DENTAL UNDERWRITING GUIDELINES SMALL GROUP AETNA PRODUCT OFFERINGS Product Combinations
DMO may be combined with any PPO. Freedom of Choice plans are only available standalone.
Voluntary Product Combinations
3–9 eligible: single plan option only. 10-100 eligible: DMO may be combined with any PPO. Freedom of Choice plans are only available standalone.
Additional Cleanings
Members enrolled in medical and dental will be enrolled in the Aetna Dental/Medical Integration program: The program focuses on those who are pregnant or have diabetes, coronary artery disease (heart disease) or cerebrovascular disease (stroke) and have not had a recent dental visit. Once at the dentist, these at-risk members will receive enhanced dental benefits including an extra cleaning and full coverage for certain periodontal services.
Annual Maximum Options above $2,000
Not available.
Annual Max waived for Diagnostic & Preventive
Preventive services are excluded from the calendar year maximum on plans 10B and 11B. These plans are only available to groups of 10+.
Composite Fillings for Anterior Teeth
Yes.
Cosmetic Rider
Not available.
Implant Coverage
10-100 eligible: Implants are included as a major service on the PPO in plan options 5B, 8B, 8C and 12B.
Missing Teeth Coverage
Tooth Missing But Not Replaced Rule: Coverage for the first installation of removable dentures; fixed bridgework and other prosthetic services is subject to the requirements that such removable dentures; fixed bridgework and other prosthetic services are (i) needed to replace one or more natural teeth that were removed while this policy was in force for the covered person; and (ii) are not abutments to a partial denture; removable bridge; or fixed bridge installed during the prior 8 years.
Orthodontia
Adult/Child ortho available for groups with 10+ eligible employees with a minimum of 5 enrolled.
Rollover Benefits
Not available.
Waiting Period for Services
2–9 contributory and 3-100 voluntary: 12-month wait for Major and Ortho (excludes DMO). Can be waived with qualifying previous coverage. 10–100 contributory: No waiting period.
ELIGIBILITY Group Size
2–100. DE-9C required. Must be sole dental carrier offered.
Stand-Alone
Groups of 2 must be sold alongside medical. Standalone available groups with 3+ eligible; some industries must be sold alongside medical.
Rate Guarantee
12 months. Rates based on EMPLOYEE zip code.
Admin Fee
None.
Contribution
2–50 eligible: 50% of employee premium or 25% of the total cost. 51–100 eligible: 100% of employee premium
Participation
2–3 eligible: 100% excluding valid waivers, minimum 2 enrolled. 4–50 eligible: 75% excluding valid waivers, minimum 2 and 50% of total eligible enrolled. 51–100 eligible: 30% excluding valid waivers. For all group sizes: If 100% employer paid then 100% participation required.
Voluntary Plan Contribution
3–50 eligible: Plans where employer contribution is below 50% of employee premium or 25% of the total cost. 51–100 eligible: 100% employee paid.
Voluntary Plan Participation
3–100 eligible: 30% excluding valid waivers, minimum 3 enrolled.
Out-of-State
No more than 49%. Out of state enrollees will receive the same plan as CA enrollees; subject to network availability.
Carve-Outs
Not available.
1099 Employees
Not eligible.
Owner Only Groups
Not allowed. Must have at least one non-spouse, “common law” employee on the DE-9C and enrolled in medical.
Industry Loads
Yes. Some industries ineligible if sold stand-alone; see California Plan Guide.
Open Enrollment
2–9 eligible (contributory) and groups 3-100 eligible (voluntary): no open enrollment. 10–100 eligible (contributory): open enrollment included.
Dependent Eligibility
Dependent children are eligible until age 26.
Rev. Date 01/04/17
Page 1 of 23
DENTAL UNDERWRITING GUIDELINES
AMERITAS PRODUCT OFFERINGS Product Combinations
May offer Core PPO/Buy-up PPO or PPO Hi/PPO Low. Ameritas PPO plans may also be offered alongside another carrier’s DHMO plan.
Voluntary Product Combinations
May offer Core PPO/Buy-up PPO or PPO Hi/PPO Low. Ameritas PPO plans may also be offered alongside another carrier’s DHMO plan.
Additional Cleanings
Ameritas can quote any of their plans with up to 4 cleanings per year. Groups with 3+ may request additional cleanings as part of the standard plan benefit; this should be requested with the RFP submission.
Annual Maximum Options above $2,000
Up to $5,000 available on MAC plans.
Annual Max waived for Diagnostic & Preventive
Preventive Plus program. Plan payments for preventive services will not accumulate toward the annual maximum benefit.
Composite Fillings for Anterior Teeth
Yes.
Cosmetic Rider
Riders are available to groups of 3+; Tooth-Color Composites on Molars rider and Cosmetic Tooth Bleaching rider Cosmetic Tooth Bleaching rider includes coverage toward 3 types of professional tooth whitening: • Per arch bleaching (upper and lower) for ages 14 and over every two years • Single tooth bleaching • Internal bleaching to lighten a discolored tooth that has had root canal therapy
Implant Coverage
Offered upon request for groups down to 3.
Missing Teeth Coverage
A tooth must have been extracted within 12 months of the date the Ameritas plan goes into effect and that the group must have had prior coverage for takeover. For virgin groups, the takeover of the prior extraction will not be covered.
Orthodontia
Available for groups of 10 or more enrolled employees.
Rollover Benefits
Dental Rewards, optional feature. To qualify for rewards, member must submit at least 1 claim per year for a covered procedure and total paid claims must be under the plans annual threshold limit. A bonus is earned for utilizing PPO providers. Earned rewards are added to the next years calendar year maximum benefit and have a maximum accumulation amount based on the plan benefit.
Waiting Period for Services
12 months for ortho and major for virgin groups for Increasing Coverage plan only. Also for late entrant enrollment for in force groups.
ELIGIBILITY Group Size
3–2,000. DE-9C not required.
Stand-Alone
Yes.
Rate Guarantee
12 months.
Admin Fee
None.
Contribution
3-75 eligible: Minimum 25% of employee and dependent premium.
Participation
60% of eligible employees with a minimum of 3 must enroll. Core/buy-up and Hi/Low combinations require at least 10 eligible. PPO plans may be offered alongside another carriers DHMO plan: must have at least 50 eligible and 20% enrolled on the Ameritas plan.
Voluntary Plan Contribution
3-75 eligible: None
Voluntary Plan Participation
Minimum 20% of all eligible or 3 enrolled, whichever is greater. Core/buy-up and Hi/Low combinations require at least 10 eligible. PPO plans may be offered alongside another carriers DHMO plan: must have at least 50 eligible and 20% enrolled on the Ameritas plan.
Out-of-State
Out of State enrollees will be paid based on the out-of-network benefits.
Carve-Outs
Allowed; 20% load applies.
1099 Employees
Not eligible.
Owner Only Groups
Allowed.
Industry Loads
Yes. Also, groups with more than 40% defined as Sales who receive compensation based on commission only will receive a 20% load.
Open Enrollment
There is no open enrollment provision. Late Entrant Provision: Exams, Cleanings and Child Fluorides only allowed in the first 12-months if insured does not enroll in the initial eligibility period.
Dependent Eligibility
Dependent children are eligible until age 26.
Rev. Date 01/04/17
Page 2 of 23
DENTAL UNDERWRITING GUIDELINES ANTHEM BLUE CROSS PRODUCT OFFERINGS Product Combinations
Single plan or HMO/PPO (plans offered must have a 20% premium differential).
Voluntary Product Combinations
Single plan or HMO/PPO.
Additional Cleanings
Dental Blue only: Members can receive additional cleanings at Anthem’s negotiated rate, Members who are pregnant or living with diabetes can receive one additional dental cleaning or periodontal maintenance procedure a year.
Annual Maximum Options above $2,000
$2,500 available.
Annual Max waived for Diagnostic & Preventive
Not available.
Composite Fillings for Anterior Teeth
Available on specific plan designs.
Cosmetic Rider
Not available.
Implant Coverage
Available on specific plan designs.
Missing Teeth Coverage
See contract. 24 month waiting period for replacement of tooth missing prior to initial effective date.
Orthodontia
Available to groups of 10+ or more enrolled employees. Not available on Value plans. Lifetime max must match annual max.
Rollover Benefits
Available on specific plan designs.
Waiting Period for Services
Dental Prime & Complete: None. Voluntary: 12-month. Waived with proof of 12 consecutive months of prior comparable group coverage.
ELIGIBILITY Group Size
2–100. DE-9C required.
Stand-Alone
Yes.
Rate Guarantee
12 months, 24 month option available.
Admin Fee
None.
Contribution
Minimum of 50% of EE premium. For all group sizes/plans: If 100% employer paid then 100% participation required.
Participation
Promo available through March 2017 for groups with 5+ enrolled: 30% of eligible employees Standalone DHMO 2-14 eligible: 70% with a minimum of 2 enrolled. 15+ eligible: 50% with a minimum of 2 enrolled. Standalone PPO 2-4 eligible: 100% with a minimum of 2 enrolled. 5-14 eligible: 70% with a minimum of 2 enrolled. 15+ eligible: 50% with a minimum of 2 enrolled. Dual Option HMO/PPO 10-14 eligible: 70% with minimum 2 enrolled in each plan. 15+ eligible: 50% with minimum 2 enrolled in each plan. Medlock Packaged enrollment: All members enrolled in the Anthem medical plan must enroll in Anthem Complete PPO dental plan. The medical plan billing must be included with new group submission materials. Dental tiering must be identical on the medical and dental plans. Example: enrollees with Single medical coverage must also have Single dental coverage; enrollees with Family medical coverage must also have Family dental coverage.
