Dental and Vision Plan Enrollment Guidelines

• To enroll dependents in the dental and/or vision plan(s), you must also enroll.
• You may select different levels of coverage for the dental, vision and medical plans.

The effective date of coverage is the first of the month following receipt of your form and required documentation for dependents. You may only terminate dental or vision plan coverage when one of the following occurs:

• The end of the plan year.
• Termination of employment.
• Retirement.
• Termination of medical coverage.

If you are a State employee married to another State employee, each of you must enroll in the dental and/or vision plan(s) under your own Social Security number.

Retirees: Take note:

• You and your dependents must be enrolled in the medical plan to enroll in the dental plan.
• If you are not currently enrolled in the dental plan, you cannot elect coverage for yourself or your dependent(s) during Open Enrollment.
• Your covered dependents may participate in the dental plan as long as you are also enrolled in dental.
  

Dental Appeals

Appeals

Delta Dental of Missouri (DDMO) has established a first-level and second-level review process for written complaints. A first-level review, whether related to an adverse benefit determination or for reasons other than an adverse benefit determination, must be submitted in writing to DDMO’s Customer Service Department. You have 180 days to submit your written complaint after receiving the denial or the notice that gave rise to the complaint. DDMO shall allow 180 days from the date allowed to file the first level complaint or 180 days from the date DDMO sent notification to the person who submitted the complaint of DDMO’s resolution of said first level complaint, whichever is later. Any complaint should be accompanied by documents or records in support of the complaint. You may review pertinent documents relating to the claim and submit issues and comments in writing for consideration.

DDMO will acknowledge receipt in writing within ten working days and will investigate the complaint within twenty working days after receipt of a complaint. If additional time is needed to complete the investigation, DDMO will notify you in writing on or before the twentieth working day with the investigation completed within thirty working days thereafter. DDMO will notify you in writing of the decision within five working days following the investigation. You have the right to request a second-level review, in which case, DDMO shall follow the same time frames as a first-level review except in the case of a request for an expedited review where life or health of an enrollee may be in jeopardy. Any first-level complaint should be sent to:

Delta Dental of Missouri
Customer Service Department
12399 Gravois Rd
St. Louis, MO 63127-1702

Second-level appeals should be sent to:

Delta Dental of Missouri
Appeals Committee
12399 Gravois Rd
St. Louis, MO 63127-1702

You have the right to file an appeal with the Director of the Missouri Department of Insurance, Financial Institutions & Professional Registration (DIFP) at any time. For detailed information on filing an appeal with the Missouri Department of Insurance, Financial Institutions & Professional Registration (DIFP) contact:

Missouri Department of Insurance, Financial Institutions & Professional Registration
Attn: Consumer Affairs
PO Box 690
Jefferson City, MO 65102

Or call: 800.726.7390.