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Dental Plan

Welcome to the Beverage and Brewery Local 67 Delta Dental PPO.
How we pay Delta Dental How to File a claim Delta Dental PPO   Delta Dental PPO is a dental plan designed to manage the cost of dental services. Using preferred dentists will minimize your out of pocket expenses.

Please note: This is a brief description of your Delta Dental PPO plan. It should be used only as a guide. It does not contain complete details of the plan. The Delta Dental PPO Subscriber Certificate, any applicable riders, and Orthodontic Endorsement define the terms and conditions, including limitations and exclusions, of your dental care coverage in greater detail. If questions arise concerning coverage, the certificates riders, and Orthodontic Endorsement will govern. You can get copies of the certificate, riders, and Orthodontic Endorsement from Customer Service or your plan sponsor.

Your Dentist
If you already have a dentist and you want to know if he or she is in the Delta Dental PPO network, you may call the dentist, call Customer Service at (800) 932-0783 or look in Our Delta Dental PPO Directory of Providers.

Your Benefits
Your benefits are subject to the co-insurance and benefit maximums chosen by the Plan. Payments are based on whether or not you receive services from an in-network or out-of -network provider. Many covered services have specific time or age limits associated with them. For example:

• We will pay for cleanings only once each six months
• Fluoride treatments are only for members under age 19
• Major restorative services such as crowns, bridges, and dentures have a 60 month time limit, etc. This means you will only receive benefits if five years has elapsed since the last time your tooth was restored.

How We Pay Delta Dental

Dentists
Payments are based on the Delta Dental PPO preferred fee schedule for covered services. Dentists who are in the Delta Dental PPO network agree to accept the preferred fee schedule allowance, in addition to your co-insurance as payment in full. You are responsible for your co-insurance and all charges beyond your calendar year benefit maximum.

How We Pay Delta Dental Dentists
Payments are based on the usual and customary charge for covered services. Dentists who are in the Delta Dental network agree to accept your plan's payment, in addition to your co-insurance as full payment. You will be responsible for your co-insurance and all charges beyond your calendar year benefit maximum. This provision does not apply to emergency care services.

Orthodontic Benefits

• Payments are provided in the same manner as other dental services. You are responsible for your co-insurance and all benefits beyond your lifetime benefit maximum.
• The lifetime benefit maximum is not part of your calendar year benefit maximum; it is a one time benefit amount payable towards orthodontic services.
• We will begin payment the day your appliances are placed. If your orthodontic treatment began before you were covered, we will pay a monthly fee for your remaining orthodontic visits until either your braces are removed or the lifetime benefit maximum is exhausted whichever comes first.

Predetermination of Benefits

• If your dentist expects that your dental treatment will involve a series of covered services that will cost more than $250, he or she should send a copy of the "treatment plan" to us before services are rendered. A treatment plan is a detailed description of the procedures that the dentist plans to perform and includes an estimate for the charges for each service.
• Your dentist should also submit a treatment plan for periodontal, denture, crown, and bridge services before any services arc tendered, even if he or she expects the cost to be $250 or less.
• Once we review the treatment plan, we'll notify you and your dentist of the benefits available for those services.

Remember, the payment estimate is based on the amount of your calendar year benefit maximum at the time & receive and review the estimate. (The actual payment may differ if your available calendar year benefit maximum has changed.)

Waiting Periods

• You are covered, without a waiting period, from the date you enroll in the plan.

Important Notice: This website provides only a brief explanation of the Health and Welfare Plan under the Beverage and Brewery Local 67 Health and Welfare Trust Fund. It is not a summary plan description. If there are any inconsistencies between this explanation and the Plan document, the Plan document shall control. Also, please refer to the Summary Plan Description for additional information about the benefits available and procedures of the Beverage and Brewery Local 67 Health and Welfare Trust Fund or contact the Welfare Fund Office.

Copyright 2007 Teamsters Local 67. All Rights Reserved
2120 Bladensburg Rd., NE
 Washington, DC 20018