19 Del. Admin. Code § 2001-10.0 - Dental and Vision Plans
10.1 Any rules related to the dental and vision plans not contained herein are subject to the applicable guidelines within Section 1.0 through subsection 9.2 of this regulation.
10.2 Employees or pensioners choosing to pay for and receive coverage under one of the Dental or Vision Plans should be aware of the following terms:
10.2.1 Dental and Vision Plans are not affected by the provisions of 29 Del.C. §
5202(d). Employees and Pensioners are required to pay the full premium;
10.2.2 Employees may enroll in a Dental or Vision plan on the first of the month following the date of hire;
10.2.3 The Dental and Vision Plans' effective date is always the first of the month following the date of hire and not on date of hire ( even if the date of hire is the first day of the month);
10.2.4 Dental and Vision Plans' refund rules are limited to 60 days or less because the Dental and Vision Plans are fully insured provided that no claims were paid during the period of the refund requested. Refunds are not made if notification is not provided within 60 days of the qualifying event;
10.2.5 Dental and Vision Plans' term dates are limited to 60 days or less from the date of the notification by the employee;
10.2.6 Dental or Vision Plan or both will be terminated in the event that employee is 30 days delinquent in payment of Dental or Vision Plans' premium and any paid claims in the same period may be reversed;
10.2.7 If an employee is terminated from employment and does not pay the Dental or Vision Plans' premium for the second half of the month in which terminated, coverage under the Dental or Vision Plans will be terminated as of the first of the month, any claims paid for that month may be reversed and a refund may be given, if employee makes request for refund within 60 days of the termination date;
10.2.8 School district, charter and higher education employees (except those of Delaware Technical Community College) who are offered school district or employer dental and vision coverage are not eligible for coverage under the State Dental or Vision Plans;
10.2.9 The employee or pensioner's selection of a Dental or Vision plan is binding for the plan year and the employee or pensioner may not change such coverage until the next open enrollment period unless the employee meets the requirements of subsections 3.7 through 3.9 of this regulation.
10.2.10 An employee on approved leave of absence without pay may waive participation in the Dental or Vision Plan. Employee must notify their Benefit Representative or Human Resources Office of request as their waive of coverage must be designated in the appropriate enrollment System and notification made to the dental or vision plan. When employee returns to work and upon submission of a signed enrollment form, participation will be reinstated in the appropriate enrollment system to be effective as of the date of the employee's return to work.
10.2.11 An employee on approved leave of absence without pay may continue to participate in the Dental or Vision Plan by making full payment of premium by the first of each month or coverage will be terminated. Employee must make payment to Benefit Representative or Human Resources Office for further processing.
Notes
15 DE Reg. 225 (08/01/11)
15 DE Reg. 1071 (01/01/12)
16 DE Reg. 1003 (03/01/13)
16 DE Reg. 1090 (04/01/13)
18 DE Reg.
24 DE Reg.
18 DE Reg.
24 DE Reg.
27 DE Reg.
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