Dental Insurance Plan

 

The Dental Plan is an indemnity plan. Under this program, covered services are reimbursed as a percentage of the "Usual and Customary" charges for that service in the state where the charge is incurred.

Obtain Services From Any Dentist

Under this program, insured members may use any dentist they choose. If you were previously a member of a dental plan requiring the use of a specific dentist, you may continue to use that dentist if you so choose, but it is not a requirement of the Dental Plan.

 

Coverage Schedule

 

Calendar Year Deductible No Deductible for - Type I Benefits$100 per person - Type II and Type III benefits, combined
Calendar Year Maximum $1,500 Per person for all covered services
$500 per person for all eligible Orthodontic services, if Optional Orthodontic Coverage is selected
Lifetime Maximum $1000 for Orthodontic services, if Optional Orthodontic Coverage is selected

 

Benefits Schedule

AFTER THE ANNUAL DEDUCTIBLE THIS PLAN WILL PAY:

 

 

  High Option Low Option
TYPE I BENEFITSPreventive Services
  • Exams
  • X-Rays
  • Cleanings
100%
of the Reasonable and Customary
charges
(No Waiting Period)
100%of the Reasonable and Customary
charges
(No Waiting Period)
TYPE II BENEFITSBasic Services
  • Fillings
  • Oral Surgery
  • Extractions

80%
of the Reasonable and Customary
charges

(No Waiting Period)

 

50%
of the Reasonable and Customary
charges

(No Waiting Period)

TYPE III BENEFITSMajor Services
  • Crowns
  • Bridges
  • Dentures
  • Periodontics

50%of the Reasonable and Customary
charges

(After 12-month
waiting period)

50%
of the Reasonable and Customary
charges

 (After 18-month
waiting period)

TYPE IV BENEFITS
(Optional Coverage)
Applies only to insured dependent children under 19

 

  • Orthodontic

50%
of the Reasonable and Customary
charges

 (After 24-month
waiting period)

50%
of the Reasonable and Customary
charges

 (After 24-month
waiting period)

 

What Is The Cost Of This Plan?

 

Click Here to view the Dental Plan Bi-Weekly Rates by state​

Click Here to view the Dental Plan Monthly Rates for

Retiree and Associate Members

Click here for a Dental Plan Activation (Enrollment) Form

 

Eligibility

All persons who are dues-paying APWU members in good standing and are actively at work on a full-time basis (at least 20 hours per week) or APWU dues-paying Retirees (including dependents) are eligible to enroll. Associate members, PSE's and Private sector members are also eligible to enroll as long as they are paying dues to the APWU. An eligible dependent is your lawful spouse or domestic partner and unmarried dependent children whom you support up to age 26. (Subject to state variations)

 

Deductible Amount

The Deductible is shown in the coverage Schedule. The Deductible is an amount of covered dental charges incurred by an insured person before benefits will be paid.

 

Calendar Year Maximum

The maximum amount payable for all Eligible Dental Expenses in any calendar year is shown in the Coverage Schedule. The Calendar year maximum will apply to each insured person.

 

Reasonable & Customary

This means a charge that does not exceed the Dentist's usual charge and the usual level of charges being made by other providers of dental services with similar training and experience in the same geographic area.

 

Waiting Period

The period of time the insured person must be continuously covered under the group policy before the insured is entitled to be reimbursed for covered dental charges. (see Coverage Schedule)

 

Eligible Expenses

Expenses must be incurred while the Policy is in force and the person is covered by the Policy. To be an Eligible Expense, the dental service must be performed by a licensed Dentist acting within the scope of this license to: (1) render dental services; (2) perform dental surgery (3) administer anesthetics for dental surgery.

 

Effective Date:Coverage will become effective on the day your activation form and first premium is received and accepted.

 

Date Insurance Ends:  This coverage will end on the earliest following date: when the group policy ends; when the premium is not paid when due; when the member leaves the union; dependent termination reasons: your insurance ends, dependents' insurance ends under the group policy, the person is no longer a dependent, premium is not paid for the dependent; with respect to the spouse, the date the spouse is no longer a legal spouse; or with respect to the children, the date the children are no longer dependent.

 

Coverage may not be available in all states. The following states are currently excluded from coverage in the Dental Plan:

MT, NH, OR, SD.

 

Exclusions

   

We will not pay Dental Insurance Benefits for charges incurred for:

 

