The Metropolitan Water Reclamation District Retirement Fund has arranged for a Dental and Vision insurance plan for Retirees, Surviving Spouses and their eligible dependents.

This benefit provides coverage for you and your eligible dependents for Preventative, Basic, and Major dental services such as exams, cleanings, x-rays, fillings, crowns, root canals, etc. In addition, you can select a Vision Benefit program through the Vision Service Plan (VSP) Choice Network.

These programs are only available to MWRDRF Retirees, Surviving Spouses and their eligible dependents.

These programs have been arranged through MWRDRF as part of its continuing efforts to provide members access to additional benefits. They will be administered by Group Benefit Associates and Guardian, not MWRD or the MWRD Retirement Fund.

Eligibility

In order to participate, the individual must be a retiree of MWRD, a Surviving Spouse, or an eligible dependent.

Eligible Dependents:

• Your legal spouse
• Qualified Domestic Partners
• Your Qualified Domestic Partner’s children
• Your dependent children until age 26/30*
• Legally adopted children
• Step-children who depend on you for most of their support and maintenance

*Coverage for unmarried dependents is extended to age 30 for Illinois residents with prior military service receiving an honorable discharge.

The Dental Benefit

This plans offered by Group Benefit Associates and insured by Guardian gives members the opportunity to choose either a Dental PPO Plan or a Dental DHMO Plan. Both plans offer great coverage and the flexibility allows you to select the plan that best fits your specific needs and budget. The Dental DHMO Plan is offered in California, Colorado, Florida, Illinois, Indiana, Michigan, Missouri, New Jersey, New York, and Ohio. The Dental PPO Plan is offered in all 50 states.

The Dental PPO Plan Option

The Dental PPO plan allows you to visit any dentist or specialist you choose any time care is needed. If you elect to visit a Guardian network provider, you will receive the highest level of benefits and save on out-of-pocket costs. Best of all, the Guardian Dental PPO Plan features one of the industry’s most extensive nationwide dental networks with over 77,000 provider locations.

• Cost Effective: Guardian network dentist negotiated fee discounts up to 30% less than the average charges in the same community.
• High Satisfaction: 97% satisfaction rate among members who have seen a dentist.
• Maximum Rollover: Guardian’s innovative plan feature which allows you to roll over unused dental premium for use in the future.

The plan pays a specific amount for each dental service based upon an established fee schedule. If you go to a Guardian Dental PPO provider, the benefits described below apply. Out-of-network benefits are limited to the PPO fee schedule.

The Dental DHMO Plan Option

With the DHMO plan, you enjoy negotiated discounts from our network dentists. You pay a fixed copay for each covered service. Out-of-network visits are not covered.

 

DHMO & PPO Plan Comparison

	DHMO	PPO
Dental Network	First Commonwealth	Dental Guard Preferred
Calendar Year Deductible (waived for Preventive services)	No Deductible	$50
Annual Maximum Benefit	Unlimited	$1,000
Preventive Services Exams, Cleanings, X-Rays, Fluoride Treatments, Sealants	$0	100% of fee schedule
Basic Services Fillings, Perio Surgery, Periodontal Maintenance, Root Canal, Simple Extractions	Copay*	80% of fee schedule
Major Services New Bridges & Dentures, Dental Implants, Inlays, Crown, Bridges, Denture Repair & Maintenance, Surgical Extractions	Copay*	50% of fee schedule
Orthodontia	Copay*	not covered
Cosmetic Bleaching	$165	not covered
Office Visit Copay	$5	none
Dependent Age Limits (Non-Veteran/Veteran)	26/30**	26/30**
PRE-DETERMINATION: When a course of treatment is expected to cost $300 or more and is of a non-emergency nature, it is recommended to have your dentist submit a treatment plan before he/she begins.

This is intended only as a brief summary of benefits and is only a partial list of services. It is not an official statement of those benefits. Please See Plan Details Tab for more information.

*DHMO Copayment Schedules are available on the “Plan Details” section of our web site.

