New Jersey Division of Pensions and Benefits
RETIREE DENTAL EXPENSE PLAN
Frequently Asked Questions
(Updated April 2009)
- Who is eligible for the Retiree Dental Expense Plan?
A - Any retiree eligible to enroll in a medical plan in the Retired
Group of the State Health Benefits Program (SHBP) or School Employees' Health Benefits Program (SEHBP) is eligible
to participate in the Retiree Dental Expense Plan.
- Do I have to live in New Jersey to join the Plan?
A - No, eligible retirees may participate in the Retiree Dental
Expense Plan regardless of where they live.
- When can I enroll?
A - New
retirees must enroll in the Retiree Dental Expense Plan
when they become eligible for SHBP/SEHBP
Retired Group health plan coverage (usually at the time of
retirement, unless enrollment is waived for other employer group dental coverage).
Retiree Dental Expense Plan began operation on January 1,
with an initial enrollment period held between October
1, 2004 and March 31, 2005.
If a retiree was
but did not enroll
at that time, he or she cannot now join the plan (unless they waived enrollment because of other dental
coverage through another public employer).
- I'm still working. Will I be eligible to join the Retiree
Dental Expense Plan when I retire?
A - When you become eligible for SHBP/SEHBP Retired Group enrollment,
you will be eligible to join the Retiree Dental Expense Plan.
If you will not be eligible for SHBP or SEHBP coverage in retirement,
you will not be able to join the Retiree
Dental Expense Plan.
- I am currently covered under my spouse's dental plan at his/her
place of work (or through my other employment). Do I have to
enroll in the Retiree Dental Expense Plan now or can I wait
until my coverage under my spouse's (or my own) group dental
A - You are permitted at the time you
first become eligible for SHBP/SEHBP Retired Group coverage to waive
your Retiree Dental Expense Plan enrollment provided that you have other dental coverage through an employer group plan as either a
dependent of a spouse/eligible partner
or through other employment of your own.
your other group dental coverage
ends, you must request enrollment within 60 days from the
loss of the other coverage by contacting the Division of Pensions
and Benefits to request enrollment in the Retiree Dental Expense
Plan. Proof of the other group dental plan termination must
be submitted in the form of a HIPPA Certification of Coverage document or a letter from the employer or dental administrator
along with the Retired Change of Status Application.
Note: If you are a police or fire retiree covered by the provisions
of Chapter 330, P.L. 1997 and are not eligible for SHBP or SHBP enrollment
until you terminate any other post-retirement employment health
coverage, you will be able to enroll in the Retiree Dental
Expense Plan when you qualify for SHBP or SEHBP medical plan coverage.
- If I retire, should I continue my dental coverage from my
former employer through COBRA* or should I enroll in the Retiree
Dental Expense Plan?
A - When you retire you must make a decision whether to
enroll in the Retiree Dental Expense Plan or to continue SHBP
or SEHBP dental coverage under the provisions of COBRA.* However, retirees
need to be aware that they cannot waive Retiree Dental Expense Plan enrollment because of COBRA coverage.
Therefore, if you elect to continue with dental coverage through
COBRA, once your COBRA eligibility period ends you will
not be given any other opportunity to enroll in the Retiree
Dental Expense Plan.
Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).
- What does the Retiree Dental Expense
A - The Retiree
Dental Expense Plan covers diagnostic
and preventive dental services such as examinations,
X-rays, cleanings, and topical fluoride application for children
under the age of 19; basic services such as palliative
emergency treatment, space maintainers, simple extractions,
surgical extractions, oral surgery, anesthesia services, basic
restorations (amalgam and resin-based composite), endodontics
(treatment of diseases of the dental pulp including root canal
and associated services), and repairs to removable and fixed
dentures; and major restorative services such as inlays,
onlays, crowns, periodontal services, and prosthodontics.
- Why does the Retiree Dental Expense Plan not cover orthodontia
A - The Retiree
Dental Expense Plan was designed for retirees. Orthodontia services are not normally
needed by the vast majority of retirees so they were not included
to keep costs as low as possible.
9. Q - How much will the Retiree Dental Expense Plan pay towards
my dental care?
A - The Retiree Dental Expense Plan has a $50 per person deductible,
maximum of $150 per family, which must be met before reimbursements
are made. The deductible is waived for preventive services.
Dental Expense Plan reimburses covered services provided by any licensed dental
provider at a percentage of reasonable and customary fees at
differing levels of reimbursement, depending on the length of
time you have had dental coverage. The maximum possible benefit
in any calendar year is $1,500 per person. The Retiree
Dental Expense Plan has a network of dentists who have agreed to accept a discounted
fee for services. If you choose to use a network provider,
the fee for the service will probably be lower than that charged
by an out-of-network dentist, so your costs will be lower.
- I understand that there are three progressive benefit tiers
of coverage in the Retiree Dental Expense Plan. What benefit
tier of coverage will I get when I enroll?
A - If you were covered by a group dental plan for a minimum of
12 months within 60 days of your enrollment in the Retiree Dental
Expense Plan, you will be placed in Tier 3, the highest benefit
tier. If you were not covered by a group dental plan for a minimum
of 12 months within 60 days of your enrollment in the Retiree
Dental Expense Plan, you will be placed in Tier 1, the lowest
benefit tier. After a year in the Plan, you will be placed in
Tier 2, and after another year, to Tier 3.
- Why are there three benefit tiers of coverage in the Retiree
Dental Expense Plan?
