Website: www.deltadentalins.com
Phone: (800) 765-6003

• Delta Dental Online Resources
• Delta Dental LifePerks Discounts
• Pre-Treatment Estimate Resource
• Smiles All Around - Essential steps for your dental routine
• Authorization Form

Delta Care HMO Group #5643

• Evidence of Coverage
• Plan Summary

Website: www.deltadentalins.com
Phone: (800) 765-6003

• Delta Dental Online Resources
• Delta Dental LifePerks Discounts
• Pre-Treatment Estimate Resource
• Smiles All Around - Essential steps for your dental routine
• 7 Ways to Make the Most of Your Dental Plan (PPO)
• Authorization Form
• Delta Dental PPO Claim Form

Delta Dental PPO Group #2584

• Evidence of Coverage
• Plan Summary

The Dental In-Lieu plan allows eligible employees who are covered for dental insurance through another group dental plan a choice between selecting or continuing nontaxable dental coverage under one of the City’s dental insurance plans, or declining/dropping the City’s coverage and receiving a taxable in-lieu cash payment. The City’s Dental In-Lieu plan does not qualify as a group dental plan for COBRA purposes. 

Payment/Taxes

Payment will be made to the employee on their regular biweekly payroll check. Payment is taxable, and subject to tax withholdings. The Plan Year on which the Plan operates (including elections and payments) is the calendar year. Payment will not be made for failure to provide acceptable proof of alternate group coverage.

Eligibility

Full-time and Reduced Work Week (35+ hours per week) employees, who certify that they have alternate group coverage, and provide proof of alternate group coverage which is acceptable to the City of San José, are eligible for the Plan. Eligible employees who receive healthcare coverage as a dependent of another City employee or retiree are only eligible for the Single In-Lieu plan. Employees on an unpaid leave of absence are not eligible for the Plan and in-lieu payments.

Enrollment/Elections

Eligible employees may enroll online through eWay upon new hire, during the annual open enrollment period (typically held the first two weeks of November), or within 30 days of a qualifying life event.

The Plan and in-lieu payments are effective on the first day of the following calendar year. Employees may apply for Dental In- Lieu or switch from Dental In- Lieu to a medical plan during the year only if they become eligible due to a qualifying life event/change in family status and must apply within 30 days of the date of that change. 

Dental In-Lieu Attestation Verification

The IRS requires proof of alternate group coverage to be submitted to the City every year that the health/dental In-Lieu plan applies. The federal regulation states proof of alternate group coverage may include the employee’s attestation that the employee and all other members of the employee’s expected tax family have or will have minimum essential coverage. Annually, following Open Enrollment, employees enrolled in Health and/or Dental In-Lieu will need to complete the Health and/or Dental In-Lieu Attestation in order to qualify for the health/dental in-lieu premiums for the calendar year.  Employees enrolled in the In-Lieu programs will receive an automatic email from HR Benefits requesting the completion of the Attestation. Employees will continue to receive these emails until the Attestation has been completed and will have 30 days to complete.  If the Attestation is not completed by the deadline enrollment in the In-Lieu plan(s) will be canceled and medical/dental coverage will be waived. 

Important Dates 2023:

• Tuesday, January 17th:  Currently enrolled in Health and/or Dental In-Lieu will need to complete the 2023 Health and/or Dental In-Lieu Attestation. 
• Friday, February 17th: The deadline to complete the Attestation 
• March 1, 2023: Employees who fail to complete will have medical coverage waived effective 3/1/23.  

Review the 2023 HIL/DIL eForm Attestation Instructions to learn about how to complete the eForm.  

Need more information?

For more information, see the details in the Dental In Lieu Plan Document.