  1. Services which are not Dentally Necessary, those that do not meet generally accepted standards of care for treating the particular dental condition, or which we deem experimental in nature. 
  2. Services for which you would not be required to pay in the absence of Dental Insurance.
  3. Services or supplies received by you or your Dependent before Dental Insurance starts for that person.
  4. Services which are primarily cosmetic (for residents of Texas, see notice page section in Certificate).
  5. Services which are neither performed nor prescribed by a Dentist except for those services of a licensed dental hygienist which are supervised and billed by a Dentist and which are for:
      1. Scaling and polishing of teeth; or
      2. Fluoride Treatments.
  6. Services or appliances which restore or alter occlusion or vertical dimension.
  7. Restoration of tooth structure damaged by attrition, abrasion or erosion.
  8. Restorations or appliances used for the purpose of periodontal splinting.
  9. Counseling or instructing about oral hygiene, plaque control, nutrition and tobacco.
  10.  Personal supplies or devices including, but not limited to:  water piks, toothbrushes or dental floss.
  11. Decoration, personalization or inscription of any tooth, device, appliance, crown or other dental work.
  12. Missed appointments.
  13. Services:
    1. Covered under any workers' compensation or occupational disease law;
    2. Covered under any employer liability law;
    3. For which the employer of the person receiving such services is required to pay; or
    4. Received at a facility maintained by the Employer, labor union, mutual benefit association or VA hospital.
  14. Services covered under other coverage provided by the Employer.
  15. Temporary or provisional restorations.
  16. Temporary or provisional appliances.
  17. Prescription drugs.
  18. Services for which the submitted documentation indicates a poor prognosis.
  19. The following when charged by the Dentist on a separate basis:
    1. Claim for completion;
    2. Infection control such as gloves, masks and sterilization or supplies; or
    3. Local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide.
  20. Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food.
  21. Caries susceptibility tests
  22. Replacement of an orthodontic device.
  23. Duplicate prosthetic devices or appliances.
  24. Replacement of a lost or stolen appliance cast Restoration or Denture.
  25. Intra and extraoral photographic images.

 

A complete list of limitations and exclusions is provided in the certificate of insurance.

  

Expenses Incurred

 All covered dental services must be provided by, or under the direct supervision of a dentist.

  

Charges must be incurred by an insured person while he is insured in order to be covered charges:

  •  For a crown, bridge, or cast restoration, the charge is incurred on the date the tooth is prepared.
  • For any other prosthetic device, the charge is incurred on the date the master impression is made.
  • For root canal, the charge is incurred on the date the pulp chamber is opened.
  • For all other services, the charge is incurred on the date the services are given.

 

It's Easy To Enroll

   

  1. Simply complete the Activation Form. Please make sure you complete all the information requested. An incomplete Activation Form will be returned, resulting in a delay in processing your Activation Form.Click here for a Dental Plan Activation (Enrollment) Form​

  2. Send no money.

  3. Return your Activation form to: The Voluntary Benefits Plan, P.O. Box 12009, Cheshire, CT 06410 or fax to 1-203-754-7847.

 

  

If you're not 100% satisfied within the first 30 days after we receive your first premium payment, we'll send you a full refund of any premiums paid during that period and your certificate will be considered never issued. You will be under no further obligation.

  

Any Questions?

Call the following toll-free number 1-800-422-4492

Please Note

You must notify The Voluntary Benefits Plan of any address change for you, your dependents and/or beneficiaries, and any change in employment and union membership status change, life status change (i.e., marriage, divorce, beneficiary or name change), or benefit changes requested. Notice must be in writing.​

 

Administered By:

Voluntary Benefits Plan
P.O. Box 12009
Cheshire, CT 06410
Phone: 1-800-422-4492
Fax: 1-203-754-7847

 

   

This plan is underwritten by Metropolitan Life Insurance Company, New York, New York.  This summary is a brief description of benefits only and is subject to the terms, conditions, exclusions and limitations of Group Policy No. 122705.

 

  

Coverage may not be available in all states. The following states are currently excluded from coverage in the Dental Plan: 

MT, NH, OR, SD

 

Currently Enrolled Dental Plan Members

Dental Plan Certificates

Please click on the Dental Plan Certificate below if you reside in one of the following states (We do not currently have all certificates for all states available at this time, please check back if your Certificate is not currently listed below)

AL, AR, CO, CT, DC, DE, FL, GA, HI, KS, KY, IA, IL, MA, MI, MN, MO, MS, ND, NE, NJ, NV, NY, OH, OK, PA, RI, TN, VA, WI, WY.

Dental Plan Certificate of Coveragewithout Orthodontic Coverage

Dental Plan Certificate of Coverage with Orthodontic Coverage

 

Please click on the certificate below if you reside in the state of:

California

Dental Plan Certificate of Coverage without Orthodontic Coverage - CA

Dental Plan Certificate of Coverage with Orthodontic Coverage - CA

 

Please click on the certificate below if you reside in the state of: ​

Louisiana

Dental Plan Certificate of Coverage without Orthodontic Coverage - LA

Dental Plan Certificate of Coverage with Orthodontic Coverage - LA

 

Please click on the Certificate below if you reside in the state of:

Washington

Dental Plan Certificate of Coverage without Orthodontic Coverage - WA

Dental Plan Certificate of Coverage with Orthodontic Coverage - WA

 

Please click on the certificate below if you reside in the state of:

West Virginia

Dental Plan Certificate of Coverage without Orthodontic Coverage-WV

Dental Plan Certificate of Coverage with Orthodontic Coverage-WV

 

Please click on the certificate below if you reside in the state of:

Idaho

Dental Plan Certificate of Coverage without Orthodontic Coverage-ID

Dental Plan Certificate of Coverage with Orthodontic Coverage-ID

 

 To find our more about your member benefits today, click here.