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Dental BenefitsIn addition to basic medical benefits, the ILWU-PMA Welfare Plan offers dental care coverage to members and their families with Welfare Plan eligibility. 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 or your Area Welfare Director. Dental Plans Dental coverage is provided through Delta Dental in all areas. Some areas provide a choice in Dental Plans. Please select your area below to find more information about your Dental Plan. Areas Southern California Area / ILWU Locals 13, 26, 29, 46, 63, 94 San Francisco Area / ILWU Locals 10, 34, 75, 91 Northern California Area / ILWU Locals 18, 34A (Stockton), 54 Portland / Vancouver Areas / ILWU Locals 4, 8, 40, 92 Washington Area / ILWU Locals 7, 19, 21, 23, 24, 25, 27, 32, 47, 57, 52, 98 All other areas Dental Implant Program Dental Implant Program Information |
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Southern California Area - ILWU Locals 13, 26, 29, 46, 63, 94For
Actives in Southern California Locals 13, 26, 29, 46, 63, 94 Retirees / Survivors living in Southern California Area Dental Choice Eligible families in the Southern California Area are 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 with coverage under the new plan beginning July 1. 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 written notice of your change. The Benefit Plans will provide written confirmation of the change and notice of the effective date. Retirees and Survivors 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 Southern California Dental Program Choice Form and mail to the Benefit Plans main office. Choice forms are also available at the Locals and the Benefit Plans main office. Plans/Forms for Locals 13, 26, 63 and 94 Delta Dental of California A Delta Dental PPO directory listing the names and addresses of Delta Dental Premier providers is available at: www.deltadentalins.com Dental Health Services - Benefits described in the WA booklet apply to Southern California Area subscribers Harbor Dental Associates (formerly Sakai, Simms) Dental Program Choice Form for Locals 13, 26, 63 or 94 Plans/Forms for Locals 29 and 46 Delta Dental of California A Delta Dental PPO directory listing the names and addresses of Delta Dental Premier providers is available at: www.deltadentalins.com Dental Health Services - Benefits described in the WA booklet apply to Southern California Area subscribers Dental Program Choice Form for Locals 29 or 46 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 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. A Delta Dental PPO directory listing the names and addresses of Delta Dental Premier providers is available at: www.deltadentalins.com Harbor Dental Associates (formerly Sakai, Simms) Services provided at group offices only: 25617 Dodge Ave., at Pacific Coast Hwy., Harbor City, CA 8540 S. Sepulveda Blvd. (at Manchester), Suite 815, Los Angeles, CA All dental services are provided at the Dentists Group offices of Harbor Dental Associates. No identification card is necessary, there are no claim forms to fill out, and no prior authorization of treatment is required. Covered services are provided at no cost to the patient. 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. San Francisco Area - ILWU Locals 10, 34, 75, 91For
Actives in San Francisco Locals 10, 34, 75, 91 Retirees / Survivors living in San Francisco Area Plans Delta Dental of California A Delta Dental PPO directory listing the names and addresses of Delta Dental Premier providers is available at: www.deltadentalins.com Dental Health Services - Benefits described in the WA booklet apply to San Francisco Area subscribers Gentle Dental San Francisco Dental Choice Eligible families in the Southern California Area are 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 with coverage under the new plan beginning July 1. 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 written notice of your change. The Benefit Plans will provide written confirmation of the change and notice of the effective date. Retirees and Survivors 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 San Francisco and mail to the Benefit Plans. Choice forms are also available at the Locals and the Benefit Plans. 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 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. A Delta Dental PPO directory listing the names and addresses of Delta Dental Premier providers is available at: www.deltadentalins.com 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. Gentle Dental San Francisco Services provided at group office only: 2364 Geary Blvd. (across from Kaiser), San Francisco, CA. No identification card is necessary, there are no claim forms to fill out, and no prior authorization of treatment is required. Covered services are provided at no cost to the patient. For orthodontic services the Gentle Dental Group Plan will pay 90% of the Dentist’s Usual, Customary and Reasonable (UCR) charges for children up to age 19. The member is responsible for the remaining balance. Northern California Area - ILWU Locals 18, 34A (Stockton), 54For
Actives in Northern California Locals 18, 34A (Stockton) and 54 Retirees / Survivors living in Northern California Plans Delta Dental of California A Delta Dental PPO directory listing the names and addresses of Delta Dental Premier providers is available at: www.deltadentalins.com Dental Health Services - Benefits described in the WA booklet apply to Northern California Area subscribers 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 written notice of your change. The Benefit Plans 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. Choice forms are also available at the Locals and the Benefit Plans. 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 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. A Delta Dental PPO directory listing the names and addresses of Delta Dental Premier providers is available at:www.deltadentalins.com 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. Portland/Vancouver, WA Areas - ILWU Locals 4, 8, 40, 92For
