Dental Benefits Policy
Section Name: Employee Relations Effective Date: October 5, 2009
Section Number: 400 Date of Revision:
Policy Number: 011
Page: 1 of 2
Subject: Dental Care Benefits
1. Purpose: The purpose of this policy is to designate the dental care benefits that will be
made available for all regular full-time non-union employees and appointed officials of
the City of Monroe.
2. Statement of Policy:
2.1 The City shall provide regular, full-time employees (and their eligible
dependents 1) the dental care benefits, subject to such terms, conditions,
exclusions, limitations, deductibles, co-payments and other provisions of the
plan.
Coverage shall commence on the 91st calendar day of continuous employment.
Plan benefits include the following:
Covered Services Plan Pays Employee Pays
Class I Benefits
Diagnostic and Preventive Services 100% 0%
(includes exams, cleanings, fluoride,
and space maintainers)
Emergency Palliative Treatment 100% 0%
(temporarily relieve pain)
Radiographs - X-rays 100% 0%
Class II Benefits
Oral Surgery Services 50% 50%
Endodontic Services 50% 50%
Periodontic Services 50% 50%
1 Eligible participants include the employee, legal spouse, and unmarried dependent children to the end of the calendar year in which they turn 19.
Dependents who are between age 19 and age 25 may continue coverage under the Plan until the end of the year in which they turn 25, if they
meet the requirements as defined and provided for in the respective plan documents.
2
Relines and Repairs 50% 50%
Minor Restorative Services 50% 50%
Major Restorative Services 50% 50%
Class III Benefits
Prosthodontic Services 50% 50%
Class IV Benefits
Orthodontic Services (to age 19) 50% 50%
Maximum Payment - $800 per person total per benefit year on Class I, Class II
and Class III Benefits. Class IV Benefits will not exceed a lifetime maximum of
$1,500 per eligible person.
Subject to insurance carrier underwriting requirements and approval, and except
as otherwise provided in other leaves of absences, and Policy No. 003, Family
and Medical Leave, when on an authorized unpaid leave of absence the employee
will be permitted to continue his/her participation in the City's dental plan for the
period he/she is not on the active payroll.
Employees electing to continue such coverage shall pay the full cost of such
continued coverage. Upon return from a leave of absence, an employee’s dental
care coverage shall be reinstated commencing with the employee’s return.
Except as otherwise expressly provided in the City's Policies, an employee’s
dental care benefits shall terminate at the end of the month in which the employee
goes on a leave of absence, terminates, retires, or is laid off. An employee who is
on layoff or who terminates may elect to continue the dental care coverage herein
provided at his/her own expense as provided under COBRA.
3. Definitions: None
4. Application: This policy shall apply to all non-union employees of the City, unless
modified by an employment agreement and/or the written terms of appointment.
5. Responsibility: The Human Resources Director shall have the responsibility of
implementing and overseeing this policy.
6. Administrative Procedure: None
7. Legislative History of Authority for Creation or Revision:
Adopted pursuant to action of the Monroe City Council, dated October 5, 2009.
3
Revised pursuant to action of the Monroe City Council, dated _______________.