Healthy teeth and gums are an important part of your overall health. That’s why the Plan will pay 100% of covered expenses for preventive dental services when you visit a OneNet PPO provider for dental care (your dental benefits network is with OneNet PPO). Of course, you are free to visit any dentist you wish, but you can save yourself and the Plan money if you visit a dentist who participates in the OneNet PPO. You may also locate a participating dental provider by visiting www.onenetppo.com. The OneNet Dental PPO provides national access to more than 43,000 dental providers across the country.
- The Plan will pay 100% of eligible preventive care dental expenses when you visit a PPO dental provider. Other services are covered at 80% of the allowance with a PPO provider.
- You and your covered dependents are eligible for reimbursement of dental services of up to $2,000 per year.
- Effective January 1, 2011 children through age 17 no longer have an annual maximum.
- When you visit a PPO provider for dental care, the provider accepts the discounted rate for payment. You will need to pay your Patient’s Portion, if applicable.
- If you do not visit a PPO provider, you are responsible for payment of the balance that the provider charges above the PPO rate in addition to your Patient’s Portion.
- Orthodontics are not covered under the Plan.
What You Need To Do
- To find a participating provider, you may visit the OneNet website (www.onenetppo.com).
- When you make your appointment, identify yourself as a member of the EWTF.
- Show your EWTF ID card to be eligible for the PPO discounted rates.
- If you are having any dental service that is expected to cost more than $600, you must have your dentist complete a “treatment plan” form (see here). These forms are available from the Fund Office.
The Plan pays for necessary dental care as described in this section, up to $2,000 per covered person per calendar year. There is no dollar limitation for covered dental services rendered to an eligible patient under age 18.
For a list of preferred provider dentists convenient to you, please visit the OneNet website www.onenetppo.com or contact the Fund Office at 301-731-1050 or at 1-800-929-3983.
Please be sure to show your EWTF ID card when you go for your appointment. If you do not have the dental designation on your card, the participating dental providers do not have to honor the Plan’s discount and you will be responsible for any balance after the Fund Office considers the claim.
When you use a OneNet PPO provider, your dentist will submit your claims for you. All OneNet dental claims should be mailed directly to:
OneNet Dental PPO
PO Box 934
Frederick, MD 21705-0934
! The dental group number is AM0011.
You are not required to visit a OneNet PPO provider to receive dental care. If you visit a dentist who does not participate in the OneNet PPO, you are responsible for payment of the amount the dentist charges above the PPO discounted rate in addition to your Patient’s Portion.
You may need to pay for services at the time you receive them and submit a claim form to apply for reimbursement. Send the completed claim form to:
Electrical Welfare Trust Fund
10003 Derekwood Lane, Suite 130
Lanham, MD 20706-4811
EWTF Group Number
! The dental group number is AM0011.
Preventive Services are payable at 100% of the allowance when you visit a PPO provider, or 80% of the allowance when you visit a non-PPO provider.
This schedule shows the Basic Dental Services that are covered by this Plan. Most Basic Services are covered at 80% of the allowance, in or out of the network. Remember—if you visit a dentist who does not participate in the OneNet Dental PPO, you are responsible for charges above the allowance, if any. Refer to the Schedule of Benefits for a list of how dental services are paid.
This schedule shows the Major Dental Services that are covered by this Plan. If you use a OneNet PPO provider, Major Services are covered at 80% of the allowance. If you do not use a PPO provider, Major Services are covered at 50% of the allowance.
You are required to submit a “treatment plan” or pre-authorization for Major Services provided by your dentist to the Fund Office for prior approval when the cost of the treatment is expected to exceed $600. By submitting a proposed treatment plan in advance, both you and your dentist know what is covered under the Plan before rather than after the work is done. This also allows you to authorize direct payment to the dentist.
Reimbursement Based on Least Costly Treatment
Keep in mind that, since many dental conditions may be treated in more than one way, the Plan benefit is based on the least costly treatment that would provide a professionally satisfactory result, as determined by the Fund Office.
If your dental care coverage terminates while you are undergoing certain treatments, your covered dental expenses for these treatments continue to be covered for up to 30 days. The types of treatments that are included under this provision are:
- an appliance or its modification for which an impression was taken prior to termination of dental benefits
- a crown, bridge or gold restoration for which the tooth was prepared prior to termination of dental benefits
- root canal therapy provided that the pulp chamber was opened prior to termination of dental benefits
What’s Not Covered
Dental care benefits are not available to Employees (and/or dependents) that are self-paying for coverage or are predominantly (more than 50%) utilizing a credit of hours received under the Plan’s disability benefit. In addition, no dental care benefits are provided for:
- any dental care, treatment or supply not prescribed by or under the direction of a dentist
- replacement of a lost, stolen, or broken prosthetic device
- appliances or restoration for the purpose of splinting, increasing vertical dimension or restoring occlusion
- dental services and supplies rendered solely for cosmetic purposes, unless required as a result of an accidental injury sustained while covered under this Plan or unless specifically provided under another provision of this Plan
- an appliance or its modification, a crown, bridge, or gold restoration, or root canal therapy for which the impression was made, the tooth was prepared, or the pulp chamber was opened before the patient was covered under the Plan
- replacement of an existing partial or full denture, splint or fixed bridgework; crowns and/or inlays installed as multiple abutments; splints for periodontal treatment; or prosthetic appliances, fixed or removable, used as an adjunct to periodontal treatment, unless satisfactory evidence is presented to the Fund that the existing denture or bridgework was installed at least 36 months prior to its replacement and the prosthetic appliance, fixed or removable, is required to replace a natural tooth
- orthodontics or other treatment or procedure designed to prevent or correct malocclusion of the teeth
Please see here for an in-depth listing of your Plan’s exclusions.