Dental Care Expense Benefit

(For ALL Eligible Participants)

The Plan imposes an annual limit on dental care.  The limit applies as follows:


Under the Dental Care Expense Benefit, if you are age 18 or older, the Plan pays benefits for the actual cost of your eligible Dental Care Expenses up to the calendar year maximum of $250 per person.


The following rules apply to individuals under age 18:

  • Preventive  Care.    The  Plan  will  pay  100%  of  the  actual  cost  of  two  preventive dental  examinations  (including  cleanings)  per  calendar  year  and  one  set  of  dental  x-rays  per calendar  year.    This  100%  coverage  does  not  include sealants  or  fluoride  treatment.    This preventive care benefit is not subject to the $250 annual limit on nonpreventive benefits.
  • Nonpreventive  Care.    The  Plan  will  pay  benefits  for  the  actual  cost  of  eligible nonpreventive  Dental  Care  Expenses  provided; however,  benefits  will  only  be  payable  for nonpreventive care until the total amount paid for both preventive and nonpreventive dental care totals $250 during each calendar year.

Covered Dental Care Charges

The Dental Care Expense Benefit provides reimbursement for any non-cosmetic dental expenses, including orthodontia, up to the maximum listed in the Schedule of Benefits.  Services must be performed  by  a  dentist,  oral surgeon,  orthodontist,  or  oral  hygienist,  and  must  not  be  payable under the medical benefits program.

Exclusions from Dental Care Coverage

  1. No coverage is provided under this Dental Care Expense Benefit for loss or expense caused by, incurred for, or resulting from:
  2. Surgical or medical care for treatment of gum or mouth disease and/or injury.
  3. Injury or sickness arising out of or in the course of employment or which is compensable under Workers’ Compensation or Occupational Disease Act or Law.
  4. Declared or undeclared war, or act of war.
  5. Dental care services, screening services or supplies received from a medical department maintained by a mutual benefit association, labor union, Trustee, Employer, or a similar group.
  6. Expenses incurred for cosmetic or fashion reasons.


Filing Dental Claims

Follow these steps to obtain reimbursement:

  1. Receive dental services from the provider of your choice.
  2. Pay the bill in full when the services are rendered or the supplies are received.
  3. Obtain a claim form from the Fund Office.
  4. Complete the form and sign in the space provided.
  5. Send  the  completed  form  and  your  paid  receipt  and  mail  to the  Dental/Vision  Claims Administrator as listed in the Contact Information section.