An integral part of the PBA Retiree Health and Welfare Fund Dental Plan is the Preferred Provider Organization (PPO). The PPO is a select group of dentists who have agreed to accept the PBA Dental Plan fees as payment-in-full for all covered services for members and their eligible dependents.
All benefits are subject to the terms, conditions, and limitations of the PPO contract.
The Dental Plan provides coverage for the major areas of dentistry, i.e.:
If a dentist is selected from the PPO Dental Panel, the dentist will accept the PBA Fund's allowances as payment-in-full for all covered services. The dentist may charge for non-covered services, or for services where the Dental Plan benefits have been exhausted. However, if a dentist who is not a participant on our panel is utilized, the PBA Dental Plan will only pay the applicable allowance. The member may be required to supplement the PBA Dental Plan allowance based upon the difference between the PBA Dental Plan allowance and the fee being charged by the dentist. Furthermore, the PBA Funds Office cannot intercede on the member's behalf if there are disputes regarding charges.
All covered dental procedures are paid based on a fixed schedule of allowances, which is outlined in greater detail in the dental benefit booklet available upon request.
The member may obtain claim forms through the PBA Funds Office or use a universal dental claim form. The member should read the instructions on the reverse side of the claim form and complete the upper portion (member's section), and give the form to the dentist. The dentist must then complete the lower portion of the form. Once the dentist has completed the form, the member should read the form, sign it and date it. The completed form should then be submitted to the PBA Funds Office.
Certain types of dental procedures require approval by the PBA Funds Office before treatment is commenced. This prior approval is called "pre-certification" and applies to all:
Basic dental services (examinations, X-rays, fillings, etc.) may be submitted without prior approval of the PBA Funds Office. However, a dental claim form stating the dentist's fee, the date the service was rendered, and a description of the service rendered is required.