Your dental options
Sep 22, 2005 1:58 PM
Q&A ON THE ISSUES
What dental benefit programs are available?
The UFT Welfare Fund offers benefits through a choice of three types of dental programs:
A. A fee-for-service plan under which the cost of benefits is reimbursed based on a schedule of allowable charges. This is known as the UFT Welfare Fund Scheduled Benefit Plan.
B. A Dental HMO plan, known as Dentcare, under which comprehensive dental services are covered with no out-of-pocket expenses.
C. Florida Dental Discount Plan for year-round Florida residents only offers a large number of participating dentists with various levels of co-payments.
What are the benefits under the Scheduled Benefit Plan?
This plan provides benefits for covered services under a reimbursement schedule. A document called “ Dental Schedule” lists all covered services and the maximum reimbursement amounts.
Within this plan there are two available options:
- A Participating Panel Program - provided by Self-Insured Dental Services (SIDS).
- Direct reimbursement (administered by CIGNA).
What is the SIDS Participating Panel Program?
Within the Scheduled Benefit Plan there is available a dental panel consisting of more than 600 participating dentists. If you use a participating dentist, the reimbursable services will be provided at no cost to you, except for a $50 co-payment on selected dental procedures (i.e., crown, root canal, etc.)
What is the Direct Reimbursement Program?
If you use a non-participating dentist, you are required to pay the full cost of the service and then submit a claim for reimbursement. Such reimbursement will be made according to the schedule amount or the actual charge, whichever is less.
What are the benefits under the Dental HMO plan (Dentcare)?
This is a prepaid program of comprehensive dentistry with no deductibles, copayments or other out-of-pocket expenses when provided or authorized by your primary Dentcare dentist. There are no annual or lifetime maximums and the HMO offers 100 percent coverage on all covered dental services without having to file claim forms.
If I enroll in Dentcare, can I go to any dentist I choose?
You must choose your dentist from the Dentcare list of participating providers. That dentist will perform all necessary work or will refer you to one of the plan’s specialists.
If your current dentist is not affiliated with Dentcare, you will be required to change dentists to one who appears on the plan’s participating list.
If I enroll in Dentcare, can I use a specialist?
Specialists are available under the Dentcare program. However, you must be referred by your primary dentist. There is no coverage without the proper referral.
Can I change dentists within Dentcare?
There will be an annual “open enrollment” period once every year in the fall. You may change dentists at this time. If, however, you are not satisfied with your dentist, you may contact Dentcare and it will switch your dentist the first of the following month.
If I select a Dentcare dentist, can my family members choose a different Dentcare dentist?
Yes, each family member, including children, may choose from the list of Dentcare’s participating dentists. You, for example, may choose a dentist whose office is close to your home and your spouse may select a dentist whose office is close to your spouse’s place of work.
If I have a change in my family status (i.e., a dependent is added or dropped, or I move), do I have to notify Dentcare?
No, that’s not necessary. The UFT Welfare Fund will notify Dentcare of your change. Simply complete the fund’s “Change of Status” form as you would normally do. Dentcare will then contact you to ask, for example, which participating dentist your new dependent would like to use.
Is there a charge or payroll deduction to belong to Dentcare?
No, the program is paid for by the UFT Welfare Fund at no cost to you.
My youngest dependent is 6 months old. When I enroll in Dentcare, should I include him on the application?
Yes. However, to save the Welfare Fund money, since payment to Dentcare is per person, and since very young children do not generally need a dentist, your dependent will not actually be enrolled until age 4. If the child needs dental care for whatever reason, contact the UFT Welfare Fund office to activate coverage and the fund will notify Dentcare. The child will be enrolled immediately.
When can I start using my Dentcare dentist?
If you enroll in the Dentcare program before Oct. 15, the effective date will be Nov. 1, and you may call to make an appointment any time after Nov. 1.
Will I be notified by Dentcare that I have been accepted into the plan?
Yes, Dentcare will contact you to welcome you to its plan. It will also notify the dentist you chose that you will be a Dentcare patient.
How are emergencies treated by Dentcare?
If you are out of the service area and you have a dental emergency that requires diagnosis and treatment, the plan will pay a flat dollar amount of $50 toward alleviating your discomfort.
If you are in-area, you also would be reimbursed $50, providing all efforts to contact your plan dentist and Dentcare had failed.
I spend some part of the year in Florida. Would Dentcare be good for me?
Dentcare also serves the Florida area.
My son is in the middle of orthodontic treatment. What happens if I change to Dentcare?
If your orthodontist is already a panel dentist with Dentcare, the plan will provide benefits for the remainder of the treatment. However, if the orthodontist does not participate in the Dentcare panel, Dentcare will not pay benefits to a non-participating dentist. If, because of treatment in progress, you are in doubt about whether to join Dentcare, call the plan to discuss your individual situation.
Under normal circumstances, crowns and bridges may only be replaced once every five years. If I join Dentcare, must I wait five years to have my crown or bridge replaced?
