
Dental Document Plan Booklet
Premium Rates
How to Read BCBS Statements (EOB)
Medical/Dental Enrollment/ Termination/Change Form
Blue Cross Website
Erlanger
offers a dental benefit plan through BlueCross BlueShield of Tennessee
(BCBST). The dental
benefit plan is a self-insured plan and is administered by
BCBST in the “DentalBlue” network under group number
89550.
Eligibility
To be eligible for the Dental Benefit Plan, an employee
must be classified as a regular employee and hired as a 0.52 FTE or greater. An employee may
elect individual or family coverage.
Enrollment
Eligible employees may enroll in individual or family
dental coverage within 31 days of their hire date; or within 31 days of a
qualifying event. Eligible employees may also enroll in the Dental
Benefit Coverage during any Open Enrollment Period.
Effective Date of
Coverage
New Hires
The effective
date of the Dental Benefit Coverage will be the first of the month following the
initial one-month waiting period from an employee’s hire date.
Qualifying Events
Qualifying events that allow an employee to
enroll, terminate or make changes outside of the annual enrollment period are:
marriage, divorce, birth/adoption, spouse/dependents losing dental coverage
through no fault of their own; becoming eligible for Medicare; or transferring
from an ineligible position (below 0.52 FTE) to an eligible
position (0.52 FTE or above).
| Birth/Adoption: | Coverage becomes effective the date of the birth |
| Marriage: | Coverage becomes effective the date of the marriage |
| Divorce: | Coverage becomes effective the day after the divorce |
| Loss of coverage: | Coverage becomes effective the day after coverage ends |
All qualifying events require completion of the Medical/Dental Enrollment/Change Form and appropriate documentation of the event must accompany the form (i.e. birth certificate, divorce decree, etc.). The form and documentation must be submitted to the Benefits Department within 31 days of the event. If the completed form and documentation are not submitted to the Benefits Department within 31 days from the qualifying event, the next opportunity to enroll, terminate or make changes to the Dental Benefit Plan will be during the next open enrollment period.
How to Contact BlueCross BlueShield of
Tennessee
You may contact BlueCross BlueShield of Tennessee
by telephone at 1-800-565-9140 or through their website at www.bcbst.com. Please have your health insurance
card ready with account information.