Dental Insurance

Plan Administrator. This Dental Plan is administered by Rhodes College, 2000 North Parkway, Memphis, TN 38112 whose Internal Revenue Service Employer Identification Number is EIN620476301. The Plan Number is 504. The Plan year is July through June. This is a full insured plan. Information regarding Plan eligibility, enrollment, cost, and the procedure for applying for benefits is contained in this section. The Certificate of Coverage includes a description of benefits under the Plan and the conditions under which these benefits are available to insured individuals.

Eligible Participants. All full-time employees have the option to purchase dental insurance coverage for themselves, their domestic partner and their dependents.

Date Eligible for Coverage. Each employee becomes eligible for dental coverage under the Plan the first day of the month following the date of employment with Rhodes.

Date Eligible for Dependent Coverage. A dependent shall become eligible for coverage on either (a) the first day that the employee becomes eligible for coverage and satisfies the definition of eligible dependent coverage or (b) the day a covered employee first acquires an eligible dependent.

Benefits Provided. There are four separate Dental Plans available.

MAC Plan In-Network

• $100 lifetime deductible per covered individual (maximum 3 per family)
• Diagnostic and preventive services covered at 100%
• Basic services covered at 80% after deductible has been met
• Major services covered at 50% after deductible has been met
• $1,000 per person maximum benefit per calendar year

MAC Plan Out-of-Network

• $100 lifetime deductible per covered individual (maximum 3 per family)
• Diagnostic and preventive services covered at 100% of the network rate after the deductible has been met
• Basic services covered at 50% after the deductible has been met
• Major services covered at 25% after the deductible has been met
• $1,000 per person maximum benefit per calendar year

PPO Plan In-Network

• $100 lifetime deductible per covered individual (maximum 3 per family)
• Diagnostic and preventive services covered at 100%
• Basic services covered at 100% after deductible has been met
• Major services covered at 60% after deductible has been met
• $2,000 per person maximum benefit per calendar year

PPO Plan Out-of-Network

• $100 lifetime deductible per covered individual (maximum 3 per family)
• Diagnostic and preventive services covered at 100% after the deductible has been met
• Basic services covered at 80% after deductible has been met
• Major services covered at 50% after deductible has been met
• $1,500 per person maximum benefit per calendar year

Plan Premiums. There is a monthly charge for dental insurance coverage that is paid through payroll deduction.

Currently the insurance company is Starmount Life Insurance Company. Request for information concerning Starmount Life Insurance Company contract terms, condition and interpretation thereof, claims thereunder, any requests for review of such claims and service of legal process may be directed in writing to: Starmount Life Insurance Company, 8485 Goodwood Blvd., P.O. Box 98100, Baton Rouge, LA 70898-9100 

The requirements for being covered under this Plan, the provision concerning termination of coverage, a description of Plan benefits (including any limitations and exclusions which may result in reduction or loss of benefits) are explained in the Certificate of Coverage.

Written notice of a claim must be sent within 30 days or as soon as reasonably possible. Typically, the In-Network Dental provider will handle all claims and administrative services for you. Should you need to file a claim from an out of network provider, you must provide the claimant’s name, the policyholder’s name (if different), and the group policy number. You may submit a claim form or an itemized receipt for services to:

Starmount Life Insurance Company
P.O. Box 80139
Baton Rouge, LA 70898-0139