No, you enter Dentcare with a “clean slate.” While Dentcare does have replacement limitations, they apply only to work performed by Dentcare dentists. Any past work or history is not carried over to Dentcare and you have no waiting period or pre-existing condition clause.
Work performed by another dentist is not a problem or concern. However, any work or replacements must be medically necessary.
Dental transfer info
How do I initially select either the UFT Scheduled Benefit Plan or Dentcare?
Enrollment in the Scheduled Benefit Plan is automatic. Enrollment in the Dentcare HMO is strictly voluntary. If you desire the Dentcare option you must complete a Dental Enrollment/Transfer Form. This form is available by calling the UFT Welfare Fund at 1-212-539-0500.
How do I change dental plans?
Members who want to change plans should call the Welfare Fund to request a Dental Enrollment/Transfer package. This package will contain information about Dentcare as well as the UFT Scheduled Benefit Plan. Complete the enclosed Dental Enrollment/Transfer Form and return it to the UFT Welfare Fund.
If your form is received before Oct. 15, the transfer will be effective Nov. 1.
What if … ?
My current dentist belongs to the SIDS panel. He also participates with Dentcare. Which plan should I choose?
There are advantages and disadvantages to both plans. Under the SIDS program, there are copayments of $50 on selected dentistry (crowns, bridges, etc.). These copayments do not exist with Dentcare — all work is covered 100 percent. With the SIDS program, however, you have the option of either using your SIDS dentist or any other dentist you may prefer. In the latter case, you would be reimbursed under the UFT dental reimbursement schedule, but you would incur out-of-pocket expenses. The Dentcare HMO does not allow the use of non-panel dentists.
Your choice should be based on your needs: some limitations in choice vs. coverage with no out-of-pocket costs to you.
My spouse and I are both teachers. Since we are each covered by our own dental plan as well as by our spouse’s plan, can we coordinate benefits with the Welfare Fund?
Yes! You have several options to consider. You may both remain in the present UFT Welfare Fund “fee-for-service” plan. By coordinating benefits you can be reimbursed for charges by a non-SIDS panel dentist on both of your plans, once as a member and again as the spouse of a member — provided that the reimbursement does not exceed 100 percent of the submitted charge — just as you have been doing up to now.
If you use a SIDS panel dentist, you would generally have no out-of-pocket costs except for the $50 copayment for certain procedures. This copayment would not be reimbursable through coordination of benefits.
You may also elect to have your family covered under the Dentcare and the fee-for-service plan. This gives you what the City of New York does not allow — dual family coverage! One member and dependents enroll in Dentcare and the other member does not.
Under this latter option, you and your family members may use your Dentcare dentist at no cost to you or a non-affiliated dentist under your spouse’s coverage and be reimbursed through the UFT Welfare Fund fee schedule. Coordination of benefits (i.e., reimbursement up to twice the schedule) would no longer be applicable and the out-of-pocket costs incurred under the fee schedule is not reimbursable through Dentcare.
My dentist is in the middle of completing my dental work and I want to change plans. How will this be handled?
Before you complete the form and transfer to another plan, call the Welfare Fund and tell us the details to avoid any misunderstanding. The Welfare Fund, with its many experienced and professional advisors, is there to help you.
How often can I change plans?
Once a year, during the fall open enrollment period.
What would happen if I joined Dentcare and subsequently moved out of the area?
If you move out of the service area, you may transfer to another dental option immediately. Contact the UFT Welfare Fund when you know the date you are moving.
New Florida plan
I heard that there is a new plan for retirees living in Florida, the Florida Dental Discount Plan. Can I join now?
Yes, if you are a year-round Florida resident and do not live in an area covered by SIDS, you might consider enrolling in this newly offered plan. Call the UFT Welfare Forms hotline — 1-212-539-0539 — to request a “CompBenefits” brochure. The booklet will outline your various copayments and give you a list of participating dentists to choose.
If I enroll in the Florida Dental Discount Plan can I still submit claims to CIGNA?
No. UFT retirees who elect to participate in the Florida Dental Discount Plan are not eligible to receive any other dental benefits from the UFT Welfare Fund. UFT members who elect to participate in this plan may only change their dental plan option during the dental transfer period which takes place annually in September and October and would become effective Nov. 1.
Dental transfer period
The annual transfer period this year to change dental plans runs from the beginning of September through Oct. 15 and the effective date of any newly selected plan is Nov. 1.
Members who wish to change plans must submit a Dental Enrollment/
Transfer form to the Welfare Fund.
The fund will continue to offer three choices in dental coverage: the UFT Welfare Fund Scheduled Benefit Plan, the Dentcare HMO and the Florida Dental Discount Plan. The scheduled benefit plan allows members to use a dentist of their own choice and receive the scheduled reimbursement or to use a participating dentist in the SIDS panel at little or no out-of-pocket cost.
New members will be enrolled automatically in the UFT Welfare Fund Scheduled Benefit Plan if no enrollment/transfer form is received.
Members who need additional information or a transfer form should call the fund for a transfer kit — which includes the form as well as details of the available plans — at 1-212-539-0539. [See the Q&A for details.]