Voluntary Plan Contribution
Employer may contribute 0-49% of EE premium
Voluntary Plan Participation
Standalone: A minimum of 5 employees must enroll (no % requirement). Dual Option HMO/PPO: A minimum of 5 employees must enroll in each plan (no % requirement).
Out-of-State
No more than 49%.
Carve-Outs
Allowed.
1099 Employees
Not eligible.
Owner Only Groups
A sole proprietorship is ineligible without a common law employee. A spouse does not constitute a common law employee (refer to employee eligibility requirements). Owners, that are not spouses, may demonstrate that they meet the eligible employee criteria by providing W-2s or completing the Eligibility Statement.
Industry Loads
Yes, built into the rates. Dental offices not eligible for coverage
Open Enrollment
Yes.
Dependent Eligibility
Dependent children are eligible until age 26.
Rev. Date 01/04/17
Page 3 of 23
DENTAL UNDERWRITING GUIDELINES BLUE SHIELD PRODUCT OFFERINGS Product Combinations
Single plan options available. Dual Choice: select any 2 plans Triple Choice: select 3 plans in one of the following combinations: 2 HMO/1 PPO, 2 HMO/1 INO, OR 3 HMO. If sold with medical, additional options available: 2 PPO/1 HMO, 2 INO/1 HMO, OR 1 PPO/1 INO/1 HMO.
Voluntary Product Combinations
Same as above.
Additional Cleanings
Members who are pregnant can receive one additional dental cleaning procedure a year. A third periodontal maintenance visit is also covered, if the pregnant member needs to treat periodontal disease.
Annual Maximum Options above $2,000
Available on Smile INO Dental Plan 50/2500/Endo-Perio 80% with/without Ortho, and Simile INO Dental Plan 50/2500/EndoPerio 50% with/without Ortho.
Annual Max waived for Diagnostic & Preventive
Not available.
Composite Fillings for Anterior Teeth
Not covered.
Cosmetic Rider
Not available.
Implant Coverage
Covered as a major service under the Smile Deluxe 2000 and Smile Deluxe Plus 2000 plans. Pre-authorization required.
Missing Teeth Coverage
N/A
Orthodontia
HMO plans: Adult/Child ortho included. PPO/INO plans: Adult/Child available on select plan designs (6 ER-paid PPO, 2 ER-paid INO & 2 voluntary INO plans).
Rollover Benefits
Dental rewards. To qualify for rewards, member must visit the dentist at least once per year and total claims are below the claim threshold. A bonus is earned for utilizing in-network provider for PPO plans. Earned rewards are added to the next year's calendar year maximum benefit and have a maximum accumulation amount based on the plan benefit.
Waiting Period for Services
12 months for major services for voluntary PPO and voluntary INO plans. Waived with proof of 12 consecutive months of prior comparable group coverage.
ELIGIBILITY Group Size
1-100. DE-9C not required.
Stand-Alone
Yes.
Rate Guarantee
12 months.
Admin Fee
None.
Contribution
Minimum 50%
Participation
Minimum 65%. If 100% employer pays, then 100% participation required.
Voluntary Plan Contribution
Employer may contribute 0-49% of employee premium.
Voluntary Plan Participation
Alongside medical: Refer to medical participation guidelines. Standalone: minimum 1 enrollee.
Out-of-State
Minimum 51% of employees must be residents of CA.
Carve-Outs
Not allowed.
1099 Employees
Not eligible.
Owner Only Groups
For groups with at least 2 eligible owners, allowed. Husband and wife/domestic partner working for the same company may enroll together or separately.
Industry Loads
None.
Open Enrollment
Yes.
Dependent Eligibility
Dependents children are eligible until age 26.
Rev. Date 01/04/17
Page 4 of 23
DENTAL UNDERWRITING GUIDELINES
CALCPA PRODUCT OFFERINGS Product Combinations
Single plan option
Voluntary Product Combinations
Not available.
Additional Cleanings
For pregnant enrollees, Delta Dental will pay for the following additional services per calendar year: 1 additional oral evaluation and either 1 additional routine cleaning or 1 additional periodontal scaling and root planing per quadrant. Written confirmation of the pregnancy must be provided by the enrollee or the dentist when the claim is submitted.
Annual Maximum Options above $2,000
Not available.
Annual Max waived for Diagnostic & Preventive
Not available.
Composite Fillings for Anterior Teeth
Direct composite restorations are benefits on anterior teeth and the facial surface of bicuspids. Any other posterior direct composite restorations are optional & Delta’s payment is limited to the cost of the equivalent amalgam restorations.
Cosmetic Rider
Not available.
Implant Coverage
Covered under Major services.
Missing Teeth Coverage
Delta Dental will pay the applicable percentage of the Dentist’s Fee for a standard cast chrome or acrylic partial denture or a standard complete denture. A standard complete or partial denture is defined as a removable prosthetic appliance provided to replace missing natural, permanent teeth and which is constructed using accepted and conventional procedures and materials. Excluded: Services with respect to congenital (hereditary) or developmental (following birth) malformations or cosmetic surgery or dentistry for purely cosmetic reasons, including but not limited to: cleft palate, upper or lower jaw malformations, enamel hypoplasia (lack of development), fluorosis (a type of discoloration of the teeth) and anodontia (congenitally missing teeth).
Orthodontia
Child only ortho included for groups of 5+ enrolled. Not available to groups of 1-4 enrolled.
Rollover Benefits
Not available.
Waiting Period for Services
None.
ELIGIBILITY Group Size
2–100 eligible and enrolled. DE-9C required. Must be headquartered in California. Available to accounting firms in public practice or firms offering general financial services (SIC 8721). To be eligible, more than 50% of all of the firm’s owners (principals, proprietors, partners, shareholders, or other owners) must be CPA members of CalCPA, or Associate members of CalCPA. All CPA owners must be members of CalCPA in good standing.
Stand-Alone
Must be written alongside medical.
Rate Guarantee
12 months.
Admin Fee
None.
Contribution
Minimum 100% of employee premium.
Participation
100% of eligible employees must enroll. Dependents may participate in the coverage provided at least 50% of the individuals at the firm who have eligible dependents enroll them. If an employee chooses to enroll dependents, all of his/her eligible dependents must enroll.
Voluntary Plan Contribution
Not available.
Voluntary Plan Participation
Not available.
Out-of-State
No more than 49% may reside outside California
Carve-Outs
Not allowed.
1099 Employees
Not eligible.
Owner Only Groups
Allowed, includes husband/wife groups.
Industry Loads
None.
Open Enrollment
Open Enrollment occurs once a year through November and December, and all changes are effective January 1. This is the only Open Enrollment period, regardless of when the group joined the plan.
Dependent Eligibility
Up to age 19, or age 25 if full-time student in an accredited school, college or university).
Rev. Date 01/04/17
Page 5 of 23
DENTAL UNDERWRITING GUIDELINES CALIFORNIA DENTAL NETWORK (CDN)
CALIFORNIACHOICE®
Product Combinations
Single DHMO. Dual DHMO available with carrier approval. DHMO may be combined with PPO an approved carrier partner. Approved CDN partners: Ameritas & Principal.
All plans may be offered.
Voluntary Product Combinations
All plans are available on a voluntary basis.
One voluntary plan available.
Additional Cleanings
Covered at a higher copay.
Not available.
Annual Maximum Options above $2,000
N/A
Not available.
Annual Max waived for Diagnostic & Preventive
N/A
Not available.
Composite Fillings for Anterior Teeth
Yes.
Yes.
Cosmetic Rider
Cosmetic benefits included in plan as standard.
Not available.
Implant Coverage
Not covered.
Not covered.
Missing Teeth Coverage
N/A
A tooth must have been extracted within 12 months of the date the Ameritas plan goes into effect and that the group must have had prior coverage for takeover. For virgin groups, takeover of prior extraction will not be covered.
Orthodontia
Included on all plans.
Available to groups of 5 or more.
Rollover Benefits
N/A
Dental Rewards® By Ameritas Group. Included on EPO 3500 & PPO plans. Members who visit the dentist & use only a portion of their annual maximum benefit in a year are rewarded with additional benefits for the following year based on the plan selected, members can earn additional money toward their next year’s annual max benefit–if they use less than half of the annual maximum, they can increase next year’s coverage by $250 & additional $100-$150 if they visit a network provider.
Waiting Period for Services
None.
PPO 3500, 4000 & 5000: 12 months for Major, 24 months for Ortho. Can be waived at enrollment groups of 10+ with proof of prior similar coverage for preceding 12 months with no break in coverage. Credit given for time on prior plan.
Group Size
2+. DE-9C not required. Groups with no prior coverage must be custom quoted.
2–100 alongside medical only. DE-9C required.
Stand-Alone
Yes
No
Rate Guarantee
12 months. 24 month option available for groups of 25+; custom quote required.
12 months.
Admin Fee
$10 per month for groups with less than 25 employees.
Not specific to dental
Contribution
Minimum 50% of employee or 50% of the employee and dependent combined premium.
Minimum of 50% of lowest available rate.
Participation
75% with a minimum of 2 enrolled. Dual Choice with a CDN PPO partner: Min 1 CDN enrollee
Minimum of 70%. No minimum participation for dependents.
