Dental Group 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

Benefits Schedule

AFTER THE ANNUAL DEDUCTIBLE THIS PLAN WILL PAY:

What Is The Cost Of This Plan?

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

Eligibility

All eligible members of APWU who are actively at work, or Retirees able to perform normal duties of a person of same age and sex (including dependents) are eligible to enroll. An eligible dependent is the member's spouse and unmarried children from birth to age 19 - extended to age 25 if a full time student. (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; 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.

Exclusions

The Plan will not pay benefits for:

1. Any dental care or supply not listed as a Covered Expense shown in the COVERAGE SCHEDULE.
2. Dental care or supplies furnished in a facility operated under the direction or at the expense of the U.S. Government (or its Agency) or by a Physician or Dentist employed by such a facility.
3. Dental care and supplies for which:
   1. no charge is made
   2. would be given free of charge if the person was not insured. However, benefits will be paid for covered charges incurred by a state for medical assistance to an insured person under Title XIX of the Social Security Act of 1965.
4. Dental care or supplies resulting from taking part in the commission of an assault or felony.
5. Dental care or supplies due to an injury during the course of employment for pay, profit or gain.
6. Dental care as a result of:
   1. a war or an act of war
   2. an insurrection
   3. atomic explosion or other release of nuclear energy
   4. intentionally self-inflicted injury
7. Charges incurred after the Insured's coverage ends, regardless of when the injury or sickness occurred
8. Personal supplies for care and instructions in dental hygiene, unless used in a Physician's office.
9. Services or materials of a cosmetic nature or repair of congenital malformation solely for cosmetic purposes, unless:
   1. as a result of, and within 24 months of an accident while insured, or
   2. treatment of congenital defects of a newborn baby.
   3. cosmetic services including but not limited to:  characterizing and not personalizing prosthetic devices, making facings on prosthetic devices for any tooth in back of the second bicuspid
10. Sealants
11. Dental procedures performed by a licensed dental hygienist, unless under the supervision and direction of a licensed dentist.
12. Prescriptions drugs, unless a Covered Expense shown in the COVERAGE SCHEDULE.
13. Orthodontic care, treatment or supplies, unless covered by rider.
14. Treatment which is not essential for the necessary care or treatment of the injury or sickness involved.
15. Oral hygiene, plaque control, diet instruction, precision attachments and treatment which does not meet accepted standards of dental practice or it is experimental in nature.
16. Othodontic charges for lost or broken appliance and class 1 malocclusions.
17. Some appliances or prosthetic appliances. See your Certificate of Insurance for details.
18. Replacement of an appliance or prosthetic device unless the appliance or device is at least 10 years old and cannot be made usable;  or the appliance or device is damaged, while in the insured person's mouth in an injury which occurs while insured, and it cannot be repaired.
19. Replacement of a lost, stolen or missing appliance or prosthetic device.
20. Making a spare appliance or device.   

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 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.

Once you receive your certificate of insurance, if you're not 100% satisfied within the first 30 days, 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, union status change, life status change (i.e., marriage, divorce, or name change) or benefit changes requested. Notice must be in writing.

Administered By:

The 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 The United States Life Insurance Company in the City of New York, NAIC No. 70106, domiciled in the state of New York with a principal place of business of One World Financial Center, 200 Liberty Street, New York, NY 10281. It is currently authorized to transact business in all states plus DC, except PR. This summary is a brief description of benefits only and is subject to the terms, conditions, exclusions and limitations of Group Policy No. G-224,540, Form No. G-19000.
Coverage may vary or may not be available in all states

The underwriting risks, financial and contractual obligations and support functions associated with products issued by The United States Life Insurance Company in the City of New York (United States Life) are its responsibility.