Dental Insurance Marsh & McLennan EMPLOYEE BENEFITS

Orthodontic Claim Procedure

Orthodontic treatment is a continuing procedure and will only be reimbursed on a monthly basis. Reimbursement cannot be made in full for a procedure which is not complete. Reimbursement will be determined by the length of time a participant is scheduled to be in treatment. The normal reimbursement formula will then be calculated by dividing the total cost by the number of treatment months.

Limitations

In the event an employee or dependent is covered under an insured dental plan, Littlefield ISD Dental Benefit Plan will make reimbursement for the charges not paid by the insurance plan according to our regular reimbursement formula. The insurance company explanation of benefits must accompany the request for reimbursement. Dental prescriptions for medications may be filed under the medical plan. Repair to natural teeth due to an accident may be filed under the medical plan.

Summary

While it is not anticipated that Littlefield ISD will change any provisions in the Plan, the District reserves the right to amend the Plan or terminate the Plan at any time by giving 30 days prior notice to all participants. In the event of any dispute arising over the payment, lack of payment, or any other conflict that may arise, the District will control the manner in which the dispute is settled.

Effective: September 1st

Eligible Dental Expenses

• Type A Expenses (Preventive or Diagnostic)

• Type B Expenses (Basic Restorative and Surgical)

• Type C Expenses (Major or Prosthodontic Procedures), and/or

• Type D (Orthodontic)

Maximum Calendar Year Reimbursement (all expenses) per Individual $1,000

Employees will be reimbursed 80% of the first $250 of covered expenses

Employees will be reimbursed 50% of the next $1,600 of covered expenses

• Requests for reimbursement must be made within sixty (60) days from the time the dentist is paid.

• Orthodontic treatment will be reimbursed on a monthly basis.

• Reimbursement will only be made for a completed treatment or procedure.