DENTAL INSURANCE FOR COUNTY EMPLOYEES - HEALTHPLEX
Q: Who is eligible for dental coverage through Nassau County Healthplex plan?
A: Active employees and their eligible dependents are eligible for coverage through Nassau County Healthplex plan. Employees and their dependents can continue coverage through COBRA upon loss of active coverage (see COBRA above)
Q: What is the Healthplex reimbursement dental care option?
A: Healthplex reimbursement allows you and your eligible dependents to use the services of any dentist you wish. However, enrollees in this plan have the opportunity to reduce their out-of-pocket expenses by using one of Healthplex Preferred Providers Organizations (PPO). Please consult your dental brochure for details.
Q: Are there any eligibility requirements for my dependents?
A: Eligibility requirements for your dependents are; lawful spouse, domestic partner and unmarried children up to age 26. As of January 1, 2017 student status verification is no longer required. If your dependent becomes ineligible and dental benefits are terminated, the end of coverage is the last day of the month in which the event occurs. These individuals are entitled to enroll in dental coverage through COBRA. Please read under subtitle COBRA for details.
Q: How do I get reimbursed from Healthplex for these services?
A: You must submit a dental claim form to Healthplex. Dental reimbursement claim forms may be obtained from your department's Human Resources Representative or can be downloaded from the Healthplex website.
Q: What is the comprehensive dental care option?
A: Comprehensive dental care allows you to select a dentist from a panel of dentists. The dentist provides all necessary care. See dental brochure for details.
Q: Will the dentist charge a fee if I select the comprehensive option?
A: For many dental services, such as x-rays, fillings, or prophylaxis, there is no fee. For other dental services, there may be a pre-determined charge that the enrollee is required to pay. Please consult with your dentist and review your dental brochure before having service to avoid unexpected fees.
Q: How can I change my dentist?
A: If you have chosen comprehensive coverage, you can change your dentist at any time during the year by calling Healthplex directly at 1(800) 468-0600; or going online.
Q: I continued my dental coverage through COBRA; why would Healthplex show my status as terminated by Nassau County, and I am not allowed to see the dentist?
A: COBRA dental is a month to month program. If your payment is not made timely, your account will become delinquent. Dental COBRA automatically ends if a payment is not posted to your account before the 1st of the month in which you are seeking service. Therefore, late payments and gaps in payment will cause your account to be terminated and you will not be allowed to see the dentist until your account is current. All payments thereafter should be sent to the Comptroller's Office by the 10th day of the month prior to the month for which you would like to receive coverage (i.e. send payment by April 10th for May coverage).
Q: Are there any payment options to ensure timely payments?
A: As of March 2013 there has been a change in the COBRA Dental and Optical payment schedule implemented. You may make opt to have monthly pre-authorized deductions, ACH program, directly from your checking account or you may opt to make four quarterly check payments. To view to the payment schedule and/or agreement form for ACH, please refer to the Health Benefits website. ACH payments are deducted on or about the 10th of the month prior to the month of coverage.
Q: Is it possible to switch from the comprehensive coverage to the reimbursement dental plan and vice-versa?
A: Yes, it is possible to change from one plan to another but only during the Open Enrollment Period. An Option Change Enrollment Form must be obtained from, completed, and returned to your department's Human Resources Representative. The change will be effective as of January 1 of the coming year.