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25C - AGMT GROUP INSURANCE
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25C - AGMT GROUP INSURANCE
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Last modified
2/1/2018 7:02:12 PM
Creation date
2/1/2018 7:10:52 PM
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Template:
City Clerk
Doc Type
Agenda Packet
Agency
Personnel Services
Item #
25C
Date
2/6/2018
Destruction Year
2023
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SERVICE AREA <br />SafeGuard's service area is the geographic region in the state of California where SafeGuard is authorized by <br />the California Department of Managed Health Care to provide Covered Services to Members and in which <br />SafeGuard has a panel of Selected General Dentists and Specialty Care Dentists who have agreed to provide <br />care to SafeGuard members, To enroll in the SafeGuard plan, You and Your dependents must reside, live, or <br />work in the Service Area. <br />DEPENDENT COVERAGE <br />Your Organization is responsible for determining dependent eligibility. In the absence of such a <br />determination, SafeGuard defines eligible dependents as: <br />• Your lawful Spouse or domestic partner; <br />• Your children or grandchildren up to age 28 for whom You provide care, including adopted children, <br />step -children, or other children for whom You are required to provide dental care pursuant to a court <br />or administrative order; <br />• Your children who are incapable of self-sustaining employment and support due to a developmental <br />disability or physical handicap; and <br />• Other dependents if Your Organization provides benefits for these dependents. <br />Please checkwith Your Organization if you have questions regarding your eligibility requirements. <br />WHEN COVERAGE BEGINS <br />Coverage for You and Your enrolled dependents will begin on the date determined by Your Organization. <br />Newborn children are covered the day of birth as long as You are enrolled; legally adopted children, foster <br />children and stepchildren are covered the first day of the month following placement as long as SafeGuard is <br />notified within ninety (90) days. <br />Your coverage will begin on the date determined by Your Organization. Waiting periods for eligibility, if <br />applicable, are determined by Your Organization. <br />Adopted child are covered from the earlier of the moment the child is placed in Your residence, and the child's <br />birth, if You have entered into a written agreement to adopt the child prior to its birth. Newborn children are <br />covered the first day of the month following the date of birth, and foster children and stepchildren are covered <br />the first day of the month following placement as long as Your Organization is notified within 90 days and any <br />Prepayment Fee is paid within that period. <br />Check with Your Organization if You have any questions about when Your coverage begins <br />Choice of Dentists <br />PLEASE READ THE FOLLOWING INFORMATION SO YOU WILL KNOW FROM WHOM OR WHAT <br />GROUP OF PROVIDERS DENTAL CARE MAY BE OBTAINED. <br />When enrolling for dental benefits, You and Your dependents must choose a Selected General Dental Office <br />from Our network. You and Your dependents each may select a different Selected General Dental Office. If <br />You do not select a Selected General Dental Office or the one you chose is not available, SafeGuard may do <br />so for You. Please refer to the Directory of Participating Providers for a complete listing of Selected General <br />Dental Offices. You may obtain a Directory of Participating Providers from Our website www.metlife.com\ <br />mybenefits or by calling (800) 880-1800. <br />Facilities <br />You may obtain a list of SafeGuard's Selected General Dental Offices and their hours of availability by calling <br />SafeGuard at (800) 880-1800. A list of SafeGuard's participating General Dental Offices can be found it is <br />Directory of Participating Providers or online at www.metlife.com\mybenefits. <br />GCERT2011-DHMO-EOC 25C-21 <br />
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