Read below for detailed information about this benefit:
Employees who are eligible to enroll in dental insurance include 1) full-time employees and 2) part-time employees* who are non-probationary.
Full-time employees can enroll their eligible dependents onto the dental coverage. Eligible dependents include their legal spouse and children (biological, step, legally adopted, by virtue of legal guardianship, eligible because of a court order). Dependent children are eligible to remain covered through the end of the calendar year in which they turned 25 as long as they meet all of the below criteria:
Eligibility – Child Ages 19 – 25
In order to maintain eligibility for dental insurance past the calendar year of their 19th birthday, a child must meet the following requirements: 1) has not reached the end of the calendar year in which they turned 25, 2) is a full-time student**, 3) is unmarried, 4) lives primarily with you (unless temporarily away at school), and 5) you provide over 50% support OR 1) before age 19, is mentally or physically disabled, 2) is dependent upon you for a majority of their support, and 3) is incapable of self-sustaining employment by reason of their mental or physical disability
**A "Full-time Student" is someone who enrolls during each of at least five months during the taxable year for what is considered a full-time course of study at an ongoing educational organization.
*Excludes part-time athletic coaches, Specialized Professional Services (SPS) employees, and student employees.
The following rates are for the 2021 Plan Year. Please reference the 2022 Employee Health Insurance Premiums for 2022 rates.
FULL-TIME EMPLOYEE PREMIUM
Coverage Full Monthly Premium Employee Share of Monthly Premium Employee Per Pay Period Deduction Employer Share of Monthly Premium Single $39.47 $ - $ - $39.47 Two Person $89.09 $ - $ - $89.09 Family $106.93 $ - $ - $106.93
Coverage Full Monthly Premium Employee Share of Monthly Premium Employee Per Pay Period Deduction Employer Share of Monthly Premium Single $46.30 $6.83 $3.41 $39.47 Two Person $112.50 $23.41 $11.70 $89.09 Family $139.06 $32.13 $16.06 $106.93
PART-TIME EMPLOYEE PREMIUM
Coverage Full Monthly Premium Employee Share of Monthly Premium Employee Per Pay Period Deduction Employer Share of Monthly Premium Employee Only $67.30 $67.30 $33.65 $ -
Coverage Full Monthly Premium Employee Share of Monthly Premium Employee Per Pay Period Deduction Employer Share of Monthly Premium Employee Only $74.13 $74.13 $37.06 $ -
My Coverage Resources and Forms
ADN Member ID Card
Upon initial enrollment, ADN will mail your physical member cards to your home address on file with Human Resources.
ADN Account Portal
You can view your Explanation of Benefits (EOB) statements for submitted claims and request additional ID cards by creating an account through the ADN website.
Finding In-Network Providers
Locate in-network providers through the ADN Provider Search. Enrollees can find in-network providers in the following two PPO networks:
- ADN Dental Network
- DenteMax Network
PPO providers have agreed to offer discounts on all services. By using PPO providers, you will be able to reduce your out-of-pocket expenses for dental services.
Please be aware that even if a dental office "accepts" ADN that does not necessarily mean that they are a Participating Provider with one of the two PPO networks offered. Please be specific when asking your dental office whether they are "Participating" with the ADN or DenteMax PPO networks.
Utilizing an in-network provider will offer the best discounts on services, but ADN does provide out-of-network coverage to enrollees as well. If you receive applicable services from an out-of-network provider, the provider can submit an out-of-network claim. If the provider refuses to submit the claim for you, which is unlikely, you would need to submit an itemized bill showing the following information to receive ADN discounts:
- Provider’s TIN
- Provider’s address
- Provider’s phone number
- Date(s) of service
- CDT procedure code(s)
- Tooth number(s), if applicable
- Charge for service
- Proof of payment
This can be mailed to ADN Administrators (PO Box 610, Southfield, MI 48037) or emailed to firstname.lastname@example.org.
Predetermination of Benefits
ADN strongly recommends predetermination of benefits prior to any treatment when proposed procedures exceed $250. This process allows ADN to review the dentist's treatment plan and determine allowable benefits before any costs are incurred. The treating dentist should submit a claim form indicating their proposed treatment plan and include all necessary documentation such as pre- and/or post-operative x-rays, study models, photographs, charts, laboratory reports, and written documentation of need. The plan administrator will review all pertinent information and make a determination of benefits based on the information submitted. A written predetermination will be sent to the treating dentist and patient to inform them of the benefits determined.
Benefits Enrollment & Changes
When and how can I enroll in and make changes to my eligible benefits?
Contact your HR Benefits Team at LCC-HR-Benefits@star.lcc.edu