The UFT Welfare Fund provides dental benefits through two programs: the Scheduled Benefit Plan, which provides services through either a designated panel of dentists or a dentist of your choice; and Dentcare, a no-cost dental HMO.
The open enrollment period to change plans is Sept. 1 to Oct. 15 each year, with changes taking effect on Nov. 1.
Scheduled Benefit Plan: The full-choice option
The plan you are automatically placed in when you enroll in the UFT Welfare Fund (effective your first day of work) is the Scheduled Benefit Plan. If you select one of the affiliated panel dentists (called SIDS), many routine procedures, such as cleanings, are free. Cleanings for adults are covered every three months. Exams are covered every six months with a $15 copayment. Panel dentists may charge a copay 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. If you go to a dentist not on the panel, it’s a good idea to show that dentist a copy of the UFT’s Schedule of Covered Dental Expenses since it might influence how much you are charged. The claim form and the fee schedule can both be downloaded from the health benefits section of the UFT website, or you can call the Welfare Fund’s 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 4,000 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.
If you’d like to continue seeing your current dentist, check to see if your dentist participates in Dentcare or is a SIDS panel dentist with the UFT. 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 one 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 your benefits 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 the claim payment directly to your dentist. Instead, check the appropriate box at the top right of the claim form and submit it directly to CIGNA.
A dental plan for your extended family
The UFT’s Direct Access Dental Plan provides access to quality dental care at a discounted rate to UFT members’ family members who are not covered by the regular UFT dental plan. Parents and other family members may enroll in this plan, in addition to UFT family child care providers, part-time employees and per diem substitutes without benefits.
With an individual plan rate of $36 a year and a family rate of $48 a year, your noncovered family members have access to a panel of more than 700 dentists who will charge a prenegotiated rate that is published in the discounted benefits schedule.