For questions and issues with coverage and enrollment, contact Health Plans Inc., 1-877-906-5939
Your trustee on the Health and Welfare Trust: Sue Couture, 577-2412
Look below the PDF for an overview of the coverage and percentages.dental-questions-and-answers
An overview of our plan:
|Coverage Type||PDP In-Network||Out-of-Network|
(For example, cleanings, oral examinations and other maintenance type procedures)
|100% of PDP Fee||80% of R & C fee|
(For example, fillings and other standard dental procedures)
|80% of PDP fee||60% of R & C fee|
(For example, bridges and dentures and other complex procedures) Note: If you're redoing a crown, bridge or implant, you must wait 10 years in order to have it covered.
|50% of PDF fee||30% of R & C fee|
|Annual Maxiumum Benefit||In-Network||Out-of-Network|
*PDP Fee refers to the fees that participating PDP dentists have agreed to accept as payment in full, subject to any co-payments, deductibles, cost sharing and maximums.
**R&C fee refers to the REasonable and Customary (R&C) charge, which is based on the lowest of (1) the dentist’s actual charge, (2) the dentist’s usual charge for the same or similar services, or (3) the charge of most dentists in the same geographic area for the same or similar services as determined by Metlife.
–Dependents are covered until the age of 26. You no longer have to prove they are a students.
–A recent change is that major work, like crowns, bridges and implants can only be replaced after 10 years. This was a cost-saving addition for the trust, but will affect those of you who need a replacement for any of the mentioned services that were done within the 10 year period.