ILWU-PMA Benefit Plans - San Francisco Area Dental Plans

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For

Actives in San Francisco Locals 18, 34A (Stockton) and 54
Retirees / Survivors living in Northern California

Plans

Delta Dental of California
Dental Health Services

DENTAL CHOICE

Eligible families in Northern California Locals 18, 34A (Stockton), 54 and retirees living in Northern California are now offered a choice of dental plans. The choice is made when eligibility is first obtained. Plans may be changed during a choice period each year, in May. In addition to the May choice period, members may change their dental plan once at any time during the Plan Year (July 1-June 30). You must give the Benefit Plans office written notice of your change. The Benefit Plans office will provide written confirmation of the change and notice of the effective date. Retirees are also offered a choice when they move into a new area where more than one plan is available.

If you are a new eligible, or if you want to change dental plans, complete a Dental Program Choice Form and mail to the Benefit Plans office. Choice forms are available at the Locals or the Benefit Plans office.

BENEFITS

The Dental Plans are briefly described in this section. You will be furnished with a Supplemental Summary Plan Description for your Dental Plan at the time you become eligible. You can also obtain a copy at your Local or by contacting the Benefit Plans Office or your Area Welfare Director.

Delta Dental of California

You may visit any licensed dentist. By selecting a participating dentist (member of Delta Dental) you are assured of direct payment to the dentist and a guarantee of the maximum benefits payable. No identification card is necessary. The dentist submits the claim to Delta Dental, and payment is made directly to the dentist. Most dentists in California have the necessary claim forms. The adult dental program pays 80% of the participating Dentist’s Usual, Customary and Reasonable (UCR) charges for covered services. Use of a non-Delta dentist may result in Plan payment of less than 80% and member responsibility of more than 20%. The children’s dental program covers children up to age 19 and provides covered dental services, other than orthodontic services, at no cost to the patient. For orthodontic services, Delta Dental will pay 90% of the Dentist’s Usual, Customary and Reasonable charges for children up to age 19. The member is responsible for the remaining balance.

Dental Health Services

Under this plan, all services are provided by DHS contracted dentists. You must choose a dentist from the list of Dental Health Services Participating Providers as your regular dentist. You must see this dentist except for emergencies. No identification card is necessary, there are no claim forms to fill out, and no prior authorization of treatment is required. Most covered services are provided at no cost to the patient. For orthodontic services the DHS Group Plan will pay 90% of the DHS contracted dentist’s UCR charges for children up to age 19. The member is responsible for the remaining balance.