Employee Benefits Handbook
Dental Expense Reimbursement Program
All full-time employees are automatically covered on the 31st day of employment. Those employees who wish to do so, may cover their dependents through payroll deduction. The Plan year runs from Sept. 1 through August 31.
Employees may drop/add dependent coverage during the open enrollment period in the month of September. Dependents added will require a 90-day waiting period after accounting receives the change. Dependent eligibility for the Dental Expense Reimbursement Program will be the same as outlined in the Lubbock Independent School District Employee Group Health Plan.
All procedures performed by or under the direction of a dentist licensed by the state in which the provider practices are covered without limitation. Dental prescriptions for medication are not covered by this plan. The program will not reimburse for dental services covered under any current health and/or accident plan, (i.e. services necessitated by accident).
This plan will reimburse directly to the employee at the rate of 100% of the first $100 and then 80% of the next $250, and then 50% thereafter, for a total reimbursement per covered individual of $1,000 annually. Each employee and dependent is a covered individual. Reimbursement will be based on the date of payment, not on the date of performance of the procedure.
An employee must complete a Dental Reimbursement form and submit the completed form along with a receipt, charge card receipt, or a canceled check. All receipts must be original; copies are not acceptable. Claims must be filed within 90 days of payment to be valid. Reimbursement benefits cannot be assigned to a provider. A separate claim form must be completed for each dependent.
Reimbursement for coverage on dependents will be secondary to any dental insurance plan. For dependent claims involving other insurance, an insurance payment statement must be included with the reimbursement claim. Reimbursement involving other insurance will be made using appropriate sharing percentage to the unpaid amount.
Reimbursement claims are processed as received in the Risk Management Office. Exceptions will include holidays, vacation days of staff or other unforeseen emergencies. All claims are processed for payment in a timely manner. Checks will be mailed to the campus/department unless otherwise requested. During the summer and immediately before holidays all checks are mailed to the employee's home. It is the employee's responsibility to keep their address current with the school district.
In order to continue this excellent coverage at reasonable rates in future years, it is important for each of us to work together and with members of the dentistry profession to make this program work. We ask that you only have those services performed that you would have if you did not have the reimbursement plan. Please do not unnecessarily prepay your dental bills. That places an undue burden on resources of the plan. It only shifts needed resources of the plan to the provider. Abuse, misuse, or unneeded use of the program could lead to its cancellation or make the cost prohibitive.