Voluntary Plan Contribution
Minimum 0–49% of premium regardless of family tier.
No minimum
Voluntary Plan Participation
Minimum 2 enrolled.
Voluntary enrollment.
Out-of-State
None allowed.
Yes. PPO dental plans 3500 (EPO), 4000 and 5000.
Carve-Outs
Minimum 2 enrolled. Mgmt, Owner, Key EE allowed.
Not allowed.
1099 Employees
Allowed on voluntary only.
Not eligible.
Owner Only Groups
Allowed.
Not allowed. Must have at least one non-spouse, “common law” employee on the DE-9C.
Industry Loads
None.
None.
Open Enrollment
Included on all DHMO plans.
Yes.
Dependent Eligibility
Dependent children are eligible until age 26.
Dependent children are eligible until age 26.
PRODUCT OFFERINGS
ELIGIBILITY
Rev. Date 01/04/17
Page 6 of 23
DENTAL UNDERWRITING GUIDELINES
CHOICE BUILDER PRODUCT OFFERINGS Product Combinations
DeltaCare USA HMO will be combined with one EPO/PPO carrier. All plans offered by the selected EPO/PPO dental carrier will be available.
Voluntary Product Combinations
Same as Product Combinations above.
Additional Cleanings
Not available.
Annual Maximum Options above $2,000
Not available.
Annual Max waived for Diagnostic & Preventive
Pending.
Composite Fillings for Anterior Teeth
Pending.
Cosmetic Rider
Not available.
Implant Coverage
Not available.
Missing Teeth Coverage
Pending.
Orthodontia
Ameritas: Available for child only, requires 5+ eligible. DeltaCare HMO: Included for adult and child. Delta Dental: Available for child only, requires 10+ enrolled for employer sponsored plans, and 25+ eligible for voluntary plans. Madison: Available for child only, requires 2+ enrolled.
Rollover Benefits
Ameritas: Silver and Gold plans offer Dental Rewards program. Members can earn additional benefit for the following year. DeltaCare, Delta Dental & Madison: Not available.
Waiting Period for Services Employer Sponsored Voluntary
Major Ortho Takeover Credit Major Ortho Takeover Credit
Ameritas None 12 months Available* 6 months 12 months None
DeltaCare USA None None None None None None
Delta Dental None None None 12 months None None
Madison None 12 months Available* 12 months 12 months Available*
* At initial enrollment, takeover credit is available to groups of 10+ eligible with proof of prior ortho coverage for the preceding 12 consecutive months. For Ameritas, 12 months will be waived if 12 months proof is provided, no partial credit. For Madison, up to 12 months will be waived in accordance with the proof provided.
ELIGIBILITY Group Size
2-199. DE-9C not required.
Stand-Alone
Yes.
Rate Guarantee
12 months. DeltaCare HMO rated by employee home zip code. EPO/PPO rated by employer zip code.
Admin Fee
Per group, per billing location, per month: (If group is enrolling alongside CalChoice, the CalChoice admin fee will be waived.) 2-8 employees: $20 9-20 employees: $25 21+ employees: $30
Contribution
Minimum 50% of the lowest cost plan available.
Participation
70% of eligible employees with a minimum of 2 enrolled.
Voluntary Plan Contribution
0-49%
Voluntary Plan Participation
Must have 10+ eligible employees. A minimum of 5 must enroll.
Out-of-State
No maximum. Group must be domiciled in California. Out of state employees will receive the same plan as a California enrollee; subject to network availability.
Carve-Outs
Not available.
1099 Employees
Not eligible.
Owner Only Groups
Allowed, including Husband/Wife groups.
Industry Loads
Ameritas & DeltaCare: No. Delta Dental & Madison: Loads apply by SIC code.
Open Enrollment
Yes.
Dependent Eligibility
Dependent children are eligible until age 26.
Rev. Date 01/04/17
Page 7 of 23
DENTAL UNDERWRITING GUIDELINES COPOWER ONE PRODUCT OFFERINGS Product Combinations
Dual choice Delta Dental PPO and DeltaCare USA within CoPower ONE portfolio: • If Less than 10 eligible and/or enrolled employees: minimum 2 enrolled in one plan and the remainder in the other plan. When enrolling less than 5 in PPO, use CoPower ONE Good 2-4 rates. • If 5+ enrolled on PPO and a minimum of 2 enrolled on HMO, all CoPower ONE plans are available except Voluntary plans.
Voluntary Product Combinations
Dental and Vision bundle only. Dual Choice Voluntary PPO and DeltaCare USA available for groups of 10 or more enrolling
Additional Cleanings
For pregnant enrollees, Delta Dental will pay for the following additional services per calendar year: 1 additional oral evaluation and either 1 additional routine cleaning or 1 additional periodontal scaling and root planing per quadrant.
Annual Maximum Options above $2,000
Not available.
Annual Max waived for Diagnostic & Preventive
All CoPower ONE D&P services are waived for in-network benefits. CoPower ONE Best waives D&P for both in and out of network services.
Composite Fillings for Anterior Teeth
Direct composite restorations are benefits on anterior teeth and the facial surface of bicuspids. Any other posterior direct composite restorations are optional services and Delta’s payment is limited to the cost of the equivalent amalgam restorations.
Cosmetic Rider
Not available.
Implant Coverage
Covered under Major services for PPO. Not covered on HMO.
Missing Teeth Coverage
Delta Dental will pay the applicable percentage of the Dentist’s Fee for a standard cast chrome or acrylic partial denture or a standard complete denture. A standard complete or partial denture is defined as a removable prosthetic appliance provided to replace missing natural, permanent teeth and which is constructed using accepted and conventional procedures and materials. Excluded: Services with respect to congenital (hereditary) or developmental (following birth) malformations or cosmetic surgery or dentistry for purely cosmetic reasons, including but not limited to: cleft palate, upper or lower jaw malformations, enamel hypoplasia (lack of development), fluorosis (a type of discoloration of the teeth) and anodontia (congenitally missing teeth).
Orthodontia
Child only available with CoPower ONE Better, Better Plus, and Best.
Rollover Benefits
Not available.
Waiting Period for Services
Good, Better, Better Plus, Best PPOs: None. Voluntary PPO: 12-months for all covered services except D&P, sealants, simple restorations, simple extractions and dental accident. Waiting period can be waived for initial enrollees at takeover with proof of coverage in a comprehensive dental plan with no break in coverage (copy of group’s prior carrier’s EOC and last bill)
ELIGIBILITY Group Size
2-132 eligible employees with a max of 99 enrolled. DE-9C required for all groups under 10 enrolled and any group with PPO enrollment. DE-9C not required for groups 10+ with DHMO-only enrollment. Groups currently enrolled with Delta Dental are allowed if they are converting to CoPower ONE. Groups currently enrolled with Unum Life are not eligible.
Stand-Alone
Yes.
Rate Guarantee
24 months.
Admin Fee
None.
Contribution
Minimum 75% employee, no minimum for dependents.
Participation
Minimum 75% of eligible employees must enroll with no less than 2 in Good-PPO and DeltaCare USA plans and 5 in remaining PPO plans. If employer contributes 100% then 100% participation is required.
Voluntary Plan Contribution
Less than 75% for employees.
Voluntary Plan Participation
Vol PPO: Minimum enrollment of 5 eligible employees Vol DHMO: Minimum of 75% of eligible employees must enroll but no less than 2
Out-of-State
2-3 eligible: No out-of-state employees allowed. 4 eligible: 1 eligible EE may be located out of state. 5-99 eligible & Voluntary plans: No more than 50% of may reside out-of-state. DeltaCare: Service must be rendered in California.
Carve-Outs
Can consist of union/non-union, mgmt/non-mgmt, and hourly/salaried EEs. PPO can be offered to one population and DeltaCare USA to the other; mulitple PPO plans are not allowed. Delta must be the sole dental carrier for both populations. Employers must provide a DE9C identifying the carve-out EEs; if the carve-out is all owners, a letter from the group confirming this is needed. Level 2 rating applies to carve-out groups regardless of industry. Underwriting guidelines apply to each carve-out plan.
1099 Employees
Not eligible.
Owner Only Groups
Allowed if all owners appear on the DE-9C. If owners are not on the DE-9C they are considered ineligible for coverage and do not count in calculating group size or participation.
Industry Loads
Yes, also some ineligible industries.
Open Enrollment
Available only to groups with a POP/Section 125 plan in place.
Dependent Eligibility
Dependent children are eligible until age 26.
Rev. Date 01/04/17
Page 8 of 23
DENTAL UNDERWRITING GUIDELINES COPOWER SELECT: ANTHEM PRIME AND COMPLETE PRODUCT OFFERINGS Product Combinations
Single plan. Groups 10-100 may offer DHMO/PPO, or PPO/PPO.
Voluntary Product Combinations
Single plan or DHMO/PPO.
Additional Cleanings
Members who are pregnant or living with diabetes or other select chronic conditions can receive one additional dental cleaning or periodontal maintenance procedure a year.
Annual Maximum Options above $2,000
Not available.
Annual Max waived for Diagnostic & Preventive
Yes.
Composite Fillings for Anterior Teeth
Yes.
Cosmetic Rider
Not available.
Implant Coverage
Yes.
Missing Teeth Coverage
See contract. 24 month waiting period for replacement of tooth missing prior to initial effective date.
Orthodontia
Available on certain plans for groups of 10-100 on PPO.
