AWhen major dental work is necessary, it is recommended that you get an estimate from your dentist before the services are started so that you will know in advance what your payment obligations will be. The procedure for obtaining an estimate is to have your HMO or PPO dentist submit a treatment plan to the HMO or PPO carrier. After the treatment plan is approved, your dentist can then inform you of your out-of-pocket expenses. Additionally, Active participants should contact the Plan office if there is any question whether you are enrolled in a dental plan.
Most plans for Active participants have a waiting period for new members before major work is allowed. The waiting period may be 6 months to 12 months. Crowns, bridges, and dentures are considered major work.
All plans also have limitations and calendar year maximums. Implants and cosmetic dental work are not covered expenses. Co-payments required for treatment by members can be submitted to the Plan office for reimbursement. Non-covered services are not reimbursable by the SUP Welfare Plan. Co-payments for dependents are not reimbursable expenses.
Dental treatment can be covered under the $2,000 Pensioners’ Annual Allowance with any benefits that remain after the deduction of Medicare Part B premiums for those who are receiving such reimbursements on their pension checks.
However, the allowance for dental treatment under the full $4,000 or pro-rata Special Pensioners’ Medical Benefit falls under the $500.00 fiscal year maximum allowed for any combination of medical, dental and vision co-payments.
It is also recommended that Pensioners check with their dentist about their payment obligations prior to proceeding with major dental work. The dental office may be willing to arrange for a payment plan. The new fiscal year begins August 1, 2009.