UNIVERSITY OF DELAWARE

DENTAL PLAN ENROLLMENT FORM
CONTRACTED GRADUATE STUDENT & POSTDOCTORAL STUDENTS
2024-2025 Academic Year

Coverage Period: 8/15/24 - 8/14/25

Students and dependents who wish to enroll MUST enroll and pay the full amount online by October 15, 2024.

ELIGIBILITY: This is a dental plan offered to Contacted Graduate Students and Postdoctoral Fellows attending the University of Delaware. You may purchase the Blue Edge-Highmark Dental Plan on a voluntary basis. Enrollment in the Student Health Insurance Plan is not required.

DEPENDENT ELIGIBILITY: Students who voluntarily enroll in this dental plan may also enroll eligible dependents. Proof of your dependents eligibility may be requested by University Health Plans or Highmark. The below dependents are eligible for enrollment:

• Spouse or Partner to a Civil Union
• Children under age 19

DEADLINE & COVERAGE PERIOD: To enroll, you must complete all required information below PRIOR to the deadline of on October 15, 2024, and pay the full premium by credit card. The plan will be effective from 8/15/2024 through 8/14/25. Enrollment is NOT available once the deadline has passed, eligible students can purchase Spring 2025 coverage effective 2/1/2025, when it becomes available. 

BENEFITS SUMMARY: As with any insurance plan, please make sure you have read the plan benefits before enrolling.

PROCESSING TIME: Once this form is completed, your record should be activated in Highmark's system by the plan's effective date OR about 7-10 business days after this form is submitted, whichever is later. 

ID CARDS: Members of this plan will receive an ID Card to the address provided on the form. Access is also available to you plan ID Card online or through the Highmark mobile app.

REFUNDS: No refunds of any kind will be provided after your plan becomes effective or after University Health Plans submits your information to Highmark, whichever is later.

PARTICIPATING PROVIDERS: This plan utilizes the United Concordia network and is provided through Highmark Blue Edge Dental. The network extends nationwide and provides out-of-network coverage. You do not need to select a primary care dentist under the network. You will receive the greatest out-of-pocket savings when visiting a In-Network Provider. You will receive 90th percentile coverage with an out-of-network dentist. Please utilize the provider search and review the plan benefits prior to selecting a provider.

COVERAGE PERIOD AND RE-ENROLLMENT: The plan you are purchasing will terminate at midnight on 8/14/2025. You will not be automatically re-enrolled for coverage after that date. If you are still an eligible UD Student in Fall 2025, you may voluntarily re-enroll yourself for the new plan by completing a new enrollment form during the appropriate open enrollment period for that policy year. 

This enrollment form is available only to Contracted Graduate Students and Postdoctoral Fellows. Non-Contracted Graduates and Undergraduate student are not permitted to enroll in this plan. Please review the plan option available to you.

A new list of eligible UD ID numbers are submitted to University Health Plans periodically. If you are unable to log into the form, please try again in one week. If you continue to have an issue, for longer than a week and have an active eligible contract that was processed more than a week ago, please contact the Office of Graduate & Professional Studies at UD.