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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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