When major dental work is necessary, it is recommended that you get an estimate from your dentist before the services are started. You should know in advance what your payment obligations will be.
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.
Your HMO or PPO dentist should submit a treatment plan to the HMO or PPO carrier prior to beginning major work. After the treatment plan is approved, your dentist can then inform you of what your payment obligations will be. Active Participants can contact the Plan office to make sure you are enrolled in a dental plan.
Emergency treatment performed by a dentist outside of the Plan can be submitted to the HMO carrier as a claim, however, the reimbursement allowance is very limited.
The maximum allowance for dental treatment under the Pensioners’ Annual Allowance is included in the $500.00 fiscal year maximum for medical co-payments and vision. (Example: $250.00 medical, $100.00 dental, & $150.00 vision would total the $500.00 maximum).
It is also recommended that Pensioners check with your dentist about your payment obligations before proceeding with major dental work. The dental office may be willing to arrange for a payment plan. The new fiscal year begins August 1, 2012.