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Dental and Vision Reimbursement

Eligible employees, spouses and dependent(s) receive 90% reimbursement — not to exceed the annual maximum amount of $2,500 — for dental and vision combined.

Dental and vision reimbursement plan is secondary only. All claims should be filed with the primary insurance provider before submitting a claim.

Reimbursement forms

See guidelines for dental/vision reimbursement.

Submitting your claim

You may submit your claim in any of the following ways:

Direct Deposit

Flex Administrators offers the option of signing up for direct deposit once your online dental vision reimbursement account is created (late December). 

Questions?

Contact Flex Administrators Representatives Sarah Chase at (616) 456-7908 ext-101 or Ashley Young at (616) 456-7908 ext-102.

Dental and Vision Reimbursement FAQs

General FAQs

Q:  Can I lump multiple services and dependents on once claim form or online claim submission?

A: No, if submitting a dental/vision pdf claim form you will need to complete one claim form per person. Please list dates of service and list a brief description of services with amounts. 

If submitting a claim online, please submit once claim request per person and add dates of service and description; same as would be required on the pdf form.

Q: Am I required to create an online account with Flex Administrators for Dental/Vision Reimbursement Benefits?

A: No, it is not required. Creating an online account is a convenient way to view claim status, upload claims  and view your year-to-date balance. If you do not create an online account and you need to check on the status of your reimbursement claim or need your reimbursement account balance, you will need to contact Flex Administrators: Sarah Chase at (616) 456-7908 ext-101 or Ashley Young at (616) 456-7908 ext-102.

Q: Can I submit partial payments for reimbursement?

A: Any bills that are not “paid in full” should not be submitted for reimbursement, until they are paid in full. Any bills for services that are not being treated currently will be denied as an ineligible expense. Exception: If services are for Orthodontics, monthly payments will be reimbursed only during the period of time services are being rendered.

Q: How will I be notified if a claim is missing documentation?

 A: If you create an account with Flex Administrators you will have the option to elect email notifications. If you elect email notification and your claim is missing information, Flex Administrators will send you an email asking you to log in to your Dental/Vision Reimbursement Benefit Account to view messages regarding your claim.

If you do not create an online account or do not choose the email notification option, Flex Administrators will send you a letter in the mail notifying you that your claim was not processed due to missing documentation.

Q: Why does my account show a separate benefit for Vision/Dental Under 18?

A: Flex Administrators added a separate benefit row for processing preventative care dental/vision reimbursement benefits for dependents under the age of 18. The dental/vision benefit has not changed, this row is to reimburse for dental/vision preventative care services at 100% without deducting from the dental/vision reimbursement benefit limit of $2,500. This would only apply for vision exams, dental exams and fluoride treatments for dependents that are under age 18.

Make sure you file claims for vision exam, dental exams and fluoride treatment for dependent under the age of 18 under this Vision/Dental Under 18 section. These benefits fall under preventative care services for dependent under age 18 and will be reimbursed at 100% without deducting from the dental/vision reimbursement benefit limit of $2,500.

Orthodontic Claims

Q: What if I have ongoing monthly payment(s) for Orthodontic from the previous benefit year?

A: Orthodontic monthly payments scheduled from January 1, 2021, moving forward will be reimbursed by Flex Administrators. You will need to submit a copy of the Orthodontic agreement along with the monthly paid receipt with your first reimbursement request.  After your first request, you can submit monthly reimbursement requests along with the monthly itemized paid receipts.

Q: How do I submit a NEW Orthodontic claim to Flex Administrators?

A: When submitting your first reimbursement request, you will need to submit a copy of the Orthodontic agreement, which details the total cost, the initial down payment, the monthly payment schedule, and the date on which the contract will be paid in full (the plan will not reimburse a participant a one lump-sum payment at the end of the treatment period).You will also need to include the itemized paid receipt for down payment.  After your first reimbursement, you can submit monthly reimbursement requests along with the monthly itemized paid receipts.

Q: What are the limitations and rules for Orthodontic claims?

A: The initial down payment for orthodontic services should not exceed 25% of total cost for braces. Reimbursement for orthodontics is only available on the initial down payment for services, and then for each additional monthly payment on the balance (the plan will not reimburse a participant a one lump-sum payment at the end of the treatment period).

When submitting  the initial reimbursement request for orthodontic services, please provide Flex Administrators with the orthodontic contract, which details the total cost, the initial down payment, the monthly payment schedule, and the date on which the contract will be paid in full. Plan will reimburse for orthodontic services as scheduled in the Orthodontic agreement.

Reimbursements and Flexible Spending Accounts

Q: I have a Flex Spending Health Care Account; will Flex Administrators automatically process the dental and vision balance under my FSA Health Care account?

A: No, you will need to submit a separate claim under your Flexible Spending Account.

Q: I have a Flex Spending Health Care Debit Card can I use my FSA debit card to pay for dental or vision claims?

A: No, we do not have the debit card option with our dental/vision reimbursement plan. The FSA Health Care debit card should only be used for your out of pocket medical expenses after insurance or dental/vision reimbursement benefits (10% or if you max-out your reimbursement account).

Coordination of Coverage

Q:  Both my spouse and I are employed at GRCC and both have dental/vision reimbursement benefits, will our claim automatically be processed under both reimbursement accounts and how will this be benefit be coordinated?

A: Submitting claim online: If submitting claims online you will need to add a note under notes section that your spouse also has GRCC dental/vision reimbursement benefits and request that the balance be processed under his/her account (list spouse name).

if submitting a dental/vision pdf claim form you will need to complete and submit a claim under each employee reimbursement account. You can write on the note’s sections coordination of benefits (list spouse name).

Coordination of Dental/Vision Reimbursement Benefit

Employee is primary under his/her own account and secondary on spouse account.

Coordination of coverage for dependents: the parent whose birthday (month and day only) falls first in a calendar year is the parent with the primary coverage for the dependent, balance can be submitted under spouse account as secondary

Notifications on claim issues or claim payments will be sent to what has been set up on message center/notification preferences (email or home address) make sure you select or update notification preferences.

Q: How does our Dental/Vision Reimbursement Benefit Plan Coordinate with Insurance? 

A: Any other insurance coverage is considered primary under GRCC’s dental and vision reimbursement plan. All claims should be submitted to the insurance carrier first. The insurance carrier should provide you with an Explanation of Benefits (EOB). Balance not covered by insurance can be submitted to FLEX ADMINISTRATORS for reimbursement. The Explanation of Benefits (EOB) and itemized paid receipt will be required to process your reimbursement claim.

In addition, under GRCC’s dental and vision reimbursement plan, if services are covered under the medical plan, the medical plan will provide primary coverage and dental and vision reimbursement plan will coordinate coverage on any balance. Please note: WMHIP Community Blue Plans do provide coverage for oral surgery for wisdom tooth extraction.

Contact

If you have any questions, please call Debra Davis at (616) 234-4175 or Maria Belmares Herrera (616) 234-4052.

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