AFTRA Stand Alone Dental & Vision

AFTRA has brought you Dental and Vision coverage regardless of earnings requirements

AFTRA has arranged for a Stand Alone Dental and Vision insurance plan for Union members who are NOT enrolled in the AFTRA Health Plan and their eligible dependents.

This benefit provides coverage for you and your eligible dependents for Preventative, Type II and Type III dental services, such as exams, cleanings, x-rays, fillings, crowns, root canals, etc. (Orthodontia is not included). In addition, this plan includes a vision benefit program through the Vision Service Plan network of providers.

Initial enrollment will be open for 90 days starting from the date you join the AFTRA Union. If you do not enroll during this initial offering you may be subject to a late entrant penalty.

The penalty for late entrants is Guardian will not pay for Type II services for the first 6 months and Type III services for the first 12 months that a late entrant is covered by this plan. There is no late entrant penalty for the Vision benefit of this plan.

These programs are only available to AFTRA Union members in good standing, on honorable withdrawal, and employees of AFTRA who do not have coverage under the AFTRA Health Plan.

These programs have been arranged through your Union as part of its continuing efforts to provide members access to additional benefits. They will be administered by Group Benefit Associates and Guardian, not AFTRA or the AFTRA Health & Retirement Funds.

Eligibility

AFTRA Union members in good standing or on honorable withdrawal
AFTRA members that are NOT covered under the AFTRA Health Plan
Employees of AFTRA and AFTRA H&R that are NOT covered under the AFTRA Health Plan
AFTRA Union members on Financial Core status are not eligible

In order to participate, the individual must be and remain current with any union dues that are required under AFTRA rules.

Enrollment and participation is subject to verification of primary participant's status as a member of the AFTRA union, employee of AFTRA or employee of the AFTRA H&R Funds.

Eligible Dependents:

Your legal spouse
Qualified Domestic Partners
Your Qualified Domestic Partner's children
Your dependent children- dependent children are eligible until age 20 or until age 26 if they are a full-time student
Legally adopted children
Step-children who depend on you for most of their support and maintenance

THE DENTAL BENEFIT

This high-quality plan offered by Group Benefit Associates and insured by Guardian, gives members the opportunity to choose either a Dental PPO Plan or a Dental DHMO Plan. This flexibility allows you to select the plan best fits your specific needs and budget. The DHMO Plan is offered in California, New York, New Jersey, Illinois, Florida and Texas. The PPO Plan is offered in all 50 states. Both the Dental PPO and the Dental DHMO Plan include a Vision benefit.

The Dental PPO Plan

The PPO Dental plan allows you to visit any dentist or specialist you choose any time care is needed. If you elect to visit a Guardian network provider, you will receive the highest level of benefits and save on out-of-pocket costs. Best of all, your DentalGuard Preferred PPO features one of the industry's most extensive nationwide dental networks with over 77,000 provider locations. Coverage is effective the first day of a month. It is your choice whether your coverage becomes effective in the current month or the following month.

Cost Effective: Guardian network dentist fee discounts average 30% less than what dentists usually charge.
High Satisfaction: 97% satisfaction rate among members who have seen a dentist.
Maximum Rollover: Guardian's innovative plan feature which allows you to roll over unused dental premium for use in the future.
Orthodontia Discounts: Although this plan does not include orthodontia coverage, you are eligible for significant discounts on orthodontia services by using Guardian PPO Network providers. Since all of Guardian's network services are discounted, members will save on orthodontia procedures even though orthodontia is not covered by this plan!

The plan pays a specific amount for each dental service based upon an established fee schedule. If you go to a DentalGuard Preferred Network provider, the benefits described below apply. If you go to a non-contracted dentist, the amounts charged over the scheduled fees are the patient's responsibility.

	PPO Providers	Non-PPO Providers
Calendar Year Deductible (waived for Preventive services)	$50.00	$75.00
Preventive Services Exams, Cleanings, X-Rays, Sealants and Space Maintainers for Children	100% of fee schedule	75% of fee schedule
Basic Services Fillings, Oral Surgery, Crown Repair, Bridge Repair & Denture Repair, Endodontics, Periodontics	80% of fee schedule	50% of fee schedule
Major Services New Crowns, New Bridges, Inlays, Certain Prosthodontic services	50% of fee schedule	50% of fee schedule
Calendar Year Maximum	$1,000	$1,000

**This is intended only as a brief summary of benefits. It is not an official statement of those benefits.

The DHMO Dental Plan

Guardian's DHMO Dental Plan offers economical, high-quality benefits. You must elect a Guardian DHMO dentist at the time of enrollment. Each participating state has an associated co-pay schedule. Visit the Plan Details page to review the co-pay schedules. The DHMO includes an Orthodontia Benefit when you choose a network provider. There is no benefit if you go out of network.

If you sign up for the DHMO Dental Plan before the 15th of the month, your coverage becomes effective the first of the next month. If you sign up after the 15th of the month, your coverage becomes effective the first of the following month. For example, if you sign up for coverage by December 15th, your coverage is effective January 1. If you sign up after December 15 and prior to January 1, your coverage will not become effective to February 1.

Network strength- The Managed DentalGuard network is comprised of carefully selected dentists, including specialists, dedicated to delivering personalized, expert service with an emphasis on preventive care.

Flexibility- Members choose from a directory of participating dentists. Each family member may choose a different dentist.

Ease- No claim forms to complete. In addition, all covered services have fixed patient charges so members always know what their out-of-pocket costs will be.

