Who is Eligible:
· Full time employees and eligible dependents
· Part time employees and eligible dependents
· Retirees and eligible dependents
Benefit Defined: Non-Orthodontic: Payment will be made for each dental service up to the amount provided under the Schedule of Dental Services. This schedule is contained in a separate pamphlet and on the back of the dental claim form. There is a $2,500 annual per person maximum for non-orthodontic services in a calendar year. The maximum lifetime orthodontic benefit available is $1,995.
Orthodontic Coverage: Married participants who are both eligible employees and/or retirees shall be entitled to coordination of benefits for dependent children to a maximum of the normal, reasonable and customary charges or the actual charges, whichever is less. The maximum lifetime benefit available is $1,995.
Participating Providers: While in no way endorsing the use of Participating Dentists, the Welfare Fund has established a panel of dentists who have agreed to accept the Fund’s Dental Schedule Of Allowances as full payment for all covered and reimbursable services. Participants are responsible for all charges for non-covered services. Panel dentists’ names, addresses and phone numbers can be obtained by calling S.I.D.S.,(our Dental Benefit Fund Administrator) Monday thru Friday 9am-5pm at (516) 396-5500.
Pretreatment Review: The Pretreatment Review program is designed to give participants and dentists a better understanding of the Schedule of Covered Dental Expenses payable under the play before services are provided. Dentist should submit a pretreatment review claim form for crowns, bridges, dentures or when charges for a proposed dental service or series of dental services are expected to exceed $300.00. The Fund will then determine the benefits payable for each dental service and return the approved claim to the dentist. If this Pretreatment Review Program is not followed, payment will be determined by taking into account alternate procedures or services, based on acceptable standards of dental practice.
Coordination of Benefits: This benefit must be coordinated with any other plan which provides dental coverage. Where both spouses are eligible employees and/or retirees benefits for dependent children will be covered to a maximum of the normal, reasonable and customary charges or the actual charges, whichever is less.
· Participating providers – Claims are submitted by the provider.
· Direct Reimbursement – Claims must be submitted to the Fund Office no later than 12 months from the date of service.
Limitations: A person may not have coverage as both an Eligible Employee and/or Retiree and as a covered dependent.
For more on Dental Benefits provided by ASONET, please click here.