The PSC-CUNY Welfare Fund Dental Plan change period will be from November 1 through November 30, 2011. During this time, PSC-CUNY Welfare Fund participants and benefits-eligible employees can change their dental coverage provider. Dental plan changes made during the open enrollment period will become effective January 1, 2012.
Members can switch to DeltaCare USA DMO Plan by completing the Delta Enrollment Form. Members can switch to Guardian by completing the Delta Disenrollment Form.
All welfare fund dental forms must be submitted to Central Office Human Resources by November 30, 2011.
Click the following links to obtain the forms for the changes described.
PSC-CUNY Delta Dental Transfer-Out Form – to change your dental coverage from DeltaCare USA to Guardian.
PSC-CUNY Delta Dental Enrollment Form – to change your dental coverage from Guardian to DeltaCare USA.
You must include the name and office ID number of your dentist on the enrollment application. You can get this information from the DeltaCare website at http://deltadentalins.com. The Find a Dentist box is at the lower right-hand corner of the page. The plan name is DeltaCare USA and group number is 5864-0001.