Portland / Vancouver Locals 4, 8, 40, 92 Retirees / Survivors living in the Portland / Vancouver Area Plans Oregon/Washington Dental Service (Delta Dental) A Delta Dental PPO directory listing the names and addresses of Delta Dental Premier providers is available at: www.deltadentalins.com Oregon Kaiser Dental Plan LifeMap-Willamette Dental Plan Dental Choice Eligible families in the Portland/Vancouver Area are 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 with coverage under the new plan beginning July 1. 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 written notice of your change. The Benefit Plans will provide written confirmation of the change and notice of the effective date. Retirees and Survivors 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 Oregon and mail to the Benefit Plans. Choice forms are also available at the Locals and the Benefit Plans. 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 or your Area Welfare Director. Oregon/Washington Dental Service Services provided by any licensed dentist. By selecting a participating dentist (member of Delta Dental Plan) you are assured direct payment to the dentist and a guarantee of the maximum benefits payable. The dentist submits the claim to Oregon/Washington Dental Service, and payment is made directly to the dentist. Most dentists in Oregon and Washington have the necessary claim forms. For adults, the plan pays 80% of the participating dentist’s usual, customary and reasonable (UCR) fees for covered services. For children, the plan pays 100% of covered services. (Exception: Member pays 10% of UCR fees for children’s orthodontia treatment.) A Delta Dental PPO directory listing the names and addresses of Delta Dental Premier providers is available at: www.deltadentalins.com Oregon Kaiser Dental Plan All dental services are provided at Oregon Kaiser facilities listed below. There are no claim forms to fill out and no prior authorization of treatment is required. Covered services are provided at no cost to the patient. (Exception: Member pays maximum of $300 for children’s orthodontia treatment. Services provided at plan facilities only, located: Portland 5025 S.E. 28th Avenue 1314 N.E. Grand Avenue 7201 N. Interstate Avenue 822 N.E. 181st Avenue 10102 N.E. Glisan Street Beaverton 4855 S.W. Western Avenue Clackamas 10209 S.E. Sunnyside Road Hillsboro 19350 N. W. Evergreen Parkway Tigard 7105 S.W. Hampton Street Vancouver 12711 S.E. Mill Plain Blvd. 14406 N. E. 20th Avenue Salem 2300 Lancaster Drive, N.E. 5135 Skyline Road South Lifemap-Willamette Dental Plan All dental services are provided at plan facilities listed below. There are no claim forms to fill out and no prior authorization of treatment is required. Covered services are provided at no cost to the patient. (Exception: Member pays maximum of $250 for children’s orthodontia treatment. 6950 NE Campus Way Hillsboro, OR 97124 855-433-6825 www.willamettedental.com Washington Area - ILWU Locals 7, 19, 21, 23, 24, 25, 27, 32, 47, 51, 52, 98For
Washington Locals 7, 19, 21, 23, 24, 25, 27, 32, 47, 51, 52, 98 Retirees / Survivors living in Washington Plans Washington Dental Service (Delta Dental) A Delta Dental PPO directory listing the names and addresses of Delta Dental Premier providers is available at: www.deltadentalins.com Dental Health Services Dental Choice Eligible families in the Washington area are 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 with coverage under the new plan beginning July 1. 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 written notice of your change. The Benefit Plans will provide written confirmation of the change and notice of the effective date. Retirees and Survivors 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 Washington and mail to the Benefit Plans. Choice forms are also available at the Locals and the Benefit Plans. 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 or your Area Welfare Director. Washington Dental Service Services provided by any licensed dentist. By selecting a participating dentist (member of Delta Dental Plan) you are assured direct payment to the dentist and a guarantee of the maximum benefits payable. The dentist submits the claim to Oregon/Washington Dental Service, and payment is made directly to the dentist. Most dentists in Oregon and Washington have the necessary claim forms. For adults, the plan pays 80% of the participating dentist’s usual, customary and reasonable (UCR) fees for covered services. For children, the plan pays 100% of covered services. (Exception: Member pays 10% of UCR fees for children’s orthodontia treatment.) A Delta Dental PPO directory listing the names and addresses of Delta Dental Premier providers is available at:www.deltadentalins.com 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. All Other AreasFor Areas within the states of California, Washington and Oregon where no dental plan choice is offered. Areas outside the states of California, Washington and Oregon. Plans Delta Dental A Delta Dental PPO directory listing the names and addresses of Delta Dental Premier providers is available at: www.deltadentalins.com BenefitsThe 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 or your Area Welfare Director. Delta Dental of California Services provided by any licensed dentist. By selecting a participating dentist (member of Delta Dental) you are assured 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) fees for covered services. The children’s dental program provides covered dental services at no cost to the patient. A Delta Dental PPO directory listing the names and addresses of Delta Dental Premier providers is available at: www.deltadentalins.com |
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