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Know your benefits
Open enrollment period to change plans is Sept. 1–Oct. 15; changes take effect on Nov. 1
The UFT Welfare Fund provides dental benefits through two programs: the Scheduled Benefit Plan, which provides services through the Welfare Fund panel of dentists or a dentist of your choice; and Dentcare, a no-cost dental HMO.
Scheduled Benefit Plan: The full-choice option
The plan you are automatically placed in upon enrollment in the UFT Welfare Fund (effective your first day of work) 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. Cleaning for adults is covered every three months. Exams are covered every six months with a $15 co-payment. 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.
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 will likely be higher. 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 Welfare Fund’s website or you can call the Welfare Fund Forms Hotline at 212-539-0539.
Dentcare: 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 2,000 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 copays, no claims to file and no danger of hidden costs for covered services. There are also no additional fees for porcelain crowns or composite fillings.
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. To learn more about this plan, contact Dentcare directly at 516-542-2700 or 800-468-0600.
If you’d like to continue seeing your current dentist, check to see if your dentist participates in Dentcare or is a UFT panel dentist. If your dentist belongs to both plans, you will save money by enrolling in Dentcare, though keep in mind that if you require care from a specialist, 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 with the Scheduled Benefit Plan, you are eligible for Special Coordination of Benefits. Special Coordination of Benefits can significantly increase reimbursement for dental work. If you use the services of a panel dentist, you will generally have no out-of-pocket costs on covered services. If you use the services of a nonparticipating dentist whose charges are above the scheduled payments, you will be eligible for additional reimbursement under your spouse or domestic partner’s coverage. Special Coordination of Benefits does not, however, extend the limits on time or frequency of treatment.
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.
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