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Human Resources > Benefits > Plans > Dental

Dental Care Plan

Enrollment &
Claim Forms

Choice of 2 Plans
PPO & DHMO Plans

Premiums
PPO Dental Care Plan Choice of 4 Coverage Tiers Plan Information

The purpose of the Dental Care Plan is to provide dental insurance as protection from the financial burden of catastrophic dental care needs to eligible faculty and staff and their family members. Faculty and staff must complete the enrollment process no later than 31 days from the date of University employment or initial benefits eligibility. Documentation of good dental condition is not required when enrolling in the Blue Cross dental care plan at hire or initial benefits eligibility. Dependent children may be covered through age 22 regardless of student status.

First Commonwealth HMO Dental Plan. After initial eligibility, individuals may enroll in First Commonwealth by completing the online enrollment process during Open Enrollment or within 31 days from the date of a qualifying change in employment or family status.

Enrollment in First Commonwealth requires the designation of a primary care dentist. The First Commonwealth dentist provider network is accessible online at: http://www.firstcommonwealth.net .

Blue Cross PPO Dental Plan. Individuals who elect First Commonwealth when first eligible may change enrollment to the PPO plan during Open Enrollment as well as changes in employment or family statu. Benefits are higher if care is provided by a Blue Cross PPO network dentist. The Blue Cross PPO provider directory is accessible online at http://www.bcbsil.com (select the BlueCare Preferred Choice – DPPO option)

Dental coverage may be waived by completing the enrollment-waive form within 31 days of qualifying for a change in enrollment or family status.

Thank you

*Enrollment and Claim Forms

*Monthly Contributions

Plan Literature

*Summary Plan Description (PDF PDF)

Including a descriptive summary of plan purpose, eligibility requirements, enrollment procedures and deadlines, plan and coverage choices, claim processing procedures and deadlines, and options for continuing coverage after separation of employment.

*Blue Cross PPO Dental Plan Highlights (PDF PDF)

*Blue Cross Certificate of Coverage (PDF PDF)

*First Commonwealth Schedule of Member Payment Responsibilities by Type of Dental Service (PDF PDF)

*Frequently Asked Questions

*Protection of Personal Health Information

 

Other Links

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