Dental Vision FAQ
Who is eligible to enroll for coverage?
Can I cover my dependents?
As long as you have coverage you can enroll your spouse and unmarried children (natural, legally adopted or stepchild) under age 26. In addition, a handicapped/disabled unmarried dependent child, over age 26, who is incapable of self-support, is eligible.
When can I enroll and when will the coverage be effective?
You can apply for coverage at any time during the year. Click here to enroll. The coverage will normally be effective the 1st of the following month as long as the completed form is received by the 10th day of the month (or 2 full pay periods if paying through payroll allotment).
Enrollment applications received October 1st through the end of the current year will be effective the subsequent year.
What is the difference between the 2 plan options – DMO and PPO?
DMO plan option has no waiting period for services, no deductible, no claim forms to file, and no plan maximum. For some services you will be required to pay a copay. You must select a DMO dentist at the time of enrollment in order to be covered by the plan. Any services not performed by the selected DMO dentist will not be covered except in rare cases that are pre-approved. Note: Each covered family member may select a different DMO dentist.
PPO plan option allows more freedom to choose any dentist to render treatment. However, in most cases you will have less out-of-pocket when you select a PPO dentist. There is an annual and orthodontic plan maximum. Preventive care is covered at 100% when provided by a PPO dentist. Most other services are reimbursed on a percentage basis. See the chart for more information.
Both plan options allow freedom to switch between plan options during the plan year. Plus both plan options include vision care.
What do I need to do to switch plan options?
You must send a written request to SAMBA. You can use our Contact Us feature here on the website. The request must be received in the SAMBA office by the 10th day of the month for the change to be effective the 1st day of the following month.
If you are switching to the DMO plan option, you will need to provide us with the full name of the DMO dentist you have selected and his/her 6-digit ID number. Click here to find a DMO dentist in your area.
What do I need to do to add or change dependent coverage?
I want to terminate my coverage. What do I need to do?
You must send a written request to SAMBA. You can use our Contact Us feature here on the website. The termination will normally take effect at the end of the month as long as the request is received by the 10th day of the month (or 2 full pay periods if paying through payroll allotment.)
Note: DMO termination requests received after the 10th of the month may have a two month delay before coverage actually terminates.
Termination of coverage for any reason restricts re-enrollment for 24 consecutive months from the date of termination.
I want to change my dental and vision coverage to another carrier during open season. Do I need to notify SAMBA?
Can I keep the coverage if I leave my agency?
You can keep the coverage if you change to another federal agency or retire. If you resign or lose the coverage for other reasons, you may be eligible to keep the coverage for a limited time under a COBRA arrangement. Contact Us for specific information.