Dental Benefits

Eligibility

• Active and Retired Participants and Dependents who are eligible for the medical and hospital benefits
• COBRA Participants who elect and pay for it

30-Day Extended Eligibility

If you or your Dependents lose eligibility under the Operating Engineers Health & Welfare Plan, the Fund will continue to provide benefits for completing procedures which were actually in progress at the time eligibility terminated, but not beyond 30 days following the loss of eligibility.

For example, if your eligibility terminates before dental work for prosthetic procedures (including bridges and crowns) has been completed, benefits will be provided if the impressions were made while you were eligible and the prosthetic appliance, bridge or crown is installed or delivered within 30 days after eligibility terminates.

The Plan offers the following five dental plan options:

PPO Plan

Eligible Participants are automatically covered by this Plan unless they elect one of the other options. Benefits are administered by the Fund. Participants may use any dentist they choose. However, benefits will be higher and out-of-pocket costs lower when a PPO network dentist is used. A list of PPO network dentists is available from the Fund Office or on the Plan’s website at www.oefi.org.

United Concordia Preferred Plan (DPPO)

All eligible Participants may elect this Plan which is administered by United Concordia. Participants must use one of the over 45,000 dentists and specialists in the nationwide United Concordia Advantage network. The list of network dentists is available by calling (800) 332-0366, or on United Concordia’s website at www.unitedconcordia.com under “Concordia Preferred Network”.

United Concordia Plus Plan (DHMO)

This option is available only to California residents. Eligible Participants must pre-select a dental office to provide all dental care. The list of over 1,200 DHMO offices is available by calling (800) 357-3304, or on United Concordia’s website at: www.unitedconcordia.com under “DHMO Concordia Plus.”

Delta Dental PMI (DHMO)

This option is administered by Delta Dental. Eligible Participants must pre-select a primary dental office to provide all dental care. The list of over 5,000 offices in California and Nevada is available from the Delta Dental website at www.deltadental.com under “Find a Dentist“.

Western Dental / MIB (DHMO)

This option is currently available only to California residents. Eligible Participants must pre-select a dental office to provide all dental care. The list of over 3,400 DHMO offices is available by calling (800) 992-3366, or on Western Dental-MIB’s website at: www.mibbenefitplans.com/operating-engineers-union using Plan Type “8000C3”.

Dental Benefits

^*Effective June 1, 2017

The following Limitations and Exclusions apply to the Fund’s PPO Plan.

Limitations

The following are some of the PPO Plan’s dental limitations:

1. Sealants are covered only for children under age 14
2. Removable partials, fixed bridgework, porcelain, porcelain fused to metal and cast metal crowns are not covered for children under 16 years of age
3. Prosthetic appliances (dentures, partials, fixed bridgework, crowns) are covered only once every three (3) years
4. Prophylaxis (cleaning) is covered only once every six months
5. Fluoride treatment is covered only for persons under age 19 and is limited to once every six months
6. Replacement of amalgam, silicate or plastic fillings is limited to one replacement per year
7. Post-operative X-Rays are required for all root canal therapy
8. Root canal therapy is not covered if the canals are not filled to the apices of the teeth
9. The fee allowed for a partial denture includes all teeth and clasps. Removable cast partial dentures for eligible individuals under age 16 must be approved by the Fund based on a written report from a dentist
10. Fixed bridges are not covered for patients under age 16 (except in special cases approved by the Fund Office)
11. Replacement of a second or third molar is not generally covered unless as part of a bridge restoring other missing teeth
12. Where a large number of teeth are missing in the same arch and moderate to advanced periodontal bone loss is evident radiographically, fixed prostheses are not a covered benefit, except in special circumstances approved by the Fund Office and by report
13. Jackets, crowns, inlays, onlays, and fixed bridges are a covered benefit only once in any three (3) year period unless the need for replacement is approved in advance by the Fund Office
14. Routine post-operative visits are considered part of, and included in, the fee for the total surgical procedure

Exclusions

Expenses Not Covered

Dental benefits are NOT payable for:

1. Orthodontic treatment for adults unless approved in advance by the Fund’s Dental Consultant
2. Congenital malformations (covered under Medical Plan)
3. Services purely cosmetic in nature (such as bleaching or whitening)
4. Fees for instruction in personal oral hygiene, dietary planning or prevention
5. Services provided by a “denturist” except in Idaho, Maine, Montana, Oregon and Washington
6. Pulp caps
7. Experimental procedures
8. Procedures associated with overlays
9. Charges for the completion of dental claim forms
10. Replacement of lost or stolen dentures or partials
11. Services provided by any person who is the spouse, parent, child, brother or sister of the eligible employee or Dependent
12. Premedication and analgesia (nitrous oxide), except for documented handicapped or uncontrollable patients
13. Orthodontics if provided by someone other than a Board eligible orthodontist
14. Study models, except as part of orthodontic treatment where covered
15. X-Rays that are unreadable or not diagnostically acceptable
16. Hospitalization for dental treatment unless medical necessity is established
17. Unilateral removable bridges
18. Implants must be pre-authorized