Hamburg Benefit TrustErin Holstein-financial
Julie Maxson-enrollment Debra Vertokse-retirees/COBRA Paula Litwin-secretary Amy Takacs-HTA President Please contact trustees for further information. Enrollment Form for 2017
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Dental Claim Form
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You are now able to PRINT an ID card for DELTA DENTAL when you create an account online.
Go to the website, DELTA DENTAL (click) Click---SIGN IN or REGISTER Click---Create an Account (Your Member ID # is your Social Security Number) After your account is set up, login with it... On the Left side you should see Hamburg Central Teachers Association, Delta Dental PPO Below that is Print ID Card or EMail ID Card | ||
Dental: Summary of Benefits
Summary of Benefits (Effective January 1, 2018)
| new_amended_summary_of_benefits_01-01-2018.pdf |
Summary of Benefits - effective January 1, 2016 No changes for 2017
| newamendedsummaryofbenefitsjanuary2016.docx.pdf |
Hamburg Central Teachers Association Dental Plan Evidence of Coverage
Updated January 1, 2018
| delta_eoc_20180101.pdf |
HIPPA Privacy Notice
| privacystatementdocument-hippa.rtf |
Changes in eligibility status (i.e. marriage, divorce,birth, etc.) must be reported to the Plan Administrator
(Julie Maxson) within 31 days following the event causing the change. If you do not change coverage when
first eligible, you may change later during "open enrollment".
(Julie Maxson) within 31 days following the event causing the change. If you do not change coverage when
first eligible, you may change later during "open enrollment".
If you are thinking of retiring and are currently enrolled in the dental program with Delta,
please contact (email) Deb Vertoske as soon as possible. Current annual rates for retirees are;
$475 single $800 family. These rates are subject to change.
please contact (email) Deb Vertoske as soon as possible. Current annual rates for retirees are;
$475 single $800 family. These rates are subject to change.