How the Plans Pay Benefits
The Trust Early Retiree Voluntary Dental Plans pay a percentage of covered expenses, based on usual and customary or reasonable rates (UCR), up to a maximum benefit amount per calendar year. There is no maximum for children under 19. UCR rates represent the fees and prices regularly charged by your dentist and other dentists in your area for the dental services and supplies generally furnished for cases like yours. You are responsible for paying coinsurance for covered services, costs exceeding the UCR, and all expenses over the annual benefit maximum and lifetime orthodontic maximum.
If you select a more expensive plan of treatment than is UCR, the Trust Early Retiree Voluntary Dental Plans will pay the applicable percentage of the UCR fee for the less expensive treatment. You will be responsible for the remainder of the dentist's fee.
The Basic and Buy-up Dental Plans cover many of the same services. The plans differ in the amount of benefits they pay — you will pay an annual deductible and higher coinsurance for some services under the Basic Dental Plan, but you will also pay a lower monthly premium rate for this coverage. The Basic Dental Plan also does not cover orthodontia services, while the Buy-up Dental coverage does.
Annual Deductible
The Basic Dental Plan annual deductible is $50 per person per calendar year. You pay the deductible each year before the plan begins to pay benefits.
There is no annual deductible under the Buy-up Dental Plan.
Maximum Benefits
The Basic Dental Plan pays a percentage of covered expenses based on UCR, up to $1,200 per person per calendar year.
The Buy-up Dental Plan pays a percentage of covered expenses based on UCR, up to $1,750 per person per calendar year. This plan also pays orthodontic benefits up to a lifetime maximum of $1,250 per person.
The dollar amount that the Trust pays toward covered dental services for you or a covered dependent during a calendar year is applied toward this annual maximum.
If you wish to see how much has been paid toward the annual maximum as of a given date, you may call Regence. You should remember that the amount you will be given will only reflect the bills for service that Regence has received and processed as of the date your inquiry is made.
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