a newborn child, if you notify the Fund Office, in writing, within 60 days of the birth, benefits will be paid retroactively to the date of birth. If you do not notify the Fund Office in writing, within 60 days, your newborn child’s coverage will not begin until the first day of the month following the month in which you notify the Fund Office.
When you marry, your spouse is eligible for healthcare coverage as of the date of your marriage. However, the Fund will not pay benefits on behalf of your spouse until you enroll your spouse for coverage. To enroll your spouse for coverage under the Plan, submit a completed Dependent Enrollment Form along with the required documentation (see below) to the Fund Office. You have 30 days from the date of your marriage to notify the Fund Office. Once notification is received, benefits will be paid retroactively to the date of your marriage. If you do not notify the Fund Office, in writing, within 30 days of your marriage, your spouse’s coverage will not begin until the first day of the month following the month in which you notify the Fund office.
Required documents for enrollment includes (but may not be limited to) the following:
If you are unable to work as a result of a non-work related injury or illness and you are under the care of a physician, you may be entitled to the weekly disability income benefit. To apply, submit a completed Disability Claim Form to the Fund Office. Once approved for the weekly disability benefit, you will be responsible to complete the Weekly Disability Supplementary Form.
If you have recently moved, please complete a Change of Address Form.
If coverage is lost due to lack of sufficient employer contributions and hours in your individual record system, then you will have the option to elect to continue coverage under COBRA for up to 18 months. Please contact the Fund Office with questions relating to your eligibility.
If you and your spouse get a divorce or legal separation, your spouse will no longer be eligible for coverage. However, a spouse may elect to continue coverage under COBRA for up to 36 months upon divorce or legal separation. You or your spouse must notify the Fund Office, within 60 days of the divorce or separation date for your spouse to obtain COBRA continuation coverage. You must also submit a copy of the divorce decree to the Fund Office.
If you meet certain criteria defined in the health & welfare Summary Plan Description you and your family may be eligible to participate for regular retiree plan or retiree Medicare supplement plan. Please contact the Fund Office for your retiree options for continuing health coverage.
Supplemental Plans A & B Summary Plan Description
Non-Supplemental Plans A & B Summary Plan Description
Doorstaff Summary Plan Description
In the event of your death, your dependents may continue coverage for up to 36 months by electing COBRA continuation coverage or by electing the retiree plan or the Medicare supplemental plan for surviving spouses and dependents. Your survivors will need to make the required self-contributions for this coverage.