AFTRA

AFTRA has arranged for a Supplemental Dental and Vision insurance plan for Union members who are enrolled in the AFTRA Health Plan and their eligible dependents.

This benefit provides coverage for you and your eligible dependents for Type II and Type III dental services, such as 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 qualify to receive AFTRA Health benefits. 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 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.

• AFTRA Union members in good standing
• AFTRA members that are covered under the AFTRA Health Plan
• Employees of AFTRA and AFTRA H&R that are covered under the AFTRA Health Plan

In order to participate, the individual must be and remain current with any union dues and Health Plan premiums that are required under AFTRA H&R Funds Health Plan rules.

Enrollment and participation is subject to verification of enrollment in dental coverage under the AFTRA Health Plan and primary participant's status as a member of the AFTRA union, employee of AFTRA or employee of the AFTRA H&R Funds.

 

 

THE DENTAL BENEFIT

Some of the dental covered services are:

Bridges	Caps
Crowns	Dentures
Fillings	Gum Treatment
Impactions	Oral Surgery
Periodontics	Root Canal

This supplemental dental insurance covers basic (Type II) and major (Type III) services that are not currently covered by the AFTRA H&R Dental Benefit.  The basic (Type II) services include but are not limited to: fillings, bridge, crown and denture repairs, endodontics, periodontics and Oral Surgery.  Major (Type III) services include: crowns, inlays and certain prosthodontic services. Orthodontia is not included.   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	$50.00 3x's Family Deductible	$75.00 3x's Family Deductible
BASIC SERVICES Fillings, Bridges, Oral Surgery Crown & Denture Repair Endodontics, Periodontics	80% of fee schedule	50% of fee schedule
MAJOR SERVICES Crowns, Inlays, Certain Prosthodontic Services	50% of fee schedule	50% of fee schedule
CALENDAR YEAR MAXIMUM	$1,000 per person	$1,000 per person
PRE-DETERMINATION:  When a course of treatment is expected to cost $300 or more and is of a non-emergency nature, have your dentist submit a treatment plan before he/she begins.

This is intended only as a brief summary of benefits. It is not an official statement of those benefits. For more specific information, please refer to the Summary Plan Description.

 

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:

1. Calling VSP Customer Service at (800) 877-7195
2. Looking up a VSP Provider online at www.vsp.com
3. 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 Supplemental Dental and Vision Plan is offered as a combined package and benefits cannot be separated.

All billing is done quarterly and auto drafts occur on March 15th, June 15th, September 15th and December 15th. (If the 15th falls on a weekend or holiday, the payment will be drafted the following business day.)

Quarterly Premium	2010
Individual	$93.75 / quarter
Individual and Spouse	$193.45 / quarter
Individual and Children	$193.66 / quarter
Family	$199.59 / quarter

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:

AFTRA has arranged for a Supplemental Dental and Vision insurance plan for Union members who are enrolled in the AFTRA Health Plan and their eligible dependents. 

This benefit provides coverage for you and your eligible dependents for Type II and Type III dental services, such as fillings, crowns, root canals, etc. (Orthodontia is not included).  In addition, this package 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 receive this packet.  If you do not enroll during this initial offering you may be subject to a dental waiting period.  To enroll in the program, please read the enclosed material provided.  You may also review information and enroll online at www.groupba.com and select the AFTRA Dental Vision link or via the AFTRA website at www.aftra.org.

These programs are only available to AFTRA members in good standing, on honorable withdrawal, and employees of AFTRA  who 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.  Please direct questions to Group Benefit Associates at 800-450-1271, and not to the AFTRA Health & Retirement Funds office. 

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,

Roberta Reardon
AFTRA National President

 

Dental Summary	Vision Summary
Dental Q&A	Vision Q&A
Ortho Advantage
Dental / Vision Summary Plan Description