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OPERATING ENGINEERS
TRUST FUNDS

Health and Welfare Dental

  • The Operating Engineers Dental PPO Plan

  • Overview

    This is your default dental plan unless you elect one of the optional dental plans below. Under the Dental PPO Plan, you may use any dentist you wish. If you use a PPO dentist your benefits will be higher and out-of-pocket costs lower than if you use a Non-PPO dentist.

  • Benefit

    If you use a dentist from the Fund’s list of participating PPO dentists, you will have no out-of pocket cost for covered services other than your deductible and any services provided in excess of the biennial (every two years) maximum. Subject to these limitations, you will have no out-of-pocket costs when you utilize one of our PPO dentists because these dentists have agreed to accept the Fund’s payment in full for the services provided.

  • Deductibles

    $25 annual deductible per person
    $75 family maximum deductible
  • Two-Year Benefit Maximum

    $6,200 in any two consecutive years per person
  • Preauthorization 

    Preauthorization for claims in excess of $600 is required.
    X-rays are required on all claims over $600 and for claims under $600 when removal of teeth, periodontal treatment, root canal therapy, fixed or removable bridgework or gold restorations are involved. If the claim is not pre-authorized, it would still be processed but you could be left with a large out-of-pocket expense if certain services are not covered by the Fund. Pre-authorization lets you and the dentist know the amount the Fund will pay and the amount of your out-of-pocket expense before you begin treatment.
  • Sample Benefits

    Preauthorization for claims in excess of $600 is required.
    Benefits Your Co-Pay Plan Pays
    Periodic Oral Exam $0 100%
    Teeth Cleaning $0 100%
    X-Rays, complete series $0 100%
    2-surface Filling $0 100%
  • PPO Dentist

  • Non-PPO Dentist

    If you use a dentist that is not a PPO dentist, the Fund will pay for covered services according to a fixed schedule of fees. Regardless of the dentist’s charges for services, the Fund will not pay more than the allowed amount on the fee schedule. After the deductible (see below), the Fund will pay up to the amount listed in the dental schedule, not to exceed the Plan maximum, and you will be responsible for the balance. Because of this, you may incur sizable out-of-pocket expenses when using a Non-PPO dentist.

    Fee schedule for non-participating dentists (the maximum the Plan will pay).

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