Rollover Benefits
Not available.
Waiting Period for Services
None.
ELIGIBILITY Group Size
2-100 enrolled employees; Voluntary Dental available to groups of 5-100 with a minimum of 5 enrolled. No DE-9C required.
Stand-Alone
Yes.
Rate Guarantee
12 months.
Admin Fee
None.
Contribution
Minimum of 50% of EE premium. For all group sizes/plans: If 100% employer paid then 100% participation required.
Participation
Standalone DHMO 2-14 eligible: 70% with a minimum of 2 enrolled. 15-100 eligible: 50% with a minimum of 2 enrolled. Standalone PPO 2-4 eligible: 100% with a minimum of 2 enrolled. 5-14 eligible: 70% with a minimum of 2 enrolled. 15-100 eligible: 50% with a minimum of 2 enrolled. Dual Option HMO/PPO (plans offered must have a 20% rate differential). 10-14 eligible: 70% with minimum 2 enrolled in each plan. 15-100 eligible: 50% with minimum 2 enrolled in each plan. Dual Option PPO/PPO (plans offered must have a 20% rate differential). 10-14 eligible: 75% with minimum 2 enrolled in each plan. 15-100 eligible: 50% with minimum 2 enrolled in each plan.
Voluntary Plan Contribution
Employer may contribute 0-49% of EE premium.
Voluntary Plan Participation
Standalone: A minimum of 5 employees must enroll (no % requirement). Dual Option HMO/PPO: A minimum of 5 employees must enroll in each plan (no % requirement).
Out-of-State
PPO: No more than 49%. DHMO: No
Carve-Outs
Allowed.
1099 Employees
Not eligible.
Owner Only Groups
A sole proprietorship is ineligible without a common law employee. A spouse does not constitute a common law employee (refer to employee eligibility requirements). Owners, that are not spouses, may demonstrate that they meet the eligible employee criteria by providing W-2s or completing the Eligibility Statement.
Industry Loads
Yes. Dental offices are not eligible for coverage.
Open Enrollment
Yes.
Dependent Eligibility
Dependent children are eligible until age 26.
Rev. Date 01/04/17
Page 9 of 23
DENTAL UNDERWRITING GUIDELINES COPOWER SELECT: DELTA DENTAL/DELTACARE PRODUCT OFFERINGS Product Combinations
Dual Choice available for groups of 4+ employees enrolled. Must have a minimum of 2 in one plan and the remainder of employees in the other plan. Delta must be the sole carrier offered, and non-voluntary plans may not be paired with voluntary plans. Employer contribution percentage for employee and dependent coverage must be identical for both plans. PPO can only be paired with DeltaCare HMO plans 10A, 11A, 12A, 15B-Options A or B, or 48N. When enrolling less than 5 in PPO, use the 2-4 PPO rates. When using the 2-4 PPO rates, only PPO Value and PPO Plus Premier Enhanced plans are available.
Voluntary Product Combinations
Dual Choice Voluntary PPO/HMO available for groups of 10+ enrolling, with a minimum of 5 enrolled in one plan and remainder in the other. Voluntary PPO can only be paired with Voluntary DeltaCare HMO plans 10A, 11A, 12A, 15B-Option C, or 48N.
Additional Cleanings
For pregnant enrollees, Delta Dental will pay for the following additional services per calendar year: 1 additional oral evaluation and either 1 additional routine cleaning or 1 additional periodontal scaling and root planing per quadrant.Written confirmation of the pregnancy must be provided by the enrollee or the dentist when the claim is submitted.
Annual Maximum Options above $2,000
Not available.
Annual Max waived for Diagnostic & Preventive
Optional benefit available. Not available on the Voluntary PPO.
Composite Fillings for Anterior Teeth
Direct composite restorations are benefits on anterior teeth and the facial surface of bicuspids. Any other posterior direct composite restorations are optional & Delta’s payment is limited to the cost of the equivalent amalgam restorations.
Cosmetic Rider
Not available.
Implant Coverage
PPO: Covered under Major services. HMO: Not covered.
Missing Teeth Coverage
Delta Dental will pay the applicable percentage of the Dentist’s Fee for a standard cast chrome or acrylic partial denture or a standard complete denture. A standard complete or partial denture is defined as a removable prosthetic appliance provided to replace missing natural, permanent teeth and which is constructed using accepted and conventional procedures and materials. Excluded: Services with respect to congenital (hereditary) or developmental (following birth) malformations or cosmetic surgery or dentistry for purely cosmetic reasons, including but not limited to: cleft palate, upper or lower jaw malformations, enamel hypoplasia (lack of development), fluorosis (a type of discoloration of the teeth) and anodontia (congenitally missing teeth).
Orthodontia
DPPO: Available for groups with 10+ enrolled in the PPO plan. Dependent children only. Voluntary PPO requires 25+ enrolled. DeltaCare: Included–Adult and dependent child for groups with 5+ enrolled. Dual Choice Voluntary: Available for groups with a minimum of 25 on PPO and 5 on HMO.
Rollover Benefits
Not available.
Waiting Period for Services
None, except on Voluntary PPO: 12-month wait for many services. Can be waived at initial enrollment with a copy of the group’s most recent bill showing no break in coverage, and a copy of the group’s prior carrier’s EOC in Indemnity, PPO or comprehensive DHMO. New hires subject to 12-month wait.
ELIGIBILITY Group Size
2–126 eligible employees with a max of 99 enrolled. DE-9C required for DPPO Plans. Groups of 2 may not be comprised of related individuals (ex: Husband/wife not allowed. Parent/tax-dependent and/or cohabitant child not allowed.)
Stand-Alone
Yes.
Rate Guarantee
12 months. Voluntary PPO: 24 months unless waiting period waived for major benefits, then 12 months.
Admin Fee
None.
Contribution
DPPO & DeltaCare Option B: Minimum 75% for employee. No minimum for dependents. DeltaCare Option A: 100% for employee & dependent premium.
Participation If ER contributes 100% then 100% participation is required.
DPPO: 75% of all eligible employees. Groups 2-4 must have a minimum of 2 eligible enrolled, Groups of 5-99 must have a minimum of 5 eligible enrolled. DHMO: Minimum 2 eligible employees.
Voluntary Plan Contribution
Voluntary PPO & DeltaCare Option C: Less than 75% of employee premium.
Voluntary Plan Participation
2-4 Voluntary PPO: Voluntary enrollment. Minimum of 2 enrolled. 5-50 Voluntary PPO: Voluntary enrollment. Minimum of 5 enrolled. DeltaCare Option C: Voluntary enrollment. Minimum of 2 enrolled.
Out-of-State
All Delta Dental PPO plans: Up to 50%. DeltaCare: No out of state enrollees. 2-4 PPO: Groups of 4 may have 1 member may be out of state. No out of state enrollees for groups of 2-3.
Carve-Outs
Employee class carve-outs allowed; management/non-management, union/non-union and hourly/salaried employees (excludes Voluntary PPO). The following will apply: Delta PPO can be offered to one population, DeltaCare USA to another (multiple PPOs not allowed). Not allowed with another carrier; union/non-union population must be through Delta. Level 2 rating applies regardless of industry. DE-9C must identify the carve-out EEs. Underwriting guideline apply to each of the carve-out groups.
1099 Employees
Not eligible.
Owner Only Groups
Allowed if all owners appear on the DE-9C. If owners are not, they may ineligible for coverage; contact CoPower for exceptions.
Industry Loads
DPPO: Yes, Some industries are ineligible. DeltaCare: No, however some industries are ineligible. Voluntary DPPO: None.
Open Enrollment
Employees who contribute towards the cost of coverage for themselves and/or their dependents using pretax dollars may add or delete coverage for themselves and/or their dependents during the group’s open enrollment. Children may be enrolled at the group’s anniversary up to or immediately following the child’s 4th birthday
Dependent Eligibility
Dependent children are eligible until age 26.
Rev. Date 01/04/17
Page 10 of 23
DENTAL UNDERWRITING GUIDELINES
COPOWER SELECT: DELTA CHOICE PRODUCT OFFERINGS Product Combinations
PPO+Premier/HMO, or PPO/HMO: Available for groups of 10+ enrolling with a minimum of 3 enrolled in one plan. DeltaCare Option A is available if the employer contributes 50% or more of dependent premium. Note: Delta Care Choice HMO 10B pairs with Choice PPOs only.
Voluntary Product Combinations
Not available.
Additional Cleanings
For pregnant enrollees, Delta Dental will pay for the following additional services per calendar year: 1 additional oral evaluation and either 1 additional routine cleaning or 1 additional periodontal scaling and root planing per quadrant.Written confirmation of the pregnancy must be provided by the enrollee or the dentist when the claim is submitted.
Annual Maximum Options above $2,000
Not available.
Annual Max waived for Diagnostic & Preventive
Optional benefit available. Not available on the Voluntary PPO.
Composite Fillings for Anterior Teeth
Direct composite restorations are benefits on anterior teeth and the facial surface of bicuspids. Any other posterior direct composite restorations are optional & Delta’s payment is limited to the cost of the equivalent amalgam restorations.
Cosmetic Rider
Not available.
Implant Coverage
PPO: Covered under Major services. HMO: Not covered.
