The Dental Plan will cover you and your eligible dependents. You must be prepared to prove that persons claimed as dependents are actually dependent upon you. Basic and Major Services combined have an annual maximum of $2,700.
Part I – Basic Services
Part II – Major Services (Prosthetic Appliances, Veneers, Crowns and Bridge Procedures)
Part III – Orthodontia (dependent children under 19 years of age)
To learn more about dental services listed above please refer to the HEALTH BENEFIT PLAN BOOKLET.
How a Claim is Made
Use your pay-direct card for dental claims. Present your pay-direct card to your dental office receptionist when you arrive for your appointment. If you weren’t able to use your pay-direct card and your dentist charged you for the full cost of the services provided, you can submit your claim for reimbursement using the Dental Claim form. Your dentist must complete Part 1 of the form. You complete Part 2 and Part 3.
Part 2 is where your Member information is filled in, including your Plan policy number, 70682. This number is pre-printed on the form. (If your dentist uses a Standard Dental Claim Form, the above Plan number must be included).
Part 3 is for patient information whether that is yourself, your spouse, or one of your dependent children. Part 3 also collects information about other Benefit or Insurance Plans that you may be eligible to co-ordinate a claim from.
The expenses must have been incurred by you or one of the eligible dependents currently on file with the Plan Administrator.