PEP, June 2008: Know your union benefits

This is the first in a series of frequently asked questions about the benefits provided by the DC 37 Health & Security Plan. These questions focus on enrollment and how to use your dental benefit.

Question: How do I enroll in the Health and Security Plan?
Answer: To enroll in the Health and Security Plan you must complete a white enrollment card. This card is required to add you, your eligible spouse or domestic partner and dependent children to the plan’s benefits.

If you are enrolling a spouse, domestic partner and/or dependent child, you must attach a copy of your marriage certificate, domestic partnership registration, and birth certificates of your children.

Fill out the card completely, name a beneficiary, sign it and attach all necessary documentation. Return it to the DC37 Health and Security Plan, 125 Barclay St., New York, NY 10007, Attention: Enrollment Eligibility Unit.

You only need to complete one enrollment card when you first start working in a covered title. No benefits can be provided unless an enrollment card is on file with the plan.

Q: I’m not a new employee but my family status has changed. What do I do?
A: If you have married, divorced or separated — or added a dependent — you must notify the plan. Request a change of status card, complete it, attach the documentation and return it to the plan at the above address.

Q: How can I keep my 19-year-old covered under my plan?
A: The DC 37 Health and Security Plan provides benefits for dependents up to age 19.

If your child is between 19 and 23 and attending school as a full-time day student, you must submit a letter from the registrar’s office documenting full-time status each semester to maintain coverage. To avoid an interruption in coverage, proof of schooling should be submitted twice yearly, at the beginning of the spring and fall semesters.

Q: What benefits do I receive and are my family members eligible?
A: The plan provides different benefit packages to members and retirees based on specific eligibility criteria.
In May 2008, the plan mailed benefit booklets to each eligible member and retiree. These booklets provide information on all the Health and Security benefits available to you and your eligible dependents, including dental, optical, prescription drug and many other benefits.

Q: How can I get benefit information and claim forms?
A: For benefit information, claim forms or any questions about eligibility for benefits, you should contact the DC 37 Health and Security Plan’s Inquiry Unit.

The “Forms Only” line is 212-815-1531. You can request optical vouchers and claim forms. You can also request plan benefit flyers, dental fee schedules and lists of participating panel dentists and optical providers.

The “Benefit Information” line, 212-815-1234, also known as the DC 37 Health and Security Inquiry Unit, is for more detailed information. You can check your eligibility for benefits or check the status of a particular claim you have filed.

The Inquiry Unit, at 125 Barclay St., is open Monday through Thursday 8 a.m. to 6 p.m., and Friday, from 8 a.m. to 5:30 p.m.

You can also access benefit information and lists of participating panel providers by logging on to the DC 37 Web site atwww.dc37.net and looking in the “Benefits” section.

Q: I need to see a dentist, what do I do?
A: Call the Inquiry Unit’s forms line at 212-815-1531 or go to the plan’s section of the DC 37 Web site, to request a list of participating panel dentists. You can also request claim forms or your dentist may submit a universal claim form.

Q: What are the options I have for using my dental benefit?
A: You can use the benefit in the following ways:
(a) Members and dependents may use any licensed dentist who provides these services.
(b) Members and dependents may use any dentist from the plan’s list of participating dentists.
(c) Members and dependents may also obtain treatment at the DC 37 Dental Centers. Please note that the Dental Centers can only treat a limited number of patients and there is a waiting list for new patients.

Q: How much of my dental treatment is covered?
Members who are eligible for a full dental benefit will be covered for 100 percent of the dental fee schedule. If you use a nonparticipating provider, you will be responsible for any difference between the plan’s fee schedule and the dentist’s actual charges.Members who are eligible for a partial dental benefit will be covered for 75 percent of the dental fee schedule and will be responsible for the additional 25 percent. If you use a non-participating provider, you will be responsible for any difference between the plan’s fee schedule and the dentist’s actual charges, in addition to the 25 percent of the allowable amount.

In all cases, should you obtain treatment that is restricted, has a frequency limitation, is a noncovered procedure, or if you go over the yearly maximum, you will be responsible for any additional costs incurred. The yearly maximum benefit is $1,700 per calendar year for each covered person, based on the plan’s fee schedule. In all circumstances, plan rules regarding restrictions, limitations, and annual dollar limit will apply.

Remember, you must submit a pre-authorization before beginning treatment for prosthetics (dentures and bridgework), single crowns, extensive gum treatment, TMJ therapy, or root canal therapy, whether you are using a panel dentist or not. Pre-authorization requests are proposals for treatment. Services denied on a pre-authorization are not subject to the plan’s appeal process.

Benefits are paid after claim forms for completed services are submitted to the Plan and processed based on Plan rules and guidelines.