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Download: Dental Insurance Enrollment Form (opens in a new window)
EWSD provides a self-insured dental insurance plan to eligible workers that is administered by Northeast Delta Dental. Below is a list of eligible employees:
- Teachers (0.50 FTE or greater)
- Full-time Support Staff (30+ hours/week)
- Full-time Administrators, Directors and other Non-Union Professional Staff
New hires/rehires can enroll on our plan as early as the first of the month following his/her first day of work as an eligible employee, provided a completed enrollment form is submitted prior to the effective date of coverage. There are no waiting periods for coverage. The completed enrollment form (found under forms below) and any corresponding paperwork must be received within 30 days of the date of hire or rehire. Enrollment forms received after 30 days will take effect on the next earliest open enrollment date.
Eligible employees may select single, 2-person, or family coverage. Eligible dependents include the employee's:
- Children who are under the age of 26
- Spouse’s children who are under the age of 26
- Children that do not live with the employee but the employee is responsible for their medical coverage under a court order (A copy of the court order is required)
- “Incapacitated” dependent age 26 or older (see below)
- In certain cases, a child whom the employee has assumed legal guardianship
In order for a dependent to be considered “incapacitated:, the dependent must meet the following criteria:
- They are incapable of self-support because of a physical or developmental disability, mental illness or mental retardation,
- The incapacitating disability must have begun while the dependent was still a child, and
- The dependent must be primarily dependent on the employee for support and maintenance.
In order to request coverage for an incapacitated dependent, BCBSVT requires the employee to complete a form and provide medical certification of the disability. The determination as to whether a dependent qualifies as "incapacitated" is made by BCBSVT. The status of an incapacitated dependent will be reviewed annually by BCBS.
Outline of Coverage
The benefit year for determining annual deductibles and maximum benefit amounts is the calendar year from January 1 through December 31. Below is a summary of the benefits provided under the EWSD plan:
Coverage A – Diagnostic & Preventative
$1000 per calendar year combined for Coverage A, B, and C
Coverage B – Basic
$25 per person or $75 per family
Coverage C – Major
Coverage D – Orthodontics
Lifetime maximum of $1000 per person
How to Enroll
Download and print out the Dental Insurance Enrollment form, and submit completed form to Human Resources. Note: The "Download" icon is the one with the arrow pointing to a horizontal line: If you cannot find your form, check your computer's "Downloads" folder.
Our group dentala insurance open enrollment period is November 1 - Novemver 30 each year for a January 1 effective date. During an open enrollment period, eligible employees may elect to:
- Enroll in the EWSD group insurance plans if they are not currently enrolled; or,
- Add eligible dependents who are not currently enrolled.
If you wish to take advantage of an open enrollment, please contact Human Resources to request an enrollment form. Completed enrollment forms must be returned to Human Resources for processing by November 30th. Late enrollments will not be processed until the next available open enrollment date.
If you have declined dental insurance enrollment for yourself or your dependents (including your spouse) because of other dental insurance or group dental plan coverage, you may be able to enroll yourself and your dependents in the EWSD plan if you, or you and your dependents, lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 31 days (see chart below) after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 31 to 60 days (see chart below) after the marriage, birth, adoption, or placement for adoption.
To request special enrollment please contact Sandy Emery at firstname.lastname@example.org or call (802) 857-7048 at least two weeks prior to the enrollment deadlines specified above to allow time for processing.
Type of Event
Deadline for Receipt of Enrollment/Change Form
Change Effective Date
Within 31 days following marriage
First of month following marriage/civil union
Within 32 to 60 days following marriage
First of month following date of receipt
Birth or adoption
Within 31 days following birth, adoption or placement for adoption (child is automatically covered for the first 31 days)
32nd day after the birth, adoption or placement for adoption
Birth or adoption
Within 32 to 60 days following birth, adoption or placement for adoption
First of month following receipt
Spouse Loses Coverage
Within 31 days of the loss in coverage
Date of the loss in coverage
In order to process a membership change, the employee must complete and submit an enrollment form (found under Documents below) and any additional required paperwork to Human Resources. The paperwork must be submitted at least two weeks prior to the enrollment deadlines outlined above in order to allow time for processing. Human Resources will forward the necessary paperwork to Northeast Delta Dental after processing the change on our records. Requests not received as indicated above will be processed with the next open enrollment period.
Removing an Ineligible Dependent
Employees may be responsible for the entire premium cost of the ineligible dependent’s coverage if the employee fails to complete and submit the required paperwork within the time frame indicated. Below is an outline of the timelines and requirements.
- Divorce: The spouse must be removed from the policy the first of the month following the divorce/legal separation. To do so, a completed enrollment change form (along with a copy of the separation agreement filed in court for legal separations) must be received within 60 days after the divorce. If the form is received after 60 days, the spouse will be removed the first of the month following receipt of the form. The employee must provide us with the address of the spouse so that a COBRA Notification letter can be issued.
- Child Loses Eligibility: If a participating employee’s dependent loses eligibility for coverage, the dependent must be removed from coverage effective the first of the month following the change of status. To do this, the employee must complete and submit an enrollment change form. This form must be received within 30-days of the change in status. A child is considered no longer eligible for coverage if they turn age 26.
- Death of a Dependent: A participating employee must contact Human Resources within 30 days following the death of covered participating dependent. A completed enrollment change form must be received within 60 days of the death.
Continuation Option (COBRA)
Under federal law, employees and their covered dependents have the right to continue dental coverage under the employer’s plan at their own expense for a limited period following termination of benefits under COBRA. The Dental plan benefits under COBRA are identical to those provided for employees of the district. Please see our COBRA webpage for more information.
Please refer to your collective bargaining agreement or individual employment contract for more information.
Questions? Contact Human Resources at (802) 857-7048 or write Sandy Emery at email@example.com.