Retired Member Dental Benefit
Retired Healthplex Comprehensive
(Dentcare Delivery Systems)
Forms
Retired Healthplex Co-Payment Listing (.pdf, 640kbChange Dentist Form (.pdf, 112b)
Comprehensive Enrollment Form (.pdf, 135b)
Comprehensive Disenrollment Form (.pdf, 71kb)
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www.adobe.com/products/acrobat/readstep2.htmlOutline of Plan
The Healthplex Comprehensive Plan is a preventative dental program with most services provided with minimal co-payments for prosthetics and anesthesia. The member chooses a conveniently located private dental office from a listing of participating providers. This is the only provider that the member and dependents can visit and any specialty work the primary dentist cannot perform will be referred out a participating specialist. There is no reimbursement for work not performed by the primary dentist.
Changing Dental Offices
To change dental offices, the member is required to fill out a change of dentist form. This form must be completed and received by the SOC by the 12th of the month for a change in coverage the 1st of the following month.
Enrolling/Disenrolling from Healthplex Comprehensive
To enroll or disenroll from Healthplex Comprehensive, the member is required to fill out the corresponding enrollment/disenrollment forms linked above. If a member enrolls or disenrolls from Healthplex Comprehensive, he/she is required to do so for a minimum of one year. If the member is enrolled in Dentall or Compudent/American Dental, he/she must disenroll from the previous plan to enroll in Healthplex Comprehensive.