FAQs

The Cambridge Public Employees Dental and Vision Fund is for eligible members, retirees, and their dependents who meet the Fund Policy requirements below:

• Your Spouse
• Your dependent children up to age under 26 – coverage ends on 26 birthday. For dependent children to be eligible between the ages of 19 – under 26 they must be unmarried, financially dependent on the member for support, living with the member more than half the year, and has no additional coverage.
• Full-time student dependent children between the ages of 19 – under 25 that are not claimed on the members federal tax returns, but are dependent on the member for support, unmarried, and has no additional coverage – proof of student status required
• Totally disabled, handicapped, and mentally disabled children are eligible regardless of age; as long as they are claimed on your federal tax return. A completed disabled dependent application form needs to be submitted to the Fund Office.

To learn about eligibility requirements, click on the links below.

• Active Employee
• Retirees

Most employees are enrolled in the Fund’s Plan automatically when they first become eligible. Employees at Cambridge Health Alliance must enroll during open enrollment or when they first start working and become initially eligible. Learn about eligibility for active employees and retirees.

If you or your dependent loses eligibility for Fund coverage, you or your dependent maybe eligible to continue coverage through COBRA Continuation Coverage. If you are a retiree and lose coverage, you may self-pay for retiree coverage.

At certain points in your life, you may add a dependent through marriage or the birth of a child. You may also lose a dependent through divorce or if your child is no longer eligible for coverage due to age. These are examples of special enrollment period qualifying events. If adding a dependent, your dependent will be covered by the Fund (if you and your dependent are eligible). If you lose a dependent, that dependent may be able to continue coverage. You should contact the Fund Office as soon as you know of any change in dependent status.

Married employees who are both eligible for the Cambridge Dental & Vision Fund Plan cannot have two individual plans.  Either you or your spouse must elect Family coverage. There is no additional cost for Family coverage.  Please contact your benefits department for more information.

For dependent children ages 19 to under 26 to be eligible under your plan they must be:

• Financially dependent on your for support
• Claimed as dependent on your taxes
• Be unmarried and residency must be with you (living with the member more than half the year)
• Has no additional dental coverage
• Not employed full-time where benefits are available – must take coverage through employer

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No, your dependent children do not have to be full-time students to be covered under your dental and vison coverage, if they meet the age 19 – under 26 dependent children provision requirements or are totally disabled dependent claimed on the members federal tax returns.

Full-time student dependent children between ages 19 – under 25 that are not claimed on the members federal tax returns, but are unmarried, have no additional coverage, are dependent on the member for support are eligible to continue – proof of student verification required each semester.

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Your eligible dependent children are covered up until they turn 26 –  coverage ends on their 26th birthday.  Unless your dependent is considered a disabled dependent.  Disabled dependent children can remain on your coverage regardless of age – a disabled dependent application must be completed and submitted to the Fund Office.

The Fund’s Plan covers many routine and advanced dental and vision services.

You can see a list of covered dental services here or by visiting Delta Dental’s website.

You can see a list of covered vision services here.

Most employees are enrolled in the Fund’s

Delta Dental administers your dental benefits. You can see your dental claims on Delta Dental’s website. You must log in to your account in order to see your claims. If you have not set up an account, click on “Members” under “Log In to Your Account” on the right-hand side of the page. You can then register as a new member.

The Fund administers your vision benefits. You are reimbursed for vision services and do not receive claims. To get information on your vision benefit reimbursements, contact the Fund Office.

You typically pay less when you visit a dental provider who participates in the Delta Dental network. To find a participating provider, visit Delta Dental’s website.

All eligible vision providers—except for International Optical providers—are considered participating providers. An eligible vision provider is any licensed ophthalmologist, optometrist and optician.

Delta Dental is able to reprocess any outstanding claims within twelve months from the date of service.

Vision Claims must be submitted within twelve months from the date of service and in its entirety for vision reimbursement.

Vision claims can either be mailed or emailed to the Fund Office.  Make sure to sign and complete all steps on vision claim form; and attach all required documentation including paid itemized bills, receipts, and proof of payment.

Mailing Address:

Cambridge Public Employees Dental & Vision Fund
125 CambridgePark Drive
Suite 104
Cambridge, MA 02140

Email Address:

[email protected]

PDF format only on emailed vision claims – must include scanned claim form, paid itemized bills, receipts, and proof of payment. 

You can contact the Fund by emailing, sending a message using the contact form, calling, faxing or by visiting the Fund Office. Find details on how to contact the Fund here.

Address:

Cambridge Public Employees Dental & Vision Fund
125 CambridgePark Drive
Suite 104
Cambridge, MA 02140

Federal law mandates that you be offered COBRA at the time of your retirement. Under the federal COBRA guidelines, loss of coverage due to retirement is a qualifying event. Once COBRA ends you will then be eligible to enroll under the Funds Annual Retiree Benefit Plan.

Yes, as long as you maintain continuous coverage and were covered under COBRA as a retiree.  Non-Retiree COBRA(s) are not eligible for the Annual Retiree Buy-In Plan.  The Annual Retiree Buy-In Plan is only eligible to retirees after their COBRA Retiree plan ends.

See Retiree Eligibility for more information.

• COBRA Plan – No, you can not add dependents to your COBRA plan after the election period. You can only add existing eligible active dependents on your plan at the time of election.
• Annual Buy-In Retiree Plan – No, you can not add dependents to your Annual Buy-In Retiree Plan. Only active dependents that were on your COBRA Retiree Plan are eligible.

Existing Eligible Active Dependents are active dependents currently enrolled under your plan as an “Active Employee”, before COBRA election.

Retirees – Please make sure that all dependents are actively listed on your coverage before retirement.