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Dental & Hearing Benefit Upgrades, July 1

Read the benefits enhancement announcement from Steven London, Executive Officer, PSC-CUNY Welfare Fund, here. Need help using your benefits? Get it here. Delta Dental HMO members read more here.

Dental Benefit Improvement

Guardian Network Dentists: Crowns, Implants, Oral Surgery and Orthodontics

Beginning on July 1, 2018, the Fund’s reimbursement schedule for many common but expensive procedures—when provided by participating, in-network Guardian dentists—will be further enhanced. See the new Guardian reimbursement schedule here.

The Fund Trustees targeted resources to the most common expensive procedures: dental implants, oral surgery, crowns, and orthodontics. The new enhanced schedule of reimbursements will cover a broader range of dental codes associated with each of these procedures and cover them at a higher reimbursement rate. 

Please remember that by choosing a Guardian network dentist, you can save hundreds of dollars on common procedures because Guardian-participating dentists discount their fees by 30% to 40% to our members. The Fund then pays for a portion of the dentist’s actual charge, according to a set subsidy schedule for the dental code associated with each procedure. It is the Fund’s reimbursement subsidy schedule that is being enhanced.

The table below shows the projected percentage increase in coverage for the average charge of in-network Guardian dentists.

 

Procedure

Current Coverage of Avg. Guardian Dentist Charge

New Projected Coverage of Avg. Guardian Dentist Charge

Dental Implants

62.2% 

76.4%

Oral Surgery  

84.2%

86.6%

Crowns

68.5% 

86.5%

Orthodontics

54.1% 

75.0%

In-Network and Out-of-Network: Coverage for Three Cleanings per Year

The Fund will also increase coverage of adult cleanings from two-times per year to three-times per year at current rates for both in-network and out-of-network dentists. Some members require more than two cleanings per year to maintain oral health and prevent serious dental conditions from arising. Fund Trustees want to provide this option when needed.

Hearing Benefit Improvements:

Last year (beginning on January 1, 2017) the Fund contracted with the Hear USA network to provide a major improvement in the Fund’s hearing benefit.  Eligible members and their dependents now receive significant discounts on hearing aids, and the Fund provides a $750 per-ear in-network subsidy on top of the discount once every 36 months.

Beginning on July 1, 2018, the Fund will double the per-ear, in-network subsidy from $750 to $1,500, for a total subsidy of $3,000 once every 36 months. Read more about the HearUSA benefit here

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