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The UFT Welfare Fund provides dental benefits through two programs: the Scheduled Benefit Plan, which provides services through our panel or a dentist of your choice; and Dentcare, a no-cost dental HMO.
The plan you are automatically enrolled in as a new UFT member is the Scheduled Benefit Plan. If you select one of the UFT’s panel dentists (called SIDS), many routine procedures such as cleanings are free. Panel dentists may charge a co-pay of $150 for certain high-cost procedures, such as root canals, crowns and dentures, and $200 for orthodontic appliances.
If you see a dentist not on the panel
The Scheduled Benefit Plan allows you to see any dentist, but if you go to a dentist not on the panel, your out-of-pocket costs can grow. You are responsible for the difference between your dentist’s charges and the plan’s scheduled payments.
It’s a good idea to show your dentist a copy of the UFT’s “Schedule of Covered Dental Expenses” since it might influence how much he or she charges you. The dental forms and the fee schedule can both be downloaded from the website or you can call the Welfare Fund Forms Hotline at 1-212-539-0539.
The no-cost option
Enrollment in Dentcare allows you to avoid all out-of-pocket dental expenses for covered services. Just as with a health care HMO, you select a primary dentist from Dentcare’s list of more than 350 providers in the tri-state area. That dentist will perform all necessary work or will refer you to a Dentcare specialist if deemed necessary. There are no co-pays, no claims to file, and no danger of hidden costs for covered services.
A few factors for you to consider: If you have a dental emergency while traveling, Dentcare will only reimburse you up to $50 for pain relief. You have to return home to continue any dental work. If you have young children, be aware that Dentcare does not offer pediatric dentists.
Dental services performed by a non-Dentcare provider are not reimbursable. If you would like specific information about this plan, please contact Dentcare directly at 1-800-468-0608 or 1-516-542-2700.
If your dentist belongs to both plans, you will save money by enrolling in Dentcare, though keep in mind that if you need serious dental work you will need a referral to see a specialist on the Dentcare panel. If your dentist belongs to neither plan, you’ll need to decide whether continuing to see that dentist is worth the extra out-of-pocket expense.
Special coordination of dental benefits
If you and your spouse or domestic partner are both UFT members, you don’t have to choose between benefits — you have the benefit of both when it comes to certain Welfare Fund benefits, including dental coverage. You are eligible for Special Coordination of Benefits (SCOB) when the Scheduled Benefit Plan covers both members.
SCOB can significantly increase reimbursement for dental work. If you use the services of a nonparticipating dentist whose charges are above the schedule of allowances, you will be eligible for additional reimbursement under your spouse or domestic partner’s coverage. You are covered for up to twice the fee schedule, not to exceed the dentist’s actual charges.
SCOB is applicable to panel dentists. If you use the services of a panel dentist, you will generally have no out-of-pocket costs. You will not be charged co-payments that are listed on the dental schedule. The Welfare Fund will pay the dentists for the applicable co-payments. However, upgraded or noncovered services are still the responsibility of the member.
SCOB does not extend limitations on time or frequency of treatment. For example, one exam every six months does not become one exam every three months.
Please remember: To obtain this special coordination of benefits, do not assign payment of the dental benefits directly to your dentist. Instead, check the appropriate box at the top right of the dental claim form and submit it directly to CIGNA.
If you and your spouse or domestic partner are both UFT members, one member may choose to enroll in Dentcare while the other member stays in the Scheduled Benefit Plan.
Under this option, you and your family members may use either a Dentcare dentist or a non-Dentcare dentist. Services rendered by the non-Dentcare dentist would be reimbursed according to the regular Scheduled Benefit Plan.
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