There are no changes to the QCD dental plan design but rates will be slightly lower and can be found on the scan sheet.  There will not be a rate category for employee/child, just for employee/child(ren). 

To continue current QCD dental coverage, to decline dental coverage or add/drop dependents for the CFB Dental Plan, please complete the scan sheet marking the coverage that you want for 2009.  Please list all dependents to be covered by the plan.  If currently covered dependents are not listed on the scan sheet, coverage will end 12-31-08.

QCD KEY FEATURES

·         No deductibles or coverage maximums

·         No waiting periods for services

·         Orthodontics (braces) for children and adults

·         QCD members must receive services from any QCD affiliated dentist.

·         QCD members includes vision benefits through Avesis with a variety of provider choices, including but not limited to Pearle Vision Ctrs., Target Optical, Sears Optical, JCPenney Optical, and Eyemasters.  Go to www.avesis.com for a complete listing of vision providers.

HOW DOES THE PLAN WORK?

·         All dental services performed by a QCD Affiliated General Dentist or Orthodontist will be charged according to the attached QCD Member Fee Schedule.  The Fee Schedule represents significant cost savings when you access services from an affiliated dentist

·         Dental services received from a QCD Affiliated Specialty Care Dentist will be provided at a 20% discount from usual and customary fees.  All members are asked to pay the QCD Affiliated Dentist at the time services are performed.

·         Carrollton-Farmers Branch ISD members receive 100% reimbursement for Preventative Care services outlined below, including adult and child cleanings, fluoride applications, sealants and bitewing x-rays.  Claim forms are available from the Benefits Office.  It is the member’s responsibility to file the claim form with Omega Benefits for all reimbursed services. 

Preventative Code/Name                         Member’s Copayment                Reimbursement *

            1110 Cleaning/Adult                               $24.00                                      100%

            1120 Cleaning/Child                               $24.00                                      100%

            1203 Fluoride Application-Child               $5.00                                        100%

            1204 Fluoride Application-Adult               $5.00                                        100%

            1351 Sealants                                       $14.00                                       100%

            All Bitewings-Single film X-Rays 20% Discount                                         100%                                       

* Less $8.00 Asepsis Fee for infection control

QCD Schedule of Program Fees

QCD/Avesis Vision Care

Claims are submitted to:  (contact the Benefits Office for a claim form)

            QCD of America, C/O Doris Hurtado, 12222 Merit Drive, Suite 1070

            Dallas, TX  75251,800-229-0304