A - The three tiers are designed to protect the Retiree
Dental Expense Plan, and the participants
who must pay for the entire cost of coverage, from the effects
of what is termed "adverse selection". An individual who has
not been receiving regular dental treatment is likely to need
more services and generate more dental costs than someone who
has been receiving regular dental treatment. This would cause
rates to rise. The creation of the three benefit tiers lessens
the impact of this adverse selection.
- Will the Retiree Dental Expense Plan coordinate coverage with
another dental plan?
- There is no coordination
of benefits under the SHBP or SEHBP between any two Dental Plans because no member
is eligible for coverage in more than one Dental Plan.
An individual enrolled in the Retiree Dental Expense Plan may
be covered through the SHBP or SEHBP as a retiree or as a dependent (of
another retiree or of an employee) but not as both a retiree
and a dependent. Dependent children may only be covered through
the Dental Plans by one parent.
you are covered by another (non-SHBP or non-SEHBP) group dental plan through
a former employer or through other active employment of your
own or that of a spouse or domestic partner, the Retiree Dental
Expense Plan would be the secondary plan.
- I understand that if my dentist participates in the Plan Network
that I will get a discount on my service. How can I find a dentist
that participates in the Plan Network?
A - You can access a list of participating providers on Aetna's
Web site (www.aetna.com/docfind)
or contact Aetna Dental at 1-877-238-6200 (select the Aetna
- Who can I cover as a dependent under my coverage?
A - The dependent eligibility rules for the Retiree Dental Expense
Plan are the same as those for any plan in the SHBP or SEHBP. You may
enroll your spouse, civil union partner, or an eligible same-sex domestic partner*
and any of your children who are under age 26. The definition
of children includes step-children, adopted children, foster
children, legal wards, and children of your eligible
partner, if applicable.
you have a child who is disabled and is therefore unable to
support himself or herself, that child may be continued on
your coverage (medical and dental) beyond the age of 26 with
the approval of the SHBP. You must file a Continuance for
Dependent with Disabilities form before January 31st of the year following the year in which the dependent turned
26 to apply for the extension.
Please note that duplicate coverage within the Retiree
Dental Expense Plan is not permitted; an individual may
be covered as a retiree or as a dependent but not as both a retiree and a dependent. Dependent children may be
covered by only one parent.
*Only retirees of the State — and of Local Government/Education employers who have adopted
the health benefits provisions of the Domestic Partnership
Act through resolution — can cover a same-sex domestic partner.
A Certificate of Domestic Partnership must accompany your
enrollment application if not previously submitted to the
Health Benefits Bureau for other benefit coverage.
See Fact Sheet #71, Benefits Under
the Domestic Partnership Act Adobe PDF (56K).
15. Q - Can I cover my opposite-sex domestic partner under
the Retiree Dental Expense Plan?
A - No. Opposite sex coverage is only available to a spouse through marriage. Under the provisions of the Domestic Partnership Act, opposite
sex domestic partners are not eligible for SHBP or SEHBP coverage.
For more information, see Fact Sheet #71, Benefits Under
the Domestic Partnership Act Adobe PDF (56K).
- If I die or I terminate my Retiree Dental Expense Plan coverage,
can my dependents continue the coverage?
- If you die, a covered surviving
spouse, civil union partner, or eligible same-sex domestic partner would be eligible
to continue the Retiree Dental Expense Plan coverage at their
own expense - and may cover any eligible dependents.
you terminate coverage or a dependent turns age 26
(unless the dependent child qualifies for continuance of coverage
due to disability - see Question #14) the dependent's coverage will end. There
is no provision for the continuation of coverage through
COBRA under the Retiree Dental Expense Plan.
- How much will the Retiree Dental Expense Plan cost?
A - The costs of the Retiree
Dental Expense Plan are the same for both State
and Local retirees. Current rates are available in the Division's health benefits Web site.
- How are the premium rates determined?
A - The cost of the insurance is calculated by the Actuary to
the State Health Benefits Commission. The State Health Benefits
Commission reviews and approves the rates every year.
- Who pays for the Retiree Dental Expense Plan?
A - Most retirees will pay the full cost of the insurance plan. The
State does not pay anything toward the cost of the coverage. Under
certain circumstances, a local public employer that participates
in the SHBP or SEHBP may elect to share in the cost of coverage for
their retirees through the adoption of the provisions of Chapter
- How will premium payments be made?
A - If you are receiving a monthly pension check from the Division
of Pensions and Benefits and that check is large enough to
cover the cost of your dental coverage, the monthly premiums
will be deducted from your check. If you do not receive a
pension check from the Division, or your check is not large
enough to cover the cost of the dental coverage, the Division
will bill you for your coverage each month.
- Where can I get answers to specific benefit questions about
the Retiree Dental Expense Plan coverage?
A - You can access a summary of the dental plans in Fact
Sheet #73, Retiree Dental Expense Plan Adobe PDF (38K), or call Aetna at 1-877-238-6200 (select the Aetna Member
prompt). As a member of the Retiree Dental Expense Plan,
you can register for access to Aetna Navigator on the Aetna
Web site (www.aetna.com).
Aetna Navigator is your online resource for personalized benefits
information and is available 24 hours a day, 7 days a week.
- Whom can I talk with to get answers about eligibility for
A - Contact Aetna Dental first at the number listed above (see question #21). If Aetna
cannot answer your questions, call the Division of Pensions and Benefits, Office of Client Services at (609) 292-7524
or e-mail the Division.
- Where can I get a summary of the Retiree Dental Expense Plan
A - A brief summary of the Retiree
Dental Expense Plan can be seen
Sheet #73, Retiree Dental Expense Plan Adobe PDF (38K). You can also find additional information in the Retiree
Dental Plans Member Handbook. Both publications are available on the Division of Pensions and Benefits Web site.