Dental
The University offers three options for dental insurance for faculty, staff (including Allied Union) and AAPs*.
CareFirst PPO - Standard (click for summary of benefits)
This plan provides basic coverage for routine exams, cleanings and other basic services at an affordable premium. The plan pays up to $1000 per member each calendar year. Orthodontia is not covered. Click here to access the complete Summary Plan Description.
CareFirst PPO - Enhanced (click for summary of benefits)
This plan provides expanded coverage, including periodontal and prosthodontic services, up to $1,500 per member each calendar year. In addition, the plan provides up to a $2,000 lifetime maximum orthodontia benefit for dependent children up to age 19. Click here to access the complete Summary Plan Description.
Finding a Dentist CareFirst
Both CareFirst PPO plans utilize the Regional Preferred Dental PPO network. Participants enrolling in either of the CareFirst plans may access non-network providers; however, you will receive higher levels of reimbursement when a network provider is used.
Aetna DMO (click to view summary of benefits)
The Aetna Dental Maintenance Organization (DMO) is a managed care program offering a network of area dentists. If you enroll in the Aetna DMO, you must select a dentist from the DMO network for all of your dental care. The DMO offers 100% coverage for all preventive care and most other services, with a $10 copay per visit. There is no deductible and no annual maximum on benefits.
Orthodontia for eligible participants is covered at 50%. Eligible participants are dependent children whose treatmeant begins before age 19. There is a lifetime limit on orthodontia of one time per patient.
Finding a Dentist Aetna
When enrolling in the Aetna DMO, you are required to choose a dentist for yourself and for each dependent you are enrolling. The Office of Faculty and Staff Benefits recommends the following when doing so:
- Contact the office of the dentist chosen from the DMO network
- Verify that the dentist is still a participant in the Aetn
- a DMO
- Verify that the dentist is still accepting new patients
Employee Eligibilty
You are eligible for these University sponsored dental benefits if you are:
- A staff member hired to work 30 or more hours per week, including members of the Allied International Union and the SEIU 1199;
- An academic employee working 75% time or more; or
- A fellow at the Law Center.
Dependent Eligibility
If you are covered under a dental plan, you may also elect coverage for your spouse/LDA and your eligible dependent children. You will select from one of the following levels of coverage:
- Employee only
- Employee and spouse/LDA
- Employee and child/ren
- Family (employee, spouse/LDA and child/ren)
Spouse/Legally Domiciled Adult (LDA)
For medical, dental and vision coverage only, instead of covering a spouse, you may cover another qualified adult member of your household. A qualified adult member of your household is a LDA if he/she is an individual over age 18 who has for at least 6 months lived in the same principal residence as you, remains a member of your household throughout the coverage period, and who:
-EITHER has a close personal relationship with you (not a casual roommate or tenant), shares basic living expenses and is financially interdependent with you, is neither legally married to anyone else nor legally related to you by blood in any way that would prohibit marriage, and is neither receiving benefits from an employer nor eligible for any group coverage.
-OR your blood relative who meets the definition of your tax dependent as defined by Section 152 of the Internal Revenue Code during the coverage period and is neither receiving benefits from an employer nor eligible for any other group coverage.
In no event may you have medical coverage for both a spouse and a LDA.
There may be tax and other legal implications for those who elect coverage for a LDA. You are encouraged to consult with an attorney before electing LDA coverage.
Children
Dependent children include your natural children, legally adopted children, children for whom you are the legal guardian, stepchildren who are dependent on you for support, and children for whom you are the proposed adoptive parent from the date of placement.
Age Limitations for Dependent Children CareFirst
Your unmarried dependent children are eligible until age 19, if unmarried, or until age 30 if full-time college students through CareFirst. Children who are incapable of self-care and are age 19 or older (with proof of disability) can also be covered. If your dependent over age 19 or older is a full-time student, certification is required for continued coverage.
Age Limitations for Dependent Chidren Aetna
Your dependent children are eligible until age 19, if unmarried, or until age 30 if full-time college students through Aetna. If you choose to cover family members, a provision called "Coordination of Benefits" may apply.
Enrolling in a Dental Plan
To learn more about how to enroll, or how to make changes to your coverage, click on one of the links below:
Newly eligible employees
Open enrollment
Making changes during the year
Have Questions? Check out the Frequently Asked Questons (FAQs) section, call the Office of Faculty and Staff Benefits at 202-687-2500, or email benefitshelp@georgetown.edu.
