Member and eligible dependents as defined by the Fund.

Members and their dependents are eligible for reimbursement for dental expenses in accordance with the Fund's established Schedule of Dental Benefits.

Each active covered individual is subject to annual maximums starting January 1, 2006 of $2,250 for general dentistry and $2,000 for periodontal treatment. The annual maximum prior to January 1, 2006 for general dentistry was $2,000.  Adolescent and adult orthodontics is limited to a $1,995 lifetime maximum.  Retired members and their dependents are limited to an annual maximum of $750 per family, $500 per individual for all dental services.

Request a claim form from your worksite (payroll representative) or dentist's office. All sections must be completed, including your original signature and the current date placed where indicated when you are utilizing the services of a non-participating provider. The dentist's signature and tax identification number must be contained on all claim forms, regardless of their status with the Fund.

If the procedure or series of treatments is covered is to be done by any dentist and is expected to be $500 and over, you must have your dentist file for a  Predetermination Request. Please be certain that the predetermination has been reviewed by the Fund before any treatment is begun. Payment for such treatment will not be made without this review.

In both cases, after any dental treatment is concluded, have your dentist complete the claim form or complete the reviewed predetermined claim form; then you sign and date it, returning it to the Healthplex, Inc office at 333 Earle Ovington Blvd., Suite #300, Uniondale, NY  11553-3608. According to the Fund's policies, payment will be made to either you or your dentist.

It is important that you remember that an incomplete claim form will be returned to you for more information, which may cause a delay in your benefit payment. Be sure that all claim forms are completed and all of the necessary information has been included before filing. If additional information is necessary, such as x-rays, make sure that they are also included.

NOTE: Effective September 16, 2009 Healthplex is now capable of processing one claim for dual members.