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Q: Are Identification cards issued to members?
A: Yes, the employer is supplied two Identification cards for each member. ID cards are accompanied by Certificates of Insurance and Member Welcome Letters providing customer service contact information.
Q: When can employees enroll in the GemStar Plan?
A: Employees can enroll in the GemStar plan during the annual open enrollment period or at any time during the year as a result of a qualifying event (marriage, divorce, new hire, new dependent, etc.). Benefit waiting periods will apply
for dental benefits.
Q: Is a non-US citizen eligible to enroll in the dental program?
A: Yes, all we require is a US address.
Q: If someone enrolls under the dental as applicant only, can he purchase vision as a family plan?
A: No, the same coverage level will apply to both the dental and vision coverages.
Q: How is the effective date determined?
A: The effective date is the first of the month following the day in which the application is received in the Service Center office. We will allow up to five days into the requested effective month for applications to be submitted. The group/individual should NOT cancel any other coverage until they receive written acceptance of coverage from our office.
Q: Is there a waiting period if you have had another product?
A: The GemStar product brochure provides the eligibility rules for qualifying for
dental waiting period credit. Only those insureds covered under the employer's current group sponsored dental plan shall be eligible to receive
dental credit for prior time (CPT). To qualify for CPT the group must have had comparable dental coverage for at least 12 months with no interruption in coverage. If they request CPT the employer must include a copy of the most current
dental billing statement from the prior insurance carrier. Covered employees (and eligible dependents) will receive credit for the amount of time they have been covered by the previous plan. As an example, if an employee was covered under the preceding employer sponsored
dental plan for 12 months, that employee will receive 12 months credit towards the GemStar
dental plan. In this example, the insured's dental benefits would begin at the year two level.
Q: Can a new employee and/or dependent receive CPT (Credit for Prior Time) benefits with a certificate of credible coverage via HIPAA?
A: No, HIPAA regulations regarding certificate of credible coverage do not apply to dental
or vision insurance. No employees and/or dependents, either new or existing, shall be eligible for CPT (Credit for Prior Time) benefits if not covered on the original group effective date.
Q: If a new group has current dental coverage without orthodontia coverage and they request a GemStar plan with orthodontia coverage will they receive CPT (Credit for Prior Time) for the orthodontia coverage?
A: No, CPT will only be applied for coverage they had under the preceding plan. The Group brochure indicates that the coverage must be comparable dental coverage to get CPT and since the previous coverage did not have Orthodontia then the new insurance they are getting is not comparable to the existing coverage. They can apply for the plan with orthodontia but the waiting period will apply to orthodontia services.
Q: When are bills generated?
A: Bills are generated each month on or near the 10th calendar day prior to the month in which premiums are due.
Q: Is eligibility up-dates process done timely for claim purposes?
A: The claims adjudication system is updated nightly with all eligibility information. If necessary, both the billing system and claims system can be checked if an insured cannot be located.
Q: When can a new family member be added to the plan?
A: If a new dependent is acquired (birth, adoption, marriage) that dependent may be added to the plan immediately as long as the change occurs within 31 days of the qualifying event. A change form must be completed indicating the change, waiting periods will apply.
Q: How do we terminate coverage for an insured or make changes to someone's coverage?
A: For the GemStar plan, a change form is provided to the group for such instances. The requested change (termination, addition, change of coverage, etc.) is indicated on this form. Once completed, the change form should be faxed to 518-782-3093 or mailed to the enrollment office. Do NOT mail any such changes with the premium payment. Individuals requesting changes on their PrimeStar coverage should submit a written request to the billing office. Click here for a PDF of the employer change packet.
Q: Will you pay claims on services rendered in Mexico?
A: Services must be performed by a licensed dentist acting within the scope of the license. Services must be rendered by a Mexico, licensed dentist.
Q: What level of Reasonable and Customary (U&C or R&C) do you pay
dental claims? Can we get a copy of your R&C schedule of allowances?
A: Security Life adjudicates all dental claims at the 80th percentile of HIAA. Since this U&C table is updated frequently we are unable to provide a listing. You are encouraged to submit a request for pre-determination of coverage to the claims administration office prior to any services being completed if you are concerned about the level of benefit eligible for payment. This will prevent unexpected charges.
Q: Are These Plans Fully Insured?
A: Yes. The Dental and Vision Plans are fully insured by Security Life Insurance Company of America. Security Life is headquartered in Minnetonka, MN, at 10901 Red Circle Drive. Over the last
fifty years, Security Life Insurance has earned an outstanding reputation as a leader in the field of ancillary health and wellness insurance benefits, such as dental and vision plans.
Q: Can vision coverage be added to both group and personal coverage after they initially declined the vision rider?
A: The policy owner or group owner must complete a change form requesting the change. New premiums would be charged the month following the request coinciding with the onset of coverage. The benefit waiting periods for vision coverage would begin on the date in which vision coverage became effective. All current and future insureds would automatically receive vision coverage.
Q: Does the /GemStar plan coordinate with other plans?
A: Yes, we will coordinate our plans with other group insurance plans.
Q: Is the deductible cumulative?
A: Deductibles vary by service. Deductibles for Preventive services are per lifetime of insured. Deductible for Basic and Major are per calendar year per insured. However, there are maximum deductibles illustrated on the inside cover of both brochures.
GemStar Group Dental Plans reimburse for covered dental expenses based upon the Reasonable and Customary (R&C) fees for those covered expenses.
The GemStar Group Vision Plans reimburse for covered vision expenses based
upon the contracted network fee for in-network providers and based upon R&C
for non-network vision providers.
Employers who: (1) select the GemStar Dental Plan; (2) meet minimum published contribution and participation requirements; (3) have had comparable dental coverage in force for no less than 12 consecutive months immediately prior to the GemStar Dental Plan Effective Date; and (4) have had no interruption in coverage; then the employer's employees, along with the employees' insured eligible dependents, may be eligible for credit for prior time insured (CPT) under the employer's prior dental plan towards the GemStar Dental Plan dental benefit waiting periods detailed herein. As an example, if an employee was covered under the immediately preceding employer plan for 12 months, that employee will receive 12 months credit towards the GemStar plan. The employee would then begin coverage under the second Benefit Year coinsurance levels due to the 12 months credit provided.
The agent has no authority to grant CPT or to waive the waiting period provision of the Plan. The GemStar Dental Plan benefit waiting periods will apply to all individuals not insured under the employer's prior dental plan and to all individuals insured after the employer's Initial Effective Date.
DENTAL PLAN DESCRIPTIONS (click to view the plan description)
Click here for a complete PDF copy of the GemStar Group Dental
and Vision brochure. Groups of 100 or more employees must be submitted
to the Home Office for rating.
Click Here
to download our GemStar Large Group Request Form.
GemStar Group Dental Plans are underwritten by Security Life Insurance Company of America, Minnetonka, Minnesota under policy GH-1112-38070 to the
Employer's Voluntary Benefit Insurance Trust.
If you are interested in marketing GemStar Group Dental and Vision Plans (click here).
If you are interested in purchasing GemStar Group Dental and Vision Plans (click here).
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