Who is eligible

All covered members and their eligible dependents (family coverage) are eligible for Dental Benefits.

Your Dental Benefits

You may select any dentist,* whether or not a participating dentist, and receive dental benefits. 

Participating dentists have agreed that they will be paid directly by the Fund for covered dental services. You will receive a copy of the statement of payment to the dentist. There is no charge for covered services rendered by a dentist participating in the Fund’s Dental plan, subject to plan maximums and frequency limitations. This protection makes it possible for you to receive most dental services at no out of pocket expense when you use a participating dentist.

Maximum Allowable Charge

This schedule puts a limit on the fees that participating providers are allowed to charge for non-covered services. The procedures that are represented by (4) **** have the maximum fees that the participating dentist is able to charge the patient for non-covered procedures.

Before treatment starts, identify yourself to the participating dentist as a member of the Fund. To locate a participating dentist in your area, please use this link https://mightyunion.org/dental-provider.

Non-participating dentists have no agreement with the Fund and must be paid by the member. If you select a non-participating dentist, you will be responsible for all payments to the non-participating dentist. You will be reimbursed by check directly from the Fund according to the Fund’s Schedule of Dental Benefits. The difference between the non-participating dentists’ fees and the Funds payment is your out-of-pocket expense. A complete, updated listing of the Schedule of Dental Benefits can be obtained from the Fund Office or on the Union’s website at www.mightyunion.org. In addition, the Schedule of Benefits is published annually in September in the Summary of Benefits section of The Unionist.

The Fund does not permit assignment of benefits to non-participating dentists.

Dental benefits are limited to $2,000 per covered patient per calendar year under the Fund’s schedule. In instances where both spouses/domestic partners are Welfare Fund members, both members and their dependent children can receive benefits under each spouse’s/domestic partner’s coverage, up to $4,000 per covered patient per calendar year, subject to standard frequency limits for procedures as set forth in the Fund’s schedule.

*The Dental Plan does not cover any services rendered by a provider who is related to the covered patient by blood or by marriage, or who resides in the same household

SSEU Local 371 Dental Facility, LLC

Covered members and eligible dependents are entitled to receive covered dental services at the SSEU Local 371 Dental Facility, LLC.

General practice and specializing dentists render services by personal appointment; if you have a dental emergency please call the dental facility at 212-473-4700 to receive immediate attention.

The SSEU Local 371 Dental Facility, LLC is located at 1501 Broadway, Suite 450 New York, NY 10036. All major subway and bus lines have stops in the vicinity.

Appointments are available six days a week, Monday through Saturday. To schedule an appointment, call (212) 473-4700.

Pre-Authorization

Pre-Authorization is required for the following dental procedures. All implants and related abutments including crowns and dentures, all bridgework, osseous surgery, full and partial bony extractions, full dentures and partial dentures. In such instances, the member’s dentist is required to submit x rays and treatment recommendations to the Fund for review by the Fund’s Consulting Dentist. The covered member’s dentist may proceed to render dental services as soon as the proposed course of treatment has been authorized by the Fund. The Fund reserves the right to modify or deny claims which have not been approved by the Fund’s Consulting Dentist prior to the beginning of treatment.

The Fund’s Consulting Dentist reviews proposed courses that meet the pre-authorization requirement of treatment  in order to guard against unnecessary pain and inconvenience to covered members and their eligible dependents, and to prevent frivolous or unnecessary charges to the Fund by a dentist. Also, for these reasons, the Consulting Dentist may examine selected covered members or their eligible dependents prior to approving a proposed course of treatment. In such instances, covered members receive a second professional opinion free of charge. The Fund may require examination by the Consulting Dentist of completed treatment involving covered dental services before payment is made.

Also, please keep in mind that even though a proposed course of treatment is pre-authorized as necessary, some or all of the services may not be covered services under our plan. If you want to know whether the services related to a proposed course of treatment will be covered, you should call the Fund Office at 212-777-9000, x3069.

How To Obtain Your Dental Benefits

After treatment is completed, have your dentist fill out and sign a claim form. Then sign your portion of the form. Claim forms may be obtained from the Funds’ office, and Dental Claim Forms are often available through the Union delegate at your work location or on the website at www.mightyunionfunds.org

SIMPLE STEPS FOR PROMPT PAYMENT

BEFORE YOU GO TO THE DENTIST, PLEASE PRINT THE CLAIM FORM:

1. Your FULL name and FULL address (including your ZIP Code).

2. The last four digits of your SOCIAL SECURITY NUMBER.

3. The Patient’s FULL NAME and DATE OF BIRTH.

FORWARD THE COMPLETED FORM TO THE WELFARE FUND

A Few Services The Dental Plan Does Not Provide

Services not provided under the Dental plan include, but are not limited to, replacement of lost bridges and false teeth within 5 years of insertion; cosmetic oral surgery; and splints for periodontal treatment. If you have any questions concerning whether or not a dental service is provided under the Plan, you should contact the Fund office prior to the commencement of dental treatment.

Other Dental Insurance Coverage

(Coordination of Benefits)

The purpose of the Welfare Fund Dental Benefits is to provide the broadest possible dental coverage to covered members and their eligible dependents. To achieve this objective, the Fund follows the coordination of benefits procedure that is standard among dental plans.

Under this procedure, when an employee is covered by the Fund plan and his/her spouse/domestic partner is covered by another dental plan, the Fund will assume primary coverage for the employee/patient and secondary coverage for the spouse/domestic partner patient. Responsibility for primary coverage for the dependent children is assigned to the benefit program of the parent whose month of birth falls earlier in the year. For example, if the mother’s birthday falls in April, and the father’s birthday falls in July, the claim for the dependent child must be submitted to the mother’s benefit program first.

How Coordination of Benefits Work

When your spouse/domestic partner is the patient, and is covered by any other dental insurance program or dental plan, the claim for services rendered must be filed with that plan first. The Fund Office then will accept a photocopy of that claim form, along with the explanation of benefits paid by the other plan, and will issue a check to the member for any remaining out of pocket expenses which fall within the Fund’s dental schedule.

Coordinating benefits with those provided by other plans serves the interests of all covered members and their eligible dependents.

Special Coordination of Benefits

In instances where both spouses/domestic partners are Welfare Fund members, both members and their dependent children can receive benefits under each spouse’s/domestic partner’s coverage, up to $4,000 per covered patient per calendar year, subject to standard frequency limits for procedures as set forth in the Fund’s schedule.