Dental/Vision
Dental / Vision Benefits
Dental Benefits
The Fund provides a comprehensive dental program for its members and their eligible dependents that offers coverage for oral care, hygiene and other dental services. Administered through both in-network and out-of-network dentists, the Dental PPO program has set allowances for all covered dental procedures and a network of participating providers. For more information on dental benefits or to find a participating dentist, call 215-364-6500.
| Dental PPO | ||||
|---|---|---|---|---|
| Teamsters Health & Welfare PLATINUM | Teamsters Health & Welfare GOLD | |||
| $3000 Annual Maximum per person | $3000 Annual Maximum per person | |||
| PPO Dental Copayments: | PPO Dental Copayments: | |||
| Oral Surgery/Extractions | $25 per tooth | $25 per tooth | ||
| Endodontic surgery (Root Canal) | $25 per tooth | $25 per tooth | ||
| Periodontal surgery | $25 per quadrant | $25 per quadrant | ||
| Crowns, bridges, etc. | $30 per tooth | $30 per tooth | ||
| Partial/full dentures | $50 per unit | $50 per unit | ||
| Orthodontics (ages 10yrs-18yrs) | $100 per case (once per lifetime) | $100 per case (once per lifetime) | ||
| Cone Beam CT, Implant Abutment, Implant Crown | Partial Reimbursement based on balance of annual maximum left at the end of the year | Partial Reimbursement based on balance of annual maximum left at the end of the year | ||
| Dental Non-PPO | ||||
| All services are paid based on Non-PPO fee schedule Full Dental Allowances List | ||||
Vision Benefits
The Fund’s vision care benefit is administered through National Vision Administrators (NVA). NVA provides enhanced vision benefits that are cost effective and gives our members access to over 60,000 vision care combinations. Visit the NVA website to register and find detailed information on eligibility, coverage, find an eye care professional, print NVA ID cards and much more. NVA customer service representatives are also available 24/7/365 at 800-672-7723.
NVA Website
Vision Schedule of Benefits
| Vision | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Benefit Frequency | Participating Provider | Non-Participating Provider | ||||||||||||||||||
ExaminationOnce Every 12 Months | Covered 100% | Reimbursed Amount
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FrameOnce Every 24 Months | Retail Allowance
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Contact LensesOnce Every 24 Months | In lieu of lenses & frames | In lieu of lenses & frames | ||||||||||||||||||
| Elective Contact Lenses |
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| Medically Necessary**** |
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