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DENTAL BENEFITS
DENTAL BENEFITS
Dental benefits are provided by the GARDEN CITY TEACHERS ASSOCIATION BENEFITS TRUST FUND on a Self-Insured basis to all eligible members and covered eligible dependents as defined by the Fund on page 8 of this booklet. Please refer to the Schedule of Dental Benefits for the amounts the Fund will pay for specific benefits.
Dental benefits are provided by the GARDEN CITY TEACHERS ASSOCIATION BENEFITS TRUST FUND on a Self-Insured basis to all eligible members and covered eligible dependents as defined by the Fund on page 8 of this booklet. Please refer to the Schedule of Dental Benefits for the amounts the Fund will pay for specific benefits.
MAXIMUM DENTAL BENEFITS FOR YOU AND YOUR DEPENDENTS:
MAXIMUM DENTAL BENEFITS FOR YOU AND YOUR DEPENDENTS:
- Maximum Dental Benefit per family member, per calendar year $1,500
3 Cleanings per year
2 Exams per year
1 Fluoride per yer under age 19
- Maximum Orthodontic Benefit-Lifetime per dependent child $2,000
- This is subject to the Maximum Dental Benefit.
- Maximum TMJ Benefit-Lifetime per family $1,000
- This is subject to the Maximum Dental Benefit
DENTAL CO-INSURANCE REQUIREMENT:
DENTAL CO-INSURANCE REQUIREMENT:
The Fund pays 100% of the reasonable and customary charges for Diagnostic and Preventative services
The Fund pays 100% of the reasonable and customary charges for Diagnostic and Preventative services
The plan pays 65% of reasonable and customary for Orthodontic services in the Dental Schedule of Benefits. You are responsible for a co-insurance payment of 35%.
The plan pays 65% of reasonable and customary for Orthodontic services in the Dental Schedule of Benefits. You are responsible for a co-insurance payment of 35%.
The Plan pays 100% of the scheduled allowance for all other services--refer to the maximum amounts as shown in the Fund’s Dental Schedule of Benefits.
The Plan pays 100% of the scheduled allowance for all other services--refer to the maximum amounts as shown in the Fund’s Dental Schedule of Benefits.
THE SCHEDULE OF BENEFITS
THE SCHEDULE OF BENEFITS
Members are reimbursed for covered services according to the Fund’s Dental Schedule of Benefits. A comprehensive listing of the covered dental services is provided in the Dental Schedule of Benefits.
PREFERRED PROVIDER OPTION
PREFERRED PROVIDER OPTION
An optional dental Preferred Provider Organization (PPO) is available to members and their covered eligible dependents. Each dental provider in the PPO has agreed to accept reduced fees for their services. The member’s cost is limited to the difference between the Plan benefits payment and the PPO provider’s agreed upon reduced fee for the particular service. Members opting for a provider in the PPO will usually experience an out-of-pocket savings.
An optional dental Preferred Provider Organization (PPO) is available to members and their covered eligible dependents. Each dental provider in the PPO has agreed to accept reduced fees for their services. The member’s cost is limited to the difference between the Plan benefits payment and the PPO provider’s agreed upon reduced fee for the particular service. Members opting for a provider in the PPO will usually experience an out-of-pocket savings.
THE SCHEDULE OF BENEFITS
THE SCHEDULE OF BENEFITS
NOTE: SEND ALL CLAIM FORMS PROMPTLY. CLAIM FORMS MUST BE FULLY COMPLETED BY ALL PARTIES CALLED FOR AND SUBMITTED WITHIN 180 DAYS OF THE DATE OF SERVICE. IMPROPERLY COMPLETED FORMS WILL CAUSE A DELAY IN THE PAYMENT OF A CLAIM.
Step 1 – Use the standard American Dental Association claim form, available in most dental offices and the GCTABTF website: www.GCBenefits.org
Step 2 – Complete the “Patient” statement in full. (If all questions are not answered, it will be necessary to return the claim form, which will delay payment.
Step 3 – Have your dentist complete and sign his/her portion of the claim form
Step 4 – Send to the Fund’s Dental Administrator:
Newman Company
400 Garden City Plaza
Suite 402
Garden City, New York 11530
Telephone: 516-488-1100
Fax: 516-488-1110
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