Dental Plan
Quality Care Dental Plan (QCDP)
All members have the option to either participate in the Quality Care Dental Plan (QCHP) or they may elect not to participate in the dental plan. All members and dependents have the same dental benefits available regardless of the health plan selected. Dental plan questions should be directed to the Dental Plan Administrator, CompBenefits, at 1-800-999-1669. Also visit their website at www.compbenefits.com.
CompBenefits
Group Number 950
PO Box 4677
Chicago, IL 60680-4677
(800)-999-1669
(312) 829-1298 (TDD/TTY)
www.compbenefits.com
Members enrolled in QCDP may go to any dentist. The QCDP reimburses only those services that are listed on the Dental Schedule of Benefits Listed services are reimbursed at a pre-determined maximum scheduled amount (see the Dental Schedule of Benefits at www.benefitschoice.il.gov). Members are responsible for all charges over the scheduled amount. All members will receive a card. If you do not receive one or have lost your card, contact CompBenefits at 1-800-999-1669.
| Dental Plan |
Employee Only |
Employee + 1 Dependent |
Employee +2 or more Dependents |
Retirees, Annuitants, Survivors + 1 Dependent |
Quality Care |
$11.00 |
$17.00 |
$19.50 |
$0.00 |
Dental Benefits:
| Plan Design |
Quality Care Dental Plan |
| Premium |
Required: See above rates |
| Annual Deductible |
$125 individual plan deductible for dental services other than those listed as "preventative or diagnostic" |
| Maximum Benefit Level |
$2200 per person per plan year after plan deductible |
| Maximum Benefit Level for Child Orthodontics(under age 19) |
$1750 lifetime maximum subject to course of treatment limitations. Orthodontic benefits count toward maximum annual benefits above
Contact CompBenefits for treatment explanation |
| Claim Forms |
Required |
| Dentist Selection |
Members choice of provider |
Election Not to Participate in Dental Plan
The election not to participate in the dental plan will remain in effect the entire plan year, without exception. The annual Benefit Choice Period is the only time members may enroll or re-enroll in the dental plan if the previously elected not to participate.
Dental Schedule of Benefits
Orthodonic Schedule of Benefits
Claim Forms are available on CMS's web site:
http://www.state.il.us/cms/3_servicese_ben_choice/Forms.htm