Basic Benefits/PPO

Under the IBEW-NECA Dental Plan, you and your eligible spouse will receive benefits based on a fixed fee Schedule of Allowances. The dollar amount shown for a procedure is the maximum that will be paid under the IBEW-NECA Dental Plan. Importantly, you will be responsible for the difference between what the dentist charges, and the amount paid by the Plan.

The IBEW-NECA Dental Plan provides payments for covered dental care for each Employee and spouse to a maximum benefit of $2,000 during each calendar year. Benefits will be payable only if the Employee and his/her spouse are eligible at the time services are rendered.

Under the IBEW-NECA Dental Plan, you can go to any licensed dentist of your choice. Your dentist will complete a claim form, which you will sign and it will be submitted to Allied Administrators, Inc. for claims adjudication. The Board of Trustees have contracted with Allied Administrators, Inc. to pay all claims.

The Board of Trustees has contracted with a preferred provider organization (PPO), Coastal Dental Plan, a Division of Western Dental Plan Management, Inc. to provide dental and orthodontic benefits.  Coastal Dental PPO Providers have agreed to reduced fees.  Certain procedures, such as dental exams, are provided without charge.  For major services the benefits, if covered, are provided for a fixed co-payment.  To obtain additional information, please contact Allied Administrators, Inc. or the Administrative Office to receive plan materials (current listing of dentists, orthodontists, specialists and fee schedule).

Many dental conditions can properly be treated in more than one way. This Plan is designed to help pay your dental expenses, but not on the basis of treatment that is more expensive and necessary for good dental care. If a condition is being treated for which two or more services included in the list are suitable under customary dental practices, the benefit under the Plan will be based on the least expensive of the services.

Below is an example of how this rule is applied.

It is determined that fillings would produce a professionally satisfactory result, but the patient decided to have the teeth crowned for the sake of appearance. In this case, the benefit paid would be based on the amount that would be provided for fillings.

If you are enrolled in the IBEW-NECA Dental Plan, we suggest that you ask your dentist if he/she is a member of one of the DMOs under contract with the Plan. If your dentist is a member of a DMO panel, you may save considerable out-of-pocket expense by switching to that particular Plan at open enrollment.