Missing Teeth Coverage
Delta Dental will pay the applicable percentage of the Dentist’s Fee for a standard cast chrome or acrylic partial denture or a standard complete denture. A standard complete or partial denture is defined as a removable prosthetic appliance provided to replace missing natural, permanent teeth and which is constructed using accepted and conventional procedures and materials. Excluded: Services with respect to congenital (hereditary) or developmental (following birth) malformations or cosmetic surgery or dentistry for purely cosmetic reasons, including but not limited to: cleft palate, upper or lower jaw malformations, enamel hypoplasia (lack of development), fluorosis (a type of discoloration of the teeth) and anodontia (congenitally missing teeth).
Orthodontia
Choice DPPO Plans: Available for groups with 10+ enrolled. Dependent children only. Choice 10B: Included–Adult and dependent child.
Rollover Benefits
Not available.
Waiting Period for Services
None.
ELIGIBILITY Group Size
5–99. DE-9C required for DPPO plans.
Stand-Alone
Yes.
Rate Guarantee
Minimum of 6 months.
Admin Fee
None.
Contribution
100% for employee and 50% for dependents. If offering dual choice, contribution must be identical for both plans.
Participation
Choice DPPO Plans: 100% of all eligible employees; no minimum for dependents. Minimum of 5 enrolled. Choice 10B Plan: 100% of eligible employees & minimum of 50% of dependents. Minimum of 5 enrolled.
Voluntary Plan Contribution
Not available.
Voluntary Plan Participation
Not available.
Out-of-State
All Delta Dental Choice PPO plans: Up to 50%. Choice 10B Plan: No OOS enrollees.
Carve-Outs
Not available.
1099 Employees
Not eligible.
Owner Only Groups
Allowed if all owners appear on the DE-9C. If owners are not on the DE-9C they are considered ineligible for coverage and do not count in calculating group size or participation.
Industry Loads
Industry loads on PPO & Premier Plans. Ineligible Industries on DeltaCare: law firms, associations, groups with seasonal employment, groups without an employee/employer relationship, and businesses with a high turnover.
Open Enrollment
Available for groups with employee contributions made on a pre-tax basis. Applicable for dependent enrollment only
Dependent Eligibility
Dependent children are eligible until age 26.
Rev. Date 01/04/17
Page 11 of 23
DENTAL UNDERWRITING GUIDELINES
COPOWER SELECT: DELTA OPTIONS 50–99 PRODUCT OFFERINGS Product Combinations
Dual Choice PPO/HMO available for groups of 50+ enrolling with a minimum of 10 enrolled in one plan. Employer contribution percentage for employee and dependent coverage must be identical for both plans.
Voluntary Product Combinations
Not available.
Additional Cleanings
For pregnant enrollees, Delta Dental will pay for the following additional services per calendar year: 1 additional oral evaluation and either 1 additional routine cleaning or 1 additional periodontal scaling and root planing per quadrant.Written confirmation of the pregnancy must be provided by the enrollee or the dentist when the claim is submitted.
Annual Maximum Options above $2,000
Not available.
Annual Max waived for Diagnostic & Preventive
Optional benefit available. Not available on the Voluntary PPO.
Composite Fillings for Anterior Teeth
Direct composite restorations are benefits on anterior teeth and the facial surface of bicuspids. Any other posterior direct composite restorations are optional & Delta’s payment is limited to the cost of the equivalent amalgam restorations.
Cosmetic Rider
Not available.
Implant Coverage
PPO: Covered under Major services. HMO: Not covered.
Missing Teeth Coverage
Delta Dental will pay the applicable percentage of the Dentist’s Fee for a standard cast chrome or acrylic partial denture or a standard complete denture. A standard complete or partial denture is defined as a removable prosthetic appliance provided to replace missing natural, permanent teeth and which is constructed using accepted and conventional procedures and materials. Excluded: Services with respect to congenital (hereditary) or developmental (following birth) malformations or cosmetic surgery or dentistry for purely cosmetic reasons, including but not limited to: cleft palate, upper or lower jaw malformations, enamel hypoplasia (lack of development), fluorosis (a type of discoloration of the teeth) and anodontia (congenitally missing teeth).
Orthodontia
Available for adult and child or child only.
Rollover Benefits
Not available.
Waiting Period for Services
None.
ELIGIBILITY Group Size
50–99. DE-9C required.
Stand-Alone
Yes.
Rate Guarantee
12 months.
Admin Fee
None.
Contribution
Minimum of 75% for employee & no minimum for dependents.
Participation
Minimum 75% of eligible employees and 35 enrolled. Dual Option requires a minimum of 50 enrolled employees.
Voluntary Plan Contribution
Not available.
Voluntary Plan Participation
Not available.
Out-of-State
Maximum of 50%.
Carve-Outs
Employee class carve-outs are allowed and can consist of management/non-management, union/non-union and hourly/salaried employees. The following will apply: • Delta Dental PPO can be offered to one population, DeltaCare USA can be offered to another (multiple PPOs not allowed). • Carve-outs are not allowed with another carrier; union and non-union population must be through Delta. • Level 2 rating applies to carve-out groups regardless of industry. • Employer must provide DE-9C identifying the carve-out employees. • Underwriting guideline apply to each of the carve-out groups.
1099 Employees
Not eligible.
Owner Only Groups
Allowed if all owners appear on the DE-9C. If owners are not on the DE-9C they are considered ineligible for coverage and do not count in calculating group size or participation.
Industry Loads
Yes. Also some ineligible industries.
Open Enrollment
Yes for groups when the employee contribution towards dental benefits is being made on a pre-tax basis.
Dependent Eligibility
Dependent children are eligible until age 26.
Rev. Date 01/04/17
Page 12 of 23
DENTAL UNDERWRITING GUIDELINES
COPOWER SELECT: METLIFE PRODUCT OFFERINGS Product Combinations
Single plan or Dual Option (PPO/PPO)
Voluntary Product Combinations
Single plan or Dual Option (PPO/PPO)
Additional Cleanings
Not available.
Annual Maximum Options above $2,000
Not available.
Annual Max waived for Diagnostic & Preventive
Not available.
Composite Fillings for Anterior Teeth
Included as standard for anterior and posterior.
Cosmetic Rider
Riders are not available however cosmetic procedures can be included in specific plan designs.
Implant Coverage
Included under Major services.
Missing Teeth Coverage
Exclusions: • Initial installation or replacement of a full or removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth. • Addition of teeth to a partial removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth. • Implants to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth. • Implants supported prosthetics to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth.
Orthodontia
PPO: Child Ortho available. DHMO: Adult/Child Ortho available.
Rollover Benefits
Not available.
Waiting Period for Services
None.
ELIGIBILITY Group Size
5–99. DE-9C not required. Groups with less than 10 employees, no more than 75% of the group can be direct family members. COBRA enrollees can’t exceed 15% of the enrolled lives.
Stand-Alone
Yes.
Rate Guarantee
12 months.
Admin Fee
None.
Contribution
ER pays at least 50% of the EE premium
Participation
Total participation must meet or exceed 75% of the group’s total eligible lives. Employees with valid waivers due to spousal or military coverage will not be counted in the eligible lives when determining the group’s participlation. Mar 2017: 75% of eligible employees (after valid waivers) with 2 enrolled. Plans with Ortho require at least 5 enrolled. Plans with $2000 CYM require 10 enrolled.
Voluntary Plan Contribution
0-49%
Voluntary Plan Participation
PPO: 35% and a minimum of 5 enrolled. DHMO: 30% and a minimum of 5 enrolled. Dual Choice: 35% and a minimum of 5 enrolled in each plan. CoPower SELECT MetLife Voluntary plan requirements do not count valid wavers towards participation
Out-of-State
PPO: 25% or less. PPO dental coverage is not available to groups with employees located in the extraterritorial states of Louisiana, Mississippi, Montana, & Texas DHMO: Not allowed.
Carve-Outs
Allowed.
1099 Employees
Not eligible.
Owner Only Groups
Allowed if owners are not related and also appear on the DE-9C.
Industry Loads
None. Ineligible industries include 8020-8021, 8070, 8072, 8200-8299.
Open Enrollment
None.
Dependent Eligibility
Up to age 26.
Rev. Date 01/04/17
Page 13 of 23
DENTAL UNDERWRITING GUIDELINES
COPOWER SELECT: UNITEDHEALTHCARE PRODUCT OFFERINGS Product Combinations
Single plan or dual option DMO/PPO, PPO/PPO Dual Option DMO/PPO: Any DMO + Any PPO; Must have 5+; no waivers; minimum 1 enrolled in each plan. Dual Option PPO/PPO: Classic 1000 PPO + Preferred 1500 PPO OR Elite 2000 PPO; Must have 10+ eligible with 8 enrolled in at least 5 enrolled in high PPO.
Voluntary Product Combinations
Single plan. Groups with prior coverage may offer dual option DMO/PPO, PPO/PPO Dual Option DMO/PPO: Any DMO + Any PPO; Must have 5+; minimum 1 enrolled in each plan. Dual Option PPO/PPO: Classic 1000 PPO + Preferred 1500 PPO OR Elite 2000 PPO; Must have 10+ eligible with 8 enrolled in at least 5 enrolled in high PPO.
Additional Cleanings
Not available.
Annual Maximum Options above $2,000
Not available.
Annual Max waived for Diagnostic & Preventive
Not available.
Composite Fillings for Anterior Teeth
Yes, on plans for groups of 5+ PPO.
Cosmetic Rider
Not available.
Implant Coverage
Yes, on plans for groups of 5+ PPO. DMO will have this added in 2016.
Missing Teeth Coverage
None.
