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Telephone: 212-505-5050
Email: intake@dhcook.com
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Comprehensive dental expense benefits
The WCT Welfare Trust Fund provides Comprehensive Dental Expense Benefits. This benefit is self-insured and is administered by a third-party administrator. Comprehensive Dental Expense Benefits are provided for you and your eligible dependents.
What are the covered expenses?
Covered expenses are charges for a broad range of dental services. For most services the amount counted as a Covered Expense is determined from a schedule of Covered Dental Services provided at the back of the booklet.
What is the deductible?
There is no deductible.
How do comprehensive dental benefits work?
Comprehensive Dental Expense Benefits provide scheduled reimbursement for expenses you have for preventive, basic and major non-orthodontic dental services with no deductible requirement.
The schedule of benefits
Your Comprehensive Dental Expense Benefits program pays a set amount for covered expenses you incur for preventive, basic and major dental services up to a maximum benefit of $2,250 per year for each covered member and $2,250 per year for each eligible dependent. There is no annual deductible for you or your dependents. The maximum amounts the Plan will pay for specific services are given at the back of the booklet.
Pre authorization
Pre -authorization is not required, however, benefits should be determined before you begin treatment if the charges for the treatment will be more than $400. You should ask your dentist to describe the proposed treatment and charges on a Dental Claim Form. The form should then be sent to Daniel H. Cook Associates, Inc. whose address appears on the top portion of the claim form. We will notify you and your dentist how much we will consider as Covered Expenses and how much we will pay. It is to your advantage to know exactly what you will be paid before treatment begins.
Alternate benefit provisions
When more than one dental service would provide suitable treatment, your benefits will be based on the treatment determined by the Plan to be best suited to your condition by accepted standards of dental practice. If two services would each provide satisfactory results according to accepted standards of dental practice and one service is less expensive than the other, the Plan will reimburse up to the maximum allowance for the less expensive treatment.
Dental benefit maximums
Dental (Annual) - Members: $2,250.00 - Dependents: $2250.00
All prosthetic services are payable once per five years.
All lifetime maximums are subject to the Annual Dental Maximum.. The annual dental maximum is a calendar year maximum.
Participating provider option
On behalf of the WCT Welfare Trust Fund, its third party administrator, Daniel H. Cook Associates, Inc., has contracted with certain dentists to provide basic dentistry for covered services at no out-of-pocket expense for members and co-payments for dependents.
Exclusions
Benefits will not be paid for charges for:
• treatment from anyone other than a licensed dentist or physician, except routine cleaning of teeth and fluoride application which is performed by a licensed dental hygienist under the direct supervision of, and billed by, a dentist or physician,
• facings, veneers, or similar material placed on molar crowns or pontics,
• services performed by a member of your or your spouse's immediate family,
• services or supplies that are cosmetic in nature or directed toward a cosmetic end,
• any service or supplies incurred, installed, or delivered before you or your dependents become eligible for benefits under this Plan,
• replacing a lost, missing or stolen prosthetic appliance,
• a broken appointment,
• any services received from a medical department, clinic or any facility provided or furnished by your or your dependent's employer,
• any service that is not necessary or is not normally performed for proper dental care of the condition or any service that is not approved by the attending dentist,
• services or supplies that do not meet accepted standards of dental practice including experimental services or supplies,
• services or supplies received as a result of dental disease, defect, or injury due to an act of war, declared or undeclared,
• any duplicate prosthetic appliance except as specifically provided,
• completing claim forms,
• oral hygiene, or dietary instruction or plaque control programs,
• implants and implant services,
• orthodontic appliances and treatments,
• wiring or bonding teeth or crowns to act as a splint for any reason,
• an injury arising from employment,
• illness covered by Workers' Compensation,
• services or supplies for which you are not required to pay,
• expenses incurred outside of the United States or Canada unless you or your dependents are residents of one or the other and the charges are incurred while traveling on business or for pleasure,
• appliances, restorations, or any procedure to alter vertical dimension or restore occlusion,
• services or supplies not specifically listed under covered expenses.
Extension of dental benefits
If your dental coverage terminates, benefits will be extended for expenses you have for dentures, fixed bridgework, crowns and inlays, or endodontic treatment, including root canal therapy, if:
• treatment was begun before coverage ended,
• appliances, where appropriate, were ordered before coverage ended, and treatment is completed within 60 days after the date you ended.
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