2009 Supplemental Dental Benefits Non-FEHB Benefits Available To Plan Members
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Member Benefits
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Benefits Information
The benefits described on this page are neither offered nor guaranteed under the contract with the FEHB Program, but are made available to all enrollees and family members of this Plan. The cost of the benefits described on this page is not included in the FEHB premium and any charges for these services do not count toward any FEHB deductibles, out-of-pocket maximum co-pay charges, etc. These benefits are not subject to the FEHB disputed claims review procedure.
Voluntary
Benefits
Plan Dental
Plan |
The Voluntary Benefits Plan Dental program is an optional program with an additional premium that supplements the dental benefits in your APWU Health Plan coverage. All participants of the APWU Health Plan who enroll in the Voluntary Benefits Plan Dental Plan through this offer will receive a discount in the regular premiums for that program. To enroll in this additional coverage, complete and sign the Voluntary Benefits Plan Dental Plan enrollment form, which you can obtain from your APWU Health Plan representative or by calling the Voluntary Benefits Plan office at the toll-free number listed below. Please specify that you are an APWU Health Plan participant. |
| Availability |
The Voluntary Benefits Plan
Dental Plan is available to all Active, Retired, Associate and Transitional Employee
APWU Members. May not be available in all States. Not available
in U.S. Territories of Puerto Rico, Virgin Islands, American Samoa or Guam.
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Coverage
Description |
This optional
dental plan is an indemnity insurance plan underwritten by the United States Life
Insurance Company in the City of New York. A member company of American
International Group, Inc. You may use any dentist you choose.
Covered services are reimbursed as a percentage of the "Reasonable and Customary" charges for that service in the state where the charge is incurred. Once you have satisfied the continuous coverage limitations of the program, there are no further waiting periods as long as you remain continuously insured under the plan. Both you and your eligible dependents (spouse and unmarried children to age 19 - full-time students to age 25) can be insured under this plan.
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Coverage
Schedule |
| Calendar Year Deductible: |
$50 per person - Type I benefits
$100 per person - Type II and Type III benefits, combined
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| 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
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| Lifetime Maximum: |
$1,000 for Orthodontic services, if Optional Orthodontic Coverage is selected
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Benefit Schedule
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After the Annual Deductible, this plan will pay:
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HIGH OPTION PLAN
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LOW OPTION PLAN
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TYPE I BENEFITS
Preventive Services
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100%
of the Reasonable and Customary
charges
(no waiting period)
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100%
of the Reasonable and Customary
charges
(no waiting period)
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TYPE II BENEFITS
Basic Services
- Fillings
- Oral Surgery
- Extractions
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80%
of the Reasonable and Customary
charges
(6 month waiting period)
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50%
of the Reasonable and Customary
charges
(6 month waiting period)
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TYPE III BENEFITS
Major Services
- Crowns
- Bridges
- Dentures
- Periodontics
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50%
of the Reasonable and Customary
charges
(12 month waiting period)
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50%
of the Reasonable and Customary
charges
(18 month waiting period)
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TYPE IV BENEFITS
(Optional Coverage)
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50%
of the Reasonable and Customary
charges
(24 month waiting period)
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50%
of the Reasonable and Customary
charges
(24 month waiting period)
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This is a partial summary of the terms, conditions and limitations of the Dental Plan policy #G-224540. For more information regarding the coverage, rates or to receive an enrollment form, please contact the Voluntary Benefits Plan office by calling or writing:
Benefits on this page are not part of the FEHB contract.
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