Dental Benefits

High Option Covers:

  • Office visits
  • Restorative care (fillings)
  • Simple extractions
  • Note: Office visits include examinations, prophylaxis (cleanings), X-rays of all types and fluoride treatment

Health Plan pays:

70% of the Plan allowance. Member is responsible for 30% of cost plus any difference between our allowance and the billed amount (No deductible)

Accidental Coverage:

We cover restorative services and supplies necessary to repair (but not replace) sound natural teeth.  The need for these services must result from accidental injury (a blow or fall) and must be preformed within two years of the accident.  For more information please refer to the 2010 Federal Brochure.

Consumer Driven Option:

Dental and/or vision services are reimbursable out of your PCA and must be paid up front by you. We will reimburse up to a combined maximum of $400 per Self Only enrollment or $800 per Self and Family enrollment each calendar year.

2013 Supplemental Dental Benefits

Provided by Voluntary Benefits

Benefits Information

The benefits described on this page are neither offered nor guaranteed under the contract with the FEHB Program, but are made available to all enrollees and family members of this Plan. The cost of the benefits described on this page is not included in the FEHB premium and any charges for these services do not count toward any FEHB deductibles, out-of-pocket maximum co-pay charges, etc. These benefits are not subject to the FEHB disputed claims review procedure.

Voluntary Benefits Plan Dental Plan

The Voluntary Benefits Plan Dental program is an optional program with an additional premium that supplements the dental benefits in your APWU Health Plan coverage. All participants of the APWU Health Plan who enroll in the Voluntary Benefits Plan Dental Plan through this offer will receive a discount in the regular premiums for that program. To enroll in this additional coverage, complete and sign the Voluntary Benefits Plan Dental Plan enrollment form, which you can obtain from your APWU Health Plan representative or by calling the Voluntary Benefits Plan office at the toll-free number listed below. Please specify that you are an APWU Health Plan participant.

Availability

The Voluntary Benefits Plan Dental Plan is available to all Active, Retired, Associate and Transitional Employee APWU Members. May not be available in all States. Not available in U.S. Territories of Puerto Rico, Virgin Islands, American Samoa or Guam.

Coverage Description

This optional dental plan is an indemnity insurance plan underwritten by the United States Life Insurance Company in the City of New York. A member company of American International Group, Inc. You may use any dentist you choose. Covered services are reimbursed as a percentage of the "Reasonable and Customary" charges for that service in the state where the charge is incurred. Once you have satisfied the continuous coverage limitations of the program, there are no further waiting periods as long as you remain continuously insured under the plan. Both you and your eligible dependents (spouse and unmarried children to age 19 - full-time students to age 25) can be insured under this plan.

Coverage Schedule

Calendar Year Deductible:

$50 per person - Type I benefits
$100 per person - Type II and Type III benefits, combined
 

Calendar Year Maximum:

$1,500 per person for all covered services
$500 per person for all eligible Orthodontic services, if Optional Orthodontic Coverage is selected
 

Lifetime Maximum:

$1,000 for Orthodontic services, if Optional Orthodontic Coverage is selected

Benefits Schedule

 

After the Annual Deductible, this plan will pay:
 

HIGH OPTION PLAN

LOW OPTION PLAN

TYPE I BENEFITS
Preventive Services

  • Exams
  • X-rays
  • Cleanings

100% of the Reasonable and Customary charges
(no waiting period)

100% of the Reasonable and Customary charges
(no waiting period)

TYPE II BENEFITS
Basic Services

  • Fillings
  • Oral Surgery
  • Extractions

80% of the Reasonable and Customary charges
(6 month waiting period)

50% of the Reasonable and Customary charges
(6 month waiting period)

TYPE III BENEFITS
Major Services

  • Crowns
  • Bridges
  • Dentures
  • Periodontics

50% of the Reasonable and Customary charges
(12 month waiting period)

50% of the Reasonable and Customary charges
(18 month waiting period)

TYPE IV BENEFITS
(Optional Coverage)

  • Orthodontic

50% of the Reasonable and Customary charges
(24 month waiting period)

50% of the Reasonable and Customary charges
(24 month waiting period)

This is a partial summary of the terms, conditions and limitations of the Dental Plan policy #G-224540. For more information regarding the coverage, rates or to receive an enrollment form, please contact the Voluntary Benefits Plan office by calling or writing:

Voluntary Benefits Plan
P.O. Box 12009
Cheshire, CT 06410

apwuvbp@aol.com
www.voluntarybenefitsplan.com

1-800/422-4492
1-203/754-7847 (Fax)
1-800/237-5536 (In CT)
1-203/754-4410 (T.D.D.)

Benefits with Voluntary Benefits are not part of the FEHB contract.