Orthodontia
Available on certain plans for groups of 5+ PPO and 2+ on DMO.
Rollover Benefits
CMM available on PPO plans.
Waiting Period for Services
None.
ELIGIBILITY Group Size
2–4, 5–100.
Stand-Alone
Yes.
Rate Guarantee
12 months.
Admin Fee
None.
Contribution
Minimum 50% of the employee premium.
Participation
Minimum 75% after valid waivers (other coverage),not to fall below 50% of total eligible population.
Voluntary Plan Contribution
0-49%
Voluntary Plan Participation
At least 2 eligible and minimum of 2 enrolling. Plans with ortho require a minimum of 5 eligible and 4 enrolling.
Out-of-State
Allowed for PPO. Not allowed for DMO.
Carve-Outs
Not allowed.
1099 Employees
1099’s must be working for the company full-time on a year-round basis a minimum of 30 hours per week. If elected, coverage must be offered to all 1099’s. The employer must have at least one owner or regular, taxed employee who is eligible for coverage (they are not required to enroll). UHC must be the sole carrier offered. Must have workers comp in place.
Owner Only Groups
Not allowed.
Industry Loads
Yes.
Open Enrollment
Yes.
Dependent Eligibility
Up to age 26.
Rev. Date 01/04/17
Page 14 of 23
DENTAL UNDERWRITING GUIDELINES
HEALTH NET PRODUCT OFFERINGS Product Combinations
HMO/PPO, HMO/PPO, or PPO/PPO combination available.
Voluntary Product Combinations
HMO/PPO, HMO/PPO, or PPO/PPO combination available.
Additional Cleanings
HMO plans offer up to 2 additional cleanings per year at a copay. PPO plans offer pregnant woman additional cleanings and periodontal maintenance when medical necessary; not subject to deductible and does not apply to annual max.
Annual Maximum Options above $2,000
Not available.
Annual Max waived for Diagnostic & Preventive
Not available.
Composite Fillings for Anterior Teeth
Yes. Posterior: Yes, however plans have a least expensive procedure alternate provision. Dental services are covered at the least costly, clinically accepted treatment.
Cosmetic Rider
Not available.
Implant Coverage
Not available.
Missing Teeth Coverage
Coverage excludes replacement of missing natural teeth lost prior to the onset of plan coverage until the patient has been covered under the policy for 12 continuous months.
Orthodontia
DHMO: Ortho included on all plans. PPO: Ortho isincluded with 10+ enrolledon specific plans. Included on groups of 2–9 only with prior indemnity Ortho coverage. If Voluntary, included only if 10+ enrolled regardless of prior ortho coverage.
Rollover Benefits
Not available.
Waiting Period for Services
None.
ELIGIBILITY Group Size
2–100 eligible and enrolled, based on FTE count (full-time equivalents). DE-9C required.
Stand-Alone
Yes.
Rate Guarantee
12 months.
Admin Fee
None.
Contribution
Minimum 50% for employee.
Participation
Proof of prior group coverage is required for employer paid rates. DHMO: Minimum 50% and 2 enrolled. PPO: Minimum 75% and 2 enrolled. DHMO/PPO: Minimum 75% participation with a minimum of 4 enrolled; must have a minimum of 2 enrolled on each plan offered. DHMO/DHMO or PPO/PPO: Minimum 75% participation with a minimum of 10 enrolled; must have a minimum of 2 employees enrolled on each plan offered.
Voluntary Plan Contribution
Voluntary rates apply for any group where the employer contributes less than 50%.
Voluntary Plan Participation
Voluntary rates apply for any group where the participation is less than 50% on DHMO or 75% on PPO, and all groups with no prior group coverage regardless of contribution & participation. HMO or PPO: Available with minimum of 2 enrolled. DHMO/PPO: Minimum 75% participation with a minimum of 4 enrolled; must have a minimum of 2 enrolled on each plan offered. DHMO/DHMO or PPO/PPO: Minimum 75% participation with a minimum of 10 enrolled; must have a minimum of 2 employees enrolled on each plan offered.
Out-of-State
Minimum 51% in California. Employer must be based in California. PPO plans offered to out-of-state employees.
Carve-Outs
Not available.
1099 Employees
Not eligible.
Owner Only Groups
Not allowed. Must have at least one non-spouse, “common law” employee on the DE-9C.
Industry Loads
None.
Open Enrollment
Yes.
Dependent Eligibility
Dependent children are eligible until age 26.
Rev. Date 01/04/17
Page 15 of 23
DENTAL UNDERWRITING GUIDELINES
MEDIEXCEL PRODUCT OFFERINGS Product Combinations
Single plan option only.
Voluntary Product Combinations
Single plan option only.
Additional Cleanings
Available for medical necessity.
Annual Maximum Options above $2,000
N/A
Annual Max waived for Diagnostic & Preventive
N/A
Composite Fillings for Anterior Teeth
Yes.
Cosmetic Rider
Not available. Some services are available on a discounted basis.
Implant Coverage
Not available.
Missing Teeth Coverage
$30 copay per tooth.
Orthodontia
Adult/Child ortho available for all group sizes.
Rollover Benefits
N/A
Waiting Period for Services
None.
ELIGIBILITY Group Size
1-100.
Stand-Alone
Yes.
Rate Guarantee
12 months.
Admin Fee
1-2 enrollees: $15/mo 3 enrollees: $10/mo 4+ enrollees: no admin fee
Contribution
No minimum.
Participation
1 enrollee.
Voluntary Plan Contribution
No minimum.
Voluntary Plan Participation
1 enrollee.
Out-of-State
N/A. Employees must work within the service area to be eligible.
Carve-Outs
Allowed. The carve-out classes must be IRS non-discriminatory and in compliance with ACA, and all eligible employees in the non-carve-out class are offered coverage.
1099 Employees
Not eligible.
Owner Only Groups
Not allowed.
Industry Loads
None.
Open Enrollment
Allowed.
Dependent Eligibility
Up to age 26.
Rev. Date 01/04/17
Page 16 of 23
DENTAL UNDERWRITING GUIDELINES METLIFE 2–50 HEALTHCONNECT
METLIFE 2–50 RATING TOOL
Single plan. Dual option PPO/DHMO available to groups 10+. Contact MetLife if a PPO/PPO dual option is desired. Single plan. Dual option PPO/DHMO available to groups 25+. Contact MetLife if a PPO/PPO dual option is desired. Not available.
Single plan. Contact MetLife if a PPO/PPO or PPO/DHMO dual option is desired. Single plan. Contact MetLife if a PPO/PPO or PPO/DHMO dual option is desired.
PRODUCT OFFERINGS Product Combinations Voluntary Product Combinations Additional Cleanings Annual Maximum Options above $2,000 Annual Max waived for Diagnostic & Preventive Composite Fillings for Anterior Teeth Cosmetic Rider
$2,000 plan requires 10+ enrolled.
Implant Coverage
Included under Major services.
Missing Teeth Coverage
Exclusions: • Initial installation or replacement of a full or removable Denture to replace one or more natural teeth whwillich were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth. • Addition of teeth to a partial removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth. • Implants to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth. • Implants supported prosthetics to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth. Child ortho available with a minimum of 5+ enrolled. Groups of 5-9 enrolled require proof of prior ortho coverage. Groups of 10+ enrolled require proof of prior major coverage. Not available. None.
Orthodontia Rollover Benefits Waiting Period for Services
Not available. Included as standard for anterior and posterior. Not available.
ELIGIBILITY Group Size
2-50 employer-sponsored, 5-50 voluntary. Factor Rated. DE-9C required for groups with more than 50% family members. Groups with less than 10 employees, no more than 75% of the group can be direct family members. COBRA enrollees can’t exceed 15% of the enrolled lives. Must be in business at least 1 year prior to the effective date of the coverage. No more than 2 virgin voluntary coverages are allowed.
Stand-Alone
Yes.
Yes.
Rate Guarantee
12 months.
12 months. 24 months available with 10+ alongside Vision.
Admin Fee
2-9 employees: $15 per month. 10+ employees: None.
2-9 employees: $15 per month. 10+ employees: None.
Contribution
Minimum 50% of EE premium.
Minimum 50% of EE premium.
Participation
DHMO: Minimum 30% and 5 enrolled. PPO 2–4 eligible: Minimum 100%. PPO 5–50 eligible: Minimum 50% and 3 enrolled. PPO/DHMO 10-24 eligible: 50% and 5 on each plan. PPO/DHMO 25-50 eligible: 50% and 5 on DHMO, 10 on PPO.
DHMO: Minimum 30% and 5 enrolled. PPO 2–4 eligible: Minimum 100%. PPO 5–9 eligible: Minimum 5 enrolled. PPO 10+ eligible: Minimum 50%. PPO/DHMO 10-24 eligible: 50% and 5 on each plan. PPO/DHMO 25-49 eligible: 50% and 5 on DHMO, 10 on PPO.
Voluntary Plan Contribution
Less than 50% of the employee premium.
Less than 50% of the employee premium.
Voluntary Plan Participation
DHMO: Minimum 30% and 5 enrolled. PPO: Minimum 35% and 5 enrolled. PPO/DHMO 25-50 eligible: 50% and 5 on DHMO, 10 on PPO.
DHMO: Minimum 30% and 5 enrolled. PPO 5-9 eligible: Minimum 5 enrolled. PPO 10+ eligible: Minimum 35% and 5 enrolled. PPO/DHMO 25-49 eligible: 50% and 5 on DHMO, 10 on PPO.