Limited out-of-pocket expenses compared to traditional PPO or Indemnity Plans

Small office visit co-pay

Most diagnostic and preventive services provided at no extra charge

A reasonable patient charge applies for each basic and major service- orthodontia benefits are included at no additional premium cost

No deductibles to pay

No annual maximum

What Is Covered

The dental insurance covers Preventative (Type I), Basic (Type II) and Major (Type III) services.

The Preventative (Type I) services include: exams, cleanings, x-rays, sealants and space maintainers for children.
The basic (Type II) services include but are not limited to: fillings, bridge repair, crown repair, denture repairs, endodontics, periodontics and oral surgery.
Major (Type III) services include: new crowns, new bridges, inlays and certain prosthodontic services.
Orthodontia is included with a simple co-pay. Review the co-pay schedule in the Plan Details page.

THE VISION BENEFIT

Vision benefits are provided through the Vision Service Plan network and include an annual eye exam for a $10 co-pay, in addition to discounted rates on frames, lenses, and other professional services at VSP network providers. This benefit also includes discounts on all covered services such as LASIK.

Our vision plan allows you to visit any eye doctor you wish. However, you save significantly on out-of-pocket costs when network providers are used. There's more, you will receive substantial coverage for annual eye exams and discounts on eyewear and contact lens professional services every 12 months.

Largest Quality Network

Our affiliation with Vision Service Plan (VSP) gives members access to approximately 29,000 provider locations nationwide. All network professionals, includes licensed optometrist or ophthalmologist, are committed to delivering consistent and quality service.

You can find a VSP provider near you by:

Calling VSP Customer Service at (800) 877-7195
Looking up a VSP Provider online at www.vsp.com
Requesting a provider directory from VSP by calling (800) 877-7195

Covered Services & Value Added Discounts

Eye Exams:

$10.00 copay, covered in full thereafter

Glasses:

20% off lenses, frames and the industry's most extensive list of "cosmetic extras", including tints, special lenses (e.g. progressives) and scratch resistant coatings.
20% off the retail price of additional glasses after initial pair is purchased.*

Contact Lenses and Professional Services

15% off of the network doctor's evaluation and fitting services.
20-25% off laser vision correction, or 5% off the laser surgery center's best promotional price, whichever is a better deal!**

You should call the VSP provider to schedule an appointment. When calling to schedule the appointment, identify yourself as a VSP/Guardian member and give the insured's social security number. Before you go for the appointment, the provider will contact VSP to verify eligibility and coverage. You must go for services and materials within 60 days of VSP authorization.

*The claimant must go within 12 months to the same VSP doctor who provided the exam.
**Laser surgery is not an insured benefit. The surgery is available at a discounted fee. The covered person must pay the entire discounted fee. In addition, the laser surgery discount may not be available in all states. Member's out-of-pocket costs won't exceed $1,800 per eye for LASIK and $1,500 per eye for PRK.

The Stand Alone Dental and Vision Plan is offered as a combined package. All premiums are collected on the 15th of the month prior to the month in which the premium is due.

Combined Dental and Vision Rates 2012
*The PPO Plan*
	Member Only	Member + Spouse	Member + Child(ren)	Family
California	$55.12	$101.83	$113.79	$161.54
New York/ New Jersey	$43.97	$80.12	$89.44	$126.80
Illinois	$36.31	$65.17	$72.43	$102.33
Florida/Texas	$37.64	$67.73	$75.45	$106.82
All Other	$37.74	$67.93	$75.68	$107.12
*The DHMO Plan*
	Member Only	Member + Spouse	Member + Child(ren)	Family
California	$25.79	$40.51	$37.16	$55.15
New York/ New Jersey	$26.12	$41.54	$42.59	$59.20
Illinois	$25.16	$39.17	$41.42	$57.38
Florida/Texas	$25.23	$37.26	$40.50	$55.02

The DHMO is only available in California, Florida, Illinois, New Jersey, New York, and Texas. Purchase coverage in the state where you receive your dental care.

Termination Requests: Termination requests must be received in writing by mail, fax or e-mail within the same month of the requested termination date. Terminations can only be processed on the last day of the month, mid-month terminations are not allowable.

Dear AFTRA Member:

In 2004 the AFTRA National Board made arrangements with Group Benefit Associates to provide supplemental dental and vision benefits to members who were covered by the AFTRA Health Plan. Subsequently, Group Benefit Associates has developed two plans for members who are not covered by the Health Plan. As a member of AFTRA, you have the option of enrolling in either program. Both provide dental and vision benefits. The programs are:

The PPO Dental and Vision Plan: This program provides preventive, basic and major services, as well as vision benefits, for members and their dependents.

The DHMO Dental and Vision Plan: This plan is designed for those who prefer a lower cost option for dental and vision benefits. It is available to members in California, Florida, Illinois, New York, New Jersey and Texas.

These programs are only available to AFTRA Union members in good standing, on honorable withdrawal and employees of AFTRA who do not have coverage under the AFTRA Health Plan.

Initial enrollment will be open for 90 days starting from the date you receive this packet. If you do not enroll during this initial offering, and decide to enroll later, you may be subject to a dental waiting period. To enroll in either program, please read the enclosed material. You may also review information and enroll online at www.groupba.com or via the AFTRA website at www.aftra.com.

These programs have been arranged through your Union as part of its continuing efforts to provide members access to additional benefits. They will be administered by Group Benefit Associates and Guardian, not AFTRA or the AFTRA Health & Retirement Funds. Please direct questions to Group Benefit Associates at 800-450-1271 or Guardian at 800-541-7846.

On behalf of the AFTRA National Board of Directors, we hope that you will find this coverage a welcome benefit to you and your family.

In Solidarity,