Kanawha GROUP Dental PLUS

Dental Enrollment Procedure

1) Employee must complete the application and payroll card, then return both items to their Health Benefits Representative or Division Office.

2) The Division Office or Health Benefit Representative must then forward the application and payroll card to the Fiscal Section at NC DOT in Raleigh.

Eligibility Requirements

· New Employee (has 30 days from date of hire to enroll)

· Qualifying Events   (some examples are loss of coverage from a spouse's coverage, marriage, birth of a child, etc. 30 days from the date of event to enroll.

· Open Enrollment Period (for current active employees)

Policy Changes

ADDITIONS TO AN EXISTING POLICY – Another application must be completed, marking change box at the top.  Mail with a payroll change form. Then it must be routed to the Fiscal Section at NC DOT in Raleigh. Additions can ONLY be done during open enrollment, or a Qualifying Event.

REMOVAL OF DEPENDENTS – The employee must complete TOP SECTION of form 6016B Policy Service Request, then complete section G(copy included in this manual) to remove dependents from the existing policy. Removals can be done at anytime.

CANCELLATION OF POLICY – The employee must first stop his payroll deduction, Kanawha cannot do this for them. Next, the employee needs to complete form 6016B Policy Service Request, TOP SECTION along with Section K marked ‘Special Request’ and then write in ‘Cancel Policy’. The employee must then mail it to Kanawha, P.O. Box 610, Lancaster, SC 29721. Cancellations can be done at anytime.

Important Contact Information:

For questions concerning enrollment or policy information contact the agent, Advisors Financial Group at 1-800-334- 1217.

For Policy Holder Service questions contact Kanawha Insurance Company at 1-800-635-4252 extension 2518.

For questions concerning dental claims the EMPLOYEE must contact Kanawha at 1-800-635-4252 extension 2518. Due to changes in HIPAA laws only the employee will be able to get information on claims.