Out-of-State
DHMO is only available to CA, FL, NJ, and TX employees. Contact MetLife for additional rates and plans when more than 25% of the employees do not reside in California.
Carve-Outs
Any group including a union population must be quoted to underwriting.
1099 Employees
Not eligible.
Owner Only Groups
Allowed.
Industry Loads
None. Retirees, part time, temporary, seasonal, leased and independent contractors (1099) are not eligible. Ineligible industries include 8021, 8072, 8811, 9999.
Open Enrollment
All groups of 10 or more eligible lives include an annual open enrollment.
Dependent Eligibility
Up to age 26.
Always refer to the underwriting guidelines included in the proposal generated by HealthConnect and/or the rating tool. Additional underwriting guidelines/options may be available in the rating tool. Rev. Date 01/04/17
Page 17 of 23
DENTAL UNDERWRITING GUIDELINES
METLIFE 51–499 PRODUCT OFFERINGS Product Combinations
HMO/PPO, or PPO/PPO.
Voluntary Product Combinations
HMO/PPO, or PPO/PPO.
Additional Cleanings
Not available.
Annual Maximum Options above $2,000
Up to $3,000 in increments of $50 available for groups of 10+. $5,000 available for groups of 51+. Must be quoted direct through MetLife.
Annual Max waived for Diagnostic & Preventive
Not available.
Composite Fillings for Anterior Teeth
Included as standard for anterior and posterior.
Cosmetic Rider
Riders are not available however cosmetic procedures can be included in specific plan designs.
Implant Coverage
Included under Major services.
Missing Teeth Coverage
Exclusions: • Initial installation or replacement of a full or removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth. • Addition of teeth to a partial removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth. • Implants to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth. • Implants supported prosthetics to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth.
Orthodontia
Adult/Child Ortho available to groups of 5+ lives.
Rollover Benefits
Graduating Dental Benefits program available to groups of 10+. Must request custom quote; not included in book rated products. (excluding copay plans and full service dental for retirees) Members are rewarded for maintaining their dental coverage with an increasing maximum benefit each year for up to 3 years. The highest annual maximum level is capped at 3 years or $3,000. Participants and their dependents maintain the maximum benefit once it’s reached for as long as they remain enrolled in the plan with no gap in coverage. If there is an interruption in MetLife dental overage, participants start at the beginning, with the lower benefit level, after re-enrolling in the employer’s plan.
Waiting Period for Services
None.
ELIGIBILITY Group Size
51–499 custom rated. DE-9C not required.
Stand-Alone
Yes.
Rate Guarantee
12 months.
Admin Fee
None.
Contribution
Minimum 50% employee.
Participation
Single option: 50% and a minimum of 10 enrolled. HMO/PPO: 65% and a minimum of 25 enrolled. PPO/PPO: 75% and a minimum of 25 enrolled. At least 25% of enrollment must be on the high plan.
Voluntary Plan Contribution
Between 0–49% of employee premium.
Voluntary Plan Participation
Available with 35% participation. May go down to 25% participation if plan includes waiting periods. Requires at least 10 enrolled
Out-of-State
No limit.
Carve-Outs
Allowed.
1099 Employees
Not eligible.
Owner Only Groups
Allowed.
Industry Loads
None. Ineligible industries include dental offices and dental labs.
Open Enrollment
Included on all DHMO plans. Included on DPPO for groups of 100+ with at least 50% participation.
Dependent Eligibility
Up to age 26.
Rev. Date 01/04/17
Page 18 of 23
DENTAL UNDERWRITING GUIDELINES
PREMIER ACCESS PRODUCT OFFERINGS Product Combinations
Single plan, PPO/PPO or DHMO/PPO.
Voluntary Product Combinations
Single plan, PPO/PPO or DHMO/PPO.
Additional Cleanings
Offered upon request.
Annual Maximum Options above $2,000
Offers $2,500.
Annual Max waived for Diagnostic & Preventive
Not available.
Composite Fillings for Anterior Teeth
Offered upon request.
Cosmetic Rider
Not available.
Implant Coverage
Offered upon request.
Missing Teeth Coverage
Offered if tooth was extracted within 12 months of becoming effective on a plan.
Orthodontia
Available to employer sponsored groups of 10+. Groups of 3-9 are eligible only if currently offered. Available to voluntary groups of 10+.
Rollover Benefits
Not available.
Waiting Period for Services
Employer sponsored groups of 3-9 & Voluntary plans have 12 month wait for Major Services without similar prior coverage. DHMO qualifies as prior coverage for the Premier Plus plans and Voluntary Standard Plan 5 only. Employer sponsored groups of 10-50 without similar prior coverage will have Major Services paid at 25% for first 12 months; waived with proof of similar prior coverage.
ELIGIBILITY Group Size
Employer sponsored: 3–99. Voluntary: 5–99. DE-9C required for groups 3–50.
Stand-Alone
Yes.
Rate Guarantee
12 months.
Admin Fee
Voluntary 5-9: $15 monthly fee.
Contribution
DHMO or PPO 3–9 enrolled: 100% of employee premium. DHMO or PPO 10–99 enrolled: 75% of employee premium. PPO/PPO or DHMO/PPO: 75% of employee premium on the PPO low option (PPO/PPO) or DHMO (DHMO/PPO).
Participation
PPO or DHMO: 75% of eligible with a minimum of 3 enrolled. PPO/PPO or DHMO/PPO: 75% of eligible with a minimum of 10 enrolled. A minimum of 5 must enroll in the PPO high option and 2 must enroll in the low option (PPO low or DHMO). All plans, If contribution is 100% then participation must be 90%.
Voluntary Plan Contribution
Must be less than 75% of employee premium. PPO/PPO or DHMO/PPO: Must be less than 75% of EE premium on the PPO low (PPO/PPO) or DHMO (DHMO/PPO).
Voluntary Plan Participation
DHMO: Greater of 20% or 5 enrolled. DPPO: Greater of 20% or 10 enrolled. PPO/PPO: 20% of eligible with a minimum of 10 enrolled. A minimum of 5 must enroll in the PPO high option and 2 must enroll in the low option (PPO low or DHMO). DHMO/PPO: 40% of eligible with a minimum of 25 enrolled. A minimum of 5 must enroll in the PPO high option and 2 must enroll in the low option (PPO low or DHMO).
Out-of-State
Less than 25% with book rates.
Carve-Outs
Management or Union allowed. Minimum of 3 enrolled on selected plans, or 5 enrolled on Custom Plans.
1099 Employees
Not eligible.
Owner Only Groups
Allowed.
Industry Loads
No. Some ineligible industries.
Open Enrollment
No.
Dependent Eligibility
Up to age 26 if full-time student or fully dependent per IRS standards; proof required. May also cover up to age 26 regardless of verification with % rate load.
Rev. Date 01/04/17
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DENTAL UNDERWRITING GUIDELINES
PRINCIPAL PRODUCT OFFERINGS Product Combinations
PPO/EPO available with 10+ enrolled employees. DHMO option available through CDN.
Voluntary Product Combinations
Available. Up to a $3,000 Calendar Year Max.
Additional Cleanings
Offered as a rider up to 4 per year.
Annual Maximum Options above $2,000
Up to $3,000 or up to $5,000 with ortho.
Annual Max waived for Diagnostic & Preventive
Preventive Passport rider available. Applies to preventive services.
Composite Fillings for Anterior Teeth
Offered as a rider.
Cosmetic Rider
Offered as a rider.
Implant Coverage
Offered as a rider using quoted max or as a rider with a separate max.
Missing Teeth Coverage
Benefits for the initial placement of bridges, partials and dentures are not covered if those teeth were missing prior to becoming insured under the Principal Life policy. The “Replacement of Prior Plan Provision,” also referred to as a “No Loss of Coverage” provision, applies to takeover or transfer business from one carrier to another. • It assures the initially covered persons and their dependents won’t be deprived of coverage due to a change in carriers. However, the provision doesn’t guarantee coverage levels will be the same. • It applies to only those persons and their dependents who were covered under the prior benefits on the date of its termination and who are eligible and enrolled under our benefits on its date of issue. • It waives the missing tooth provision (provided that missing tooth was extracted while the covered person was insured under the prior plan).
Orthodontia
Child Ortho available for 5+ lives. Adult Ortho available for 25+ lives. Not available for Voluntary.
Rollover Benefits
Not available.
Waiting Period for Services
None.
ELIGIBILITY Group Size
3–50. DE-9C not required. Must be in business one year to qualify for Dental.
Stand-Alone
Yes.
Rate Guarantee
12 months. Other timeframes available with rate load.
Admin Fee
None.
Contribution
Minimum 50% of employee premium.
Participation
Non-contributory: 100% of employees and 50% of eligible dependents. Contributory: 75% of employees and 50% of eligible dependents.
Voluntary Plan Contribution
No contribution required for Voluntary.
Voluntary Plan Participation
20% or 5 enrolling, whichever is greater, and 50% of dependents.
Out-of-State
Yes.
Carve-Outs
Allowed. Employers can also request to exclude dependents under age 19.
1099 Employees
Not eligible.
Owner Only Groups
Allowed.
Industry Loads
Yes (Already built into rates).
Open Enrollment
Annual enrollment included. Employees who waive and return will have deferred coverage, those not previously enrolled will have full coverage.
