You must enroll online (see page 8 in the Yellow Book for instructions) by November 15, 2022. Your effective date is on the first day of the month following two (2) full calendar months of employment. If you enroll dependents you must prove eligibility. Dependent Eligibility forms are found on the Enrollment site https://jmsmith.bcenroll.net > Posted Forms.
NOTE: If you do not enroll in Dental Benefits when first 'eligible', waiting periods for dental benefits apply.
|Annual Deductible||$50 per person|
|Non-orthodontic care||$1,500 (per calendar year)|
|Orthodontic care||$1,500 (lifetime maximum)|
|Oral exams (2 exams per 12 months)||Plan pays 100% of the allowable charges, you pay 0% Waiting Period for Benefits to begin: None|
|Cleanings (2 exams per 12 months)||Waiting Period for Benefits to begin: None|
|Bitewing x-rays (2 every 12 months)|
|Full set of x-rays (every 36 months)|
|Space maintainers for dependent children under the age of 16.|
|Fluoride treatments for dependent children under the age of 18. (2 each calendar year)|
|Sealants for dependent children under the age of 18 once per tooth in any 36 months.|
|Fillings, other than gold.||Plan pays 80% of the allowable charges, you pay 20% (Subject to the deductible if not already met).|
|Periodontics||Waiting Period for benefits to begin: Late Entrants Only - The first 6 months of the covered person's coverage.|
|Crowns,Dentures & Bridgework||Plan pays 50% of the allowable charges, you pay 50% (Subject to the deductible if not already met).|
|Repairs to crowns, bridges and dentures||Waiting Period for benefits to begin: Late Entrants Only - The first 6 months of the covered person's coverage.|
|Benefit is available for adults and children||Plan pays 50% of the allowable charges, you pay 50%|
|Waiting Period for Benefits to begin: Late Entrants Only - The 1st 24 months of the covered person's coverage.|
Note: This is a convenient brief summary. Always check your booklet certificate. The contract is the official source of information.
You may continue coverage for you and your covered dependents at your own expense under COBRA. You will be provided with information and costs upon leaving your employment with J M Smith Corporation.
Your dental benefits are administered by Delta Dental of Missouri (DDMO), a not-for-profit corporation.
You may visit the dentist of your choice and select any dentist on a treatment by treatment basis. It is important to remember your out-of-pocket costs may vary depending on your choice. You have three options:
Phone: 864.582.1216 ext. 1508
There in this form.