Dental Plan Highlights

Two coverage options are available:

• "High Plan" (Comprehensive)
• "Low Plan" (Basic)
• Enrollment is allowed only as a new hire, through qualifying events, or biannual (2yr) open enrollment
• Coverage is continuous unless actively changed

Basic Plan

• Preventative services covered at 100% (not subject to deductible)
• Basic dental services covered at 80%
• Annual maximum benefit of $1000

Comprehensive Plan

• Preventative services covered at 100% (not subject to deductible)
• Basic dental services covered at 80%
• Other basic dental services covered at 50%
• Major dental services covered at 50%
• Orthodontic services covered at 50%
• Annual maximum benefit of $1500

2-Step Enrollment

Two steps to enroll in the Delta Dental Plan of your choice:

1. Complete the Medical/Dental/Vision enrollment form

2. Complete the Salary Reduction Agreement form
- if you intend to contribute your own money to your HSA

Provider Look-Up

Find a Dentist
Or by telephone:

800-237-6060

Delta Dental Online

DeltaDentalVa.com
Website registration is required

• Track claims
• Next cleaning eligability
• View Explanations of Benefits
• In-network provider look-up
• Manage plan ID cards
• Your Cost Estimator

Health Savings Account Highlights

• The Health Savings Account is held by JP Morgan Chase
• Allows employees to set aside money on a tax-exempt basis to pay for qualifying medical, dental and vision expenses
• AUI contributes to the first three years of a new participant's HSA
• To be eligible for this three-year, stepped-down contribution you have two options:
  1. As a current employee, sign up for the current year plan year of the HSA/HDHP
  2. As a new hire, sign up for the HSA/HDHP at the time of your hire.
• Employees who choose to participate outside of these windows are not eligible for employer contributions.
• Contributions are made on a quarterly basis, beginning the first week of January.

Plan Documents and Links

Current Year Dental Premiums

Dental Plan Document
Document regulating AUI's benefit plan (excluding medical) administration. Plan definitions, eligibility, funding, COBRA and HIPAA requirements, claims and appeals are covered.

Summary Plan Description

"High Plan" (Comprehensive)

"Low Plan" (Basic)

Erollment Forms and Links

Medical/Dental/Vision enrollment form

Salary Reduction Agreement - HSA

Claim Forms

Dental Claim and Predetermination Form

HSA Documents and Links

HSA FAQ

Using Your HSA Card

Current Year Employer Contributions and IRS Limits

IRS HSA Publications

IRS Defined Qualifying Expenses

"Summary of Coverage and Benefits" document

The Patient Protection and Affordable Care Act (PPACA) requires the AUI Comprehensive Medical Insurance Plan to provide a “Summary of Coverage and Benefits” to plan participants prior to the close of annual open enrollment.

These documents were produced by Cigna HealthCare and follow specific federal guidelines. Please note that these are only summaries and do not outline the comprehensive details of your plan. For complete coverage details you should refer to the Summary Plan Description for your plan as posted on this site.

The updated current year Summary Plan Descriptions will be available online and in hard copy form upon request in the first quarter of the current year.

You have a right to receive a paper copy of the Summary of Coverage and Benefits upon request at no charge to you. If you would like to request a paper copy, or if you have any questions, please contact the benefits office.