Dependent Eligibility
Dependent children are eligible for dental coverage up to age 26 and ortho coverage up through age 18.
Rev. Date 01/04/17
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DENTAL UNDERWRITING GUIDELINES
RELIANCE STANDARD PRODUCT OFFERINGS Product Combinations
Single plan option only.
Voluntary Product Combinations
Single plan option only.
Additional Cleanings
Not available.
Annual Maximum Options above $2,000
Not available.
Annual Max waived for Diagnostic & Preventive
Not available.
Composite Fillings for Anterior Teeth
Yes. Note: Posterior composites are not covered and the plan does not consider white composites (fillings) on back teeth as an eligible expense
Cosmetic Rider
Not available.
Implant Coverage
Not available.
Missing Teeth Coverage
Limited prior extraction coverage provides for a procedure to replace teeth extracted while insured under a prior plan, applies to initial insureds only. A 12-month maximum time period between extraction (while insured under prior plan) and replacement (while insured under our plan).
Orthodontia
Adult and child orthodontia included on Plan B. Orthodontia not available on Plan A or Plan C.
Rollover Benefits
MaxRewards included on all plans. To qualify for rewards, member must submit at least 1 claim per year for a covered procedure and total paid claims must be under the plans annual threshold limit. A bonus is earned for utilizing PPO providers. Earned rewards are added to the next years calendar year maximum benefit and have a maximum accumulation amount based on the plan benefit.
Waiting Period for Services
12-months for Major. Waived with proof of 12 consecutive months similar prior group coverage with no lapse in coverage. Plan B Groups of 2-9: 24-months for orthodontic services. This cannot be waived. Groups 10-19: 12-months for orthodontic services. Waived on takeover plans.
ELIGIBILITY Group Size
SmartChoice 2–19. DE-9C not required but may be requested. Must be in business one year to qualify for Dental.
Stand-Alone
Yes for groups of 3–19. Groups with 2 enrolled must also enroll in two additional lines of coverage.
Rate Guarantee
12 months. 24 month option available.
Admin Fee
$5/month for electronic billing, or $12/month for paper billing. (Groups enrolling in dental must elect paper billing)
Contribution
Employer may contribute from 0-100% of the premium.
Participation
2 eligible employees: 100% of eligible. 3-5 eligible employees: All but one must enroll. 6-9 eligible employees: All but two must enroll. 10-19 eligible employees: 75% must enroll. Part-time EEs working 20-30 hours/week may be included if less than 25% of total eligible. Participation requirements apply to eligible dependents as well. If employer contributes 100% then 100% participation is required. Plan C Only: Employers may add the Reduced Participation Option which allows for 50% participation with a minimum of 5 lives insured.
Voluntary Plan Contribution
All plans may be 100% employee paid, full participation requirements must still be met.
Voluntary Plan Participation
All plans may be 100% employee paid, full participation requirements must still be met.
Out-of-State
No limit.
Carve-Outs
Allowed with 2 or more eligible employees within a class. 20% rate load applies.
1099 Employees
Not eligible.
Owner Only Groups
Allowed.
Industry Loads
20% load on the following industries: Beauty Shops, Funeral Services, Jewelry Business, Automotive Dealers, Direct Selling Establishments, Security & Commodity Brokers/Dealers, Real Estate Agents/Developers, Educational Services. Ineligible groups: Dental offices, association groups, trusts, membership organizations, fraternal organizations, unions where benefits and rates are subject to labor mgmt negoations, voluntary arrangements (e.g., cafeteria plans, section 125 plans)
Open Enrollment
Yes.
Dependent Eligibility
Up to age 19 if unmarried and not working for the company or up to age 24 if unmarried and a full-time student.
Rev. Date 01/04/17
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DENTAL UNDERWRITING GUIDELINES
UNITEDHEALTHCARE PRODUCT OFFERINGS Product Combinations
Single plan, HMO/HMO, HMO/PPO, PPO/PPO.
Voluntary Product Combinations
Single plan, HMO/HMO, HMO/PPO, PPO/PPO.
Additional Cleanings
FlexAppeal Enhanced rider available on certain PPO plans. This benefit allows for any combination of 4 cleanings or periodontal maintenance treatments in a 12-month period.
Annual Maximum Options above $2,000
$3,500 annual max (in network only) available for groups of 10+.
Annual Max waived for Diagnostic & Preventive
FlexAppeal Preventive MaxMultiplier rider available on certain PPO plans to groups with 10+ eligible.
Composite Fillings for Anterior Teeth
FlexAppeal Enhanced rider available on certain PPO plans.
Cosmetic Rider
Available to large group (100+) only.
Implant Coverage
FlexAppeal Enhanced rider available on certain PPO plans.
Missing Teeth Coverage
No missing teeth clause.
Orthodontia
Child only or Adult/Child Ortho available for groups with a minimum of 10 eligible and 8 enrolled.
Rollover Benefits
Consumer MaxMultiplier available to groups of 2+. To be eligible a member must use their dental benefits at least once per year. If the total of all claims paid for the member is less than the established threshold amount then the member receives an award that is added to the next years annual maximum. Members can earn an additional $100 award if all services and claims during the year are from in-network providers. There is an accumulation limit for the Consumer MaxMultiplier account that will be based on the value of the plans original annual maximum.
Waiting Period for Services
Voluntary plans 2–9 eligible: 12 month for Major, waived with prior coverage.
ELIGIBLITY Group Size
2–100. DE-9C required.
Stand-Alone
Yes.
Rate Guarantee
12 months.
Admin Fee
None.
Contribution
Minimum 50% of employee premium.
Participation
HMO: Minimum 75% of employees. PPO: Minimum 75% of employees and 51% including valid waivers. HMO/HMO: Minimum 5 eligible and 3 enrolled; plans must be high/low combinations. Target differential 30%. HMO/PPO: Min 5 eligible and 3 enrolled. A minimum of 10 eligible employees and 8 enrolled is required for any PPO plan offered that includes orthodontic services. PPO/PPO: Minimum 10+ eligible and enrolled; plans must differ by more than ortho coverage. A minimum of 10 eligible employees and 8 enrolled is required for any PPO plan offered that includes orthodontic services, even if both plans offer ortho.
Voluntary Plan Contribution
No minimum.
Voluntary Plan Participation
Minimum of 2 enrolled for single plan. Groups with prior coverage: For dual option minimums, see Participation above.
Out-of-State
No limit. Plans/rates available based the state with 51% of the employees.
Carve-Outs
Available with 5+ eligible and enrolling employees. Eligible class descriptions include: Salary/Hourly, Union/Non-Union and Management/Non-Management.
1099 Employees
No more than 25% of the enrolled groups can be 1099 employees.
Owner Only Groups
S-Corps, C-Corps, and LLCs: Allowed with at least 2 eligible owners. If only 1 owner then must have at least one non-spouse, “common law” employee on the DE-9C or one non-spouse 1099 as eligible. All Others: Not allowed. Must have at least one non-spouse, “common law” EE on the DE-9C or one non-spouse 1099 as eligible.
Industry Loads
Yes.
Open Enrollment
Yes.
Dependent Eligibility
Dependent children are eligible until age 26.
Rev. Date 01/04/17
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DENTAL UNDERWRITING GUIDELINES
UNUM PRODUCT OFFERINGS Product Combinations
Standalone PPO, High/Low PPO, Standalone DHMO, Dual Option PPO/DHMO.
Voluntary Product Combinations
Same as Product Combinations above. If less than 20% participation then restricted to DHMO only.
Additional Cleanings
Additional cleanings available but must be approved through underwriting. Non-standard provisions not allowed below 50 lives.
Annual Maximum Options above $2,000
$2500 and $5000 available.
Annual Max waived for Diagnostic & Preventive
Yes, standard.
Composite Fillings for Anterior Teeth
Yes, posterior and anterior teeth as standard.
Cosmetic Rider
Not available.
Implant Coverage
Yes, can be added for additional cost.
Missing Teeth Coverage
No missing tooth exclusion policy.
Orthodontia
Available to groups with 10+ enrolled and prior ortho coverage, or groups with 25+ lives. Groups with no prior coverage below 25 lives are not eligible for ortho.
Rollover Benefits
Yes, can be added for additional cost.
Waiting Period for Services
None.
ELIGIBLITY Group Size
10+ enrolled.
Stand-Alone
Yes.
Rate Guarantee
12 months or 24 months available.
Admin Fee
None.
Contribution
No minimum.
Participation
The greater of 20% or 10 enrolled.
Voluntary Plan Contribution
No more than 49% employer contribution.
Voluntary Plan Participation
Must have 10 enrolled. If less than 20% participation then restricted to DHMO only.
Out-of-State
No minimum requirements on the number of employees that must reside in CA. Coverage offered may have limitations depending on the other states. DHMO is only available in CA and TX.
Carve-Outs
yes, carveouts allowed with 10+ enrolled. Carveouts cannot be discriminatory.
1099 Employees
Not eligible.
Owner Only Groups
pending
Industry Loads
Yes.
Open Enrollment
Yes.
Dependent Eligibility
Dependent children are eligible until age 26.
All information published herein is gathered from sources which are thought to be reliable, but the reader should not assume that the information is official or final. Reliance on this information received from LISI shall be at your sole risk, and LISI assumes no responsibility for any errors, omissions, or damages arising. Users of this information are encouraged to confirm with other sources, and to seek qualified advice if embarking on any actions that could carry personal or organizational liabilities. Rev. Date 12/23/16
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