**Coverage for unmarried dependents is extended to age 30 for Illinois residents with prior military service receiving an honorable discharge.

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The Vision Benefit

Eye care is a vital component of a healthy lifestyle. With Vision Insurance, having regular exams and purchasing contacts or glasses is simple and affordable.

The VSP Choice Network

This option allows you to visit any doctor, but save by visiting any of the 50,000+ locations in the nations largest vision network.

Vision Plan	Full Feature
Vision Network	VSP Choice
Exam Copay	$10
Materials Copay (Waived for non-formulary elective contact lenses)	$25
Eye Exams (in network / out of network)	$0/Amt over $39
Single Vision Lenses (in network / out of network)	$0/Amt over $23
Lined Bifocal Lenses (in network / out of network)	$0/Amt over $37
Lined Trifocal Lenses (in network / out of network)	$0/Amt over $49
Lenticular Lenses (in network / out of network)	$0/Amt over $64
Frames (in network / out of network)	80% of Amt over $130 / Amt over $46
Contact Lenses (sample) (in network / out of network)*	Amt over $130 / Amt over $100
Glasses (in network / out of network)	20% off retail / no discount
Frequency: Exams	Every Year
Frequency: Lenses	Every Year
Frequency: Frames	Every 2 Years
Dependent Age Limits (Non-Veteran/Veteran)	26/30**

*This is intended only as a brief summary of benefits and is only a partial list of services. It is not an official statement of those benefits. Please See Plan Details Tab for more information.

**Coverage for unmarried dependents is extended to age 30 for Illinois residents with prior military service receiving an honorable discharge.

You have the option to choose a Dental Plan and/or a Vision Plan. All monthly premiums are collected on the 15th of the month prior to the month in which the premium is due.

2021 Monthly Premiums
Dental Plan Choices
	Member Only	Member + Spouse	Member + Child(ren)	Family
PPO Dental Plan	$50.97	$98.19	$90.10	$143.06
DHMO Dental Plan	$24.46	$43.82	$55.35	$80.80
Vision Plan
	Member Only	Member + Spouse	Member + Child(ren)	Family
VSP Choice Network	$17.00	$27.22	$27.72	$42.68

 

The Dental DHMO Plan is only available in California, Colorado, Florida, Illinois, Indiana, Michigan, Missouri, New Jersey, New York, and Ohio. Purchase coverage in the state where you receive your dental care.

Cancellation Requests: Cancellation requests must be received in writing by mail, fax, or e-mail. Cancellations will become effective on the last day of the month in which they are received.

Premium Payments: Your initial premium due will be collected within 5 business days of your enrollment. Subsequent premiums will be collected automatically from a Visa, MasterCard, or direct debit from a checking account on the 15th of each month. If the 15th falls on a weekend or holiday, the charge will occur on the next business day.

Forms & Documents

The following documents below are provided for your reference:

Enrollment Form

Dental Summary

Vision Summary

Maximum Rollover Summary

DHMO Fee Schedule

PPO Dental Claim Form

VSP Network – Vision Claim Form

 

Frequently asked questions:

Q: How can I cancel my policy?

A: GBA must receive your cancellation request by email, fax or mail. We do not accept cancellations by telephone.

 

Q: I have the DHMO Plan and I would like to change my provider.

A: Please call Guardian at 800-541-7846 to change your DHMO provider.

 

Q: I would like to add a dependent to my plan.

A: You may add eligible dependents to your plan during open nenrollment. Open enrollment is held annually on 10/15 – 11/15. Coverage begins January 1.

 

Q: I would like to remove a dependent from my plan.

A: GBA must receive your removal request by email, fax or mail. We do not accept these types of changes by telephone.

 

Q: I would like to change my plan options. (Example: changing from the PPO Plan to the DHMO Plan, adding the Vision Plan, changing from the DHMO Plan to the PPO Plan).

A: You may change plans during open enrollment. Open enrollment is held annually on 10/15 – 11/15. Coverage begins January 1.

Click below to enroll online

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