Dental Plan Information

The NCMS Plan offers several Dental Plan options to best fit the needs of a practice. Plan offers include 9 tiers of coverage: Plan A, Plan B, Plan B with Orthodontia, Plan C, Plan C with Orthodontia, Plan D, Plan D with Orthodontia, Plan E, and Plan E with Orthodontia.

The NCMS Plan partners with MetLife. MetLife acts as the NCMS Plan’s provider which means leveraging MetLife’s network, systems, and tools to administer our benefits.

The NCMS Plan provides the option to elect a single plan or dual plans.

ID Cards are not issued for Dental, the member’s Social Security Number (SSN) is the member’s ID Number.

Dental Terminology

Term	Definition
Plan Administrator	Medical Mutual Insurance Company of North Carolina.
Corporation	MetLife.
Member	Employee or dependent currently enrolled in plan.
Dependents	Spouse or Domestic Partner and/or Child (biological, stepchild, adopted, foster, or under your legal guardianship) to age of 26 / Orthodontia to age 19.
Preferred Dentist Program (PDP)	Participating dentists with dental carrier.
PDP Fee Schedule	Payment agreed upon by participating dentists as full payment.
Benefits Plan Effective Date	The first day the plan becomes effective.
In-Network Benefits	Benefits provided under the plan are performed by a participating dentist
Negotiated Fees	Fees that participating dentists agreed to accept as payment in full (subject to copayments, deductibles, cost sharing and benefit maximums) - Applies to Type A, B & C services.
Out-of-Network Benefits	Benefits provider under this plan are not performed by a participating dentist. Rendered services are payable using the lowest of Reasonable & Customary charge.
Reasonable & Customary (R&C)	Benefits limited to a charge determined by locality. Based on the lowest of: 1) Dentist Actual Charge, 2) Dentist Usual Charge for similar services, or 3) Usual Charge of most Dentists in same geographic area for similar services.
Dentally Necessary	Diagnostic examination, treatment and use of dental equipment/appliances required to prevent deterioration of dental and to restore dental function.
Alternate Benefits	Two or more professionally acceptable dental treatments for a dental condition.
Pre-Existing Condition	Teeth that are/were missing prior to the enrollment/effective date of coverage.
Exclusions & Limitations	Dental expenses that are not covered under the plan.
Waiting Period	Set period of time before a member is eligible for benefits for some specific dental procedures.
Qualifying Life Event (QLE)	Situation in life that impacts or can cause a change in benefit coverage. QLE Categories: Loss of Coverage, Marriage (applies to adding dependents only, not coverage for the employee), Birth / Adoption / Placement for Adoption / Fostering of a dependent child, Death of Spouse, Court Ordered Dependent Coverage, Divorce / Legal Separation / Annulment
Pediatric Dental Essential Health Benefit	One of the core set of services defined by federal law that are covered with no annual or lifetime dollar limits applied for services: 10) Pediatric Services (includes oral and vision care).

NCMS Eligibility Requirements

EMPLOYER CONTRIBUTION

Employer must contribute 25% or more of employee cost.

GROUP CONTRIBUTION

75% of eligible employees must enroll.

EMPLOYEE PROBATIONARY PERIOD

Group elects.

0 days = coverage effective on first day of employment
30-Days = coverage effective 1st of month following completion of 30-days of employment
60-Days = coverage effective 1st of month following completion of 60-days of employment
90-Days = coverage effective on date following 90-days of employment

EMPLOYEE COVERAGE TERMINATION

Group elects.

FULL TIME EMPLOYEE REQUIREMENTS

Group elects.

RETIREE COVERAGE

Group elects if employer offers Retiree Coverage and maintains participation in the NCMS Plan.

ENROLLMENT PROVISIONS

Q: When to provide enrollment information and forms to eligible new hires?
A: Within the first week of employment.

Q: When to request forms to be returned for submission from eligible new hires?
A: Within 30-days of hire date (regardless of probationary period).

Q: When to provide enrollment information and forms to eligible existing employees?
A: When there is a Qualifying Life Event or Open Enrollment.

Q: When to request forms to be returned for submission for eligible existing employees?
A: Within 30-days of Qualifying Life Event or Open Enrollment.