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Q.
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Do I have dental coverage?
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A.
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Dental benefits are available to participants and eligible dependents covered under the Active Indemnity plan. Participants and their dependents covered under the Casual and Retiree plans are not eligible for dental benefits.
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Q.
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What is my claim status?
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A.
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You should contact your administrative office for the status of specific claims.
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Q.
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Why was my claim denied?
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A.
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Your Explanation of Benefits should provide the specific reason as to why a claim was denied. If you have further questions, please contact your administrative office.
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Q.
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At what percentage do you pay?
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A.
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The Indemnity Dental plan reimburses 85% of UCR for Preventive Care services, 80% of UCR for Basic care services and 50% of UCR for Major restorative services.
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Q.
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What does my Dental Plan cover?
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A.
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Eligible preventive, basic, major restorative and prostethic services are covered under your Indemnity Dental plan. Specific plan limitations and exclusions can be found in your plan booklet.
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Q.
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How do I use my dental plan?
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A.
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Under the indemnity plan, you can go to any licensed dental practitioner. Your provider should then submit the billing to the administrative office. If your provider does not submit claims to insurance, you will need to forward an itemized statement to your administrative office. Please make sure that the participant's name and social security number are clearly indicated on the billing.
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Q.
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Can I use any dentist of my choice?
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A.
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Under the indemnity plan, you can utilize the services of any licensed dental provider.
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Q.
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What is your mailing address?
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A.
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There are several area administrative offices for the Western Teamsters Welfare Trust. Please refer to the address indicated on your I.D. card for the address of your administrative office.
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Q.
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Do you accept electronic billing?
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A.
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At the current time, we are not able to accept electronic claims.
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Q.
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How long does it take to process a pre-authorization and claim for payment?
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A.
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Our normal turn around time is 10 to 14 working days. Some may take longer to process depending on whether or not all information needed to process the claim is included with the original submission.
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Q.
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Is prior approval required?
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A.
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It is strongly recommended that you obtain a "predetermination of benefits" when charges for services are going to exceed $500.00. This is provided as a courtesy to inform you and your provider with an estimate of your out of pocket expenses. Please note that a "Predetermination of Benefits" is not a guarantee of benefits.
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Q.
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Is there a Plan maximum?
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A.
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The maximum benefit for eligible dental services is $2,000.00 per person per calendar year. Orthodontic services are not considered under the regular dental benefits. They are subject to their own maximums and exclusions.
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Q.
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Is there a Dental Plan deductible?
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A.
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There is a $50.00 per person per calendar year deductible for all dental services. Orthodontic services are not subject to the $50.00 calendar year deductible.
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Q.
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Are orthodontic benefits available for adults?
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A.
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No. Orthodontic benefits are limited to eligible dependent children covered under the Indemnity Dental Plan.
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Q.
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Are sealants covered and up to what age?
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A.
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Sealants are covered for eligible dependent children under 19 years of age and are limited to once in any three year period to the first and second molars with no previous caries.
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Q.
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Are dental implants covered?
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A.
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Yes, implants are covered under your dental plan and benefits are subject to the $2,000.00 calendar year maximum for all dental services.
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Q.
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Are benefits available for dental services obtained outside of the U.S.A.?
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A.
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Yes. However, dental services received outside the USA are subject to the same maximums, limitations and exclusions as services received within the United States.
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Q.
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If I get laid off or terminated, how long will I be covered for dental benefits?
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A.
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Benefits cease at the end of your last covered month. However, benefits will be extended for one month for any eligible dental service which was already started, provided the work is done by the same dentist, and benefits would have been paid had the coverage remained in effect. In no event will diagnosis, prophylaxis (cleaning), or the taking of x-rays constitute service started.
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Q.
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Do you coordinate benefits? Birthday rule? Gender?
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A.
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The indemnity Medical and Dental plans follow standard coordination of benefits guidelines. In the case of dependent children of married parents, the birthday rule is used to determine the order of benefits. In the case of divorced parents, the order of benefit determination is based on the custodial parent unless there is a court decree, which defines who is financially responsible for maintaining health benefits on the dependent children. For specific information regarding the Order of Benefit Determination, please refer to your plan booklet.
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Q.
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How do I change my address?
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A.
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You should notify your administrative office in writing of any address change. This can be in the form or a letter to the administrator, or more preferably, a new Participant Data Form completed and returned to the administrative office.
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Q.
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How do I add a dependent to my coverage?
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A.
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When there is a change in your dependents due to a birth, marriage, age attainment, divorce, etc., you will need to complete a new Participant Data Form and send it to your administrative office. This must be done before any claims can be processed or benefits released on new dependents.
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Q.
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Can the member's spouse sign the claim form?
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A.
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Claim forms are no longer required by the Trust. If a claim form is being used, the participant will need to sign the form.
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Q.
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What is UCR?
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A.
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UCR is defined as the maximum amount that is considered for reimbursement. A specific definition of this term can be found in the General Definitions section of the plan booklet.
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Q.
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Where can I get a plan booklet and ID card?
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A.
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If you are in need of a plan booklet or I.D. card, you should contact your administrative office.
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Q.
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Do I have vision coverage under my plan?
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A.
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Vision benefits are available to Active and Casual participants and their eligible dependents. Your vision benefits are administered by Vision Service Plan. You can contact VSP at:
VISION SERVICE PLAN
P.O. Box 997100
Sacramento, CA 95899
1-800-662-7444
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Q.
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Why do I have to pay upfront for my Prescriptions instead of just paying my co-pay?
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A.
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When you use an NBN/RX Network Pharmacy or Non-Network Pharmacy, there are no co-pays on the Active Plan. You pay the pharmacy up front for the full amount. The plan will reimburse you the applicable percentage. When you use the Mail Order Pharmacy, you pay a $10.00 co-payment on brand name drugs and you pay nothing on generics.
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Q.
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Why only a 34-day supply?
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A.
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The limitation of a 34 day supply or 100 units is for NBN/Rx Network and Non-Network Pharmacies only. When you use the Mail Order Pharmacy, you can receive up to a 100 day supply.
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Q.
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Why such a low reimbursement for retirees of 50% and 60%?
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A.
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Bob?
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