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Health
& Welfare Dental
Dental - Orthodontic
Benefits
The following dental plans include orthodontic coverage for eligible
dependent children:
Plan 500
Dental
601
Dental
603
Dental
606 |
Payment under your Plan is 50% of the usual and customary charges.
Please note that no
orthodontic benefits are available for adults. The
lifetime
maximum
for
orthodontic benefits is $2,000.
Most orthodontists charge a pre-determined fee for the entire course
of the orthodontic treatment and accept a down payment followed by
monthly or quarterly payments.
Benefits for monthly adjustments are paid at 50%
The Plans will cover 50% of the down payment fee, providing
the down payment fee is not more than 35% of the total
orthodontic fee. See
example 1
and
2
below.
Payment
will not be made until the bands have actually been placed.
Monthly payments are not automatic, these bills should be submitted in
the usual fashion and must indicate the dates of service.
|
Example 1: |
|
|
Initial banding fee |
$ 750 |
|
Monthly fees (20 months @ $100) |
2,000 |
|
Total treatment cost |
$2,750 |
35%
of total treatment cost
($2,750.00 x .35) |
$963 |
|
Payment (initial banding fee x 50%) |
$375 |
The Plan will pay $375 of the initial banding fee. Since the initial
banding fee of $750 is less than 35% ($963) of the total treatment
cost, the
Plan will pay 50% of $750.
|
Example 2: |
|
|
Initial banding fee |
$1,500 |
|
Monthly
fees (20 months @ $100) |
2,000 |
|
Total treatment cost |
$3,500 |
35% of total treatment cost
($3,500 x .35) |
$1,225 |
|
Payment (initial banding fee x 50%) |
$612.50 |
The Plan will pay $612.50 of the initial banding fee. Since the
initial banding fee of $1,500 is greater than 35% ($1,225) of the
total treatment cost, the
Plan will pay 50% of $1,225.
Pre-existing Limitations
Orthodontic coverage is subject to pre-existing limitations. If
initial banding occurs prior to becoming eligible with the Alaska
Electrical Health and Welfare Fund, ongoing treatment will not be
covered for the first 12 months of eligibility. Should you provide a
HIPAA letter showing credible coverage, the 12 month period may be
reduced.
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