Oct 1, 2009 1:58 PM
The UFT Welfare Fund offers benefits through a choice of three types of dental programs:
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:
Within the Scheduled Benefit Plan there is available a dental panel consisting of more than 700 participating dentists. If you use a participating dentist, the reimbursable services will be provided at no cost to you, except for a $50 or $100 co-payment on selected dental procedures (consult the dental fee schedule — available on the Welfare Fund Web site, www.uftwf.org.)
If you use a nonparticipating 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.
This is a prepaid program of comprehensive dentistry with no deductibles, co-payments 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.
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.
Specialists are available under the Dentcare program. However, you must be referred by your primary dentist. There is no coverage without the proper referral.
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.
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.
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.
No, the program is paid for by the UFT Welfare Fund at no cost to you.
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 in Dentcare 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.
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.
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.
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.
Dentcare also serves a few areas in Florida. Contact the Welfare Fund for a Florida listing.
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 nonparticipating dentist. If, because of treatment in progress, you are in doubt about whether to join Dentcare, call the plan to discuss your individual situation.
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.
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.
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.
There are advantages and disadvantages to both plans. Under the SIDS program, there are co-payments of $50 or $100 on selected dentistry (crowns, bridges, etc.). These co-payments 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.
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 or $100 co-payment for certain procedures. As a new benefit this year, this co-payment would 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 nonaffiliated 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 are not reimbursable through Dentcare.
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 advisers, is there to help you.
Once a year, during the fall open enrollment period.
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.
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 Fund forms hotline, 1-212-539-0539, to request a CompBenefits brochure. The booklet will outline your various co-payments and give you a list of participating dentists from which to choose.
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.