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RETIREE FUND
Dental Plan
An integral part of the PBA Retiree Health and Welfare
Fund Dental Plan is the Preferred Provider Organization (PPO).
The PPO is a select group of dentists who have agreed to accept
the PBA Dental Plan fees as payment-in-full for all covered services
for members and their eligible dependents. A separate listing of
all of the PPO locations is published and may be obtained by contacting
the PBA Funds Office.
All benefits are subject to the terms, conditions,
and limitations of the PPO contract.
The Dental Plan provides coverage for the major areas of dentistry,
i.e.:
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Basic (exams, X-rays, fillings, cleanings, etc.)
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Prosthodontics (crowns, bridges, etc.)
-
Orthodontics (dependent children to age 19)
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Sealants (dependent children to age 12)
If a dentist is selected from the PPO Dental Panel, the dentist
will accept the PBA Fund's allowances as payment-in-full for all
covered services. The dentist may charge for non-covered services,
or for services where the Dental Plan benefits have been exhausted.
However, if a dentist who is not a participant on our panel is utilized,
the PBA Dental Plan will only pay the applicable allowance. The
member may be required to supplement the PBA Dental Plan allowance
based upon the difference between the PBA Dental Plan allowance
and the fee being charged by the dentist. Furthermore, the PBA Funds
Office cannot intercede on the member's behalf if there are disputes
regarding charges.
All covered dental procedures are paid based on a fixed schedule
of allowances, which is outlined in greater detail in the dental
benefit booklet available upon request.
The member may obtain claim forms through the PBA
Funds Office or use a universal dental claim form. The member should
read the instructions on the reverse side of the claim form and
complete the upper portion (member's section), and give the form
to the dentist. The dentist must then complete the lower portion
of the form. Once the dentist has completed the form, the member
should read the form, sign it and date it. The completed form should
then be submitted to the PBA Funds Office.
Certain types of dental procedures require approval
by the PBA Funds Office before treatment is commenced. This prior
approval is called "pre-certification" and applies to
all:
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Prosthodontic services, e.g., full or partial dentures, inlays,
crowns, bridges, etc.
-
Orthodontic services.
Basic dental services (examinations, X-rays, fillings, etc.) may be submitted
without prior approval of the PBA Funds Office. However, a dental
claim form stating the dentist's fee, the date the service was rendered,
and a description of the service rendered is required.
- Signature on file with the dental office is acceptable.
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