The Dental Benefit Plan of the Electrical Industry gives you three optional programs from which you and your eligible dependents can choose to receive coverage as listed below. Please note, participants in the Dental Benefit Plan of the Elevator Division should go to that plan’s page for more about for information about their plan.
- Anthem Blue Cross and Blue Shield (fka Empire BlueCross BlueShield) Fee-For-Service Program: You can visit the dentist of your choice, but you have to pay out of pocket for expenses exceeding the Plan’s maximum allowance, which is based on a fee schedule.
- Anthem Blue Cross and Blue Shield (fka Empire BlueCross BlueShield) Dental Managed Network Program: No out-of-pocket expenses if you go to a network dentist, but you must remain with that dentist or program for at least one year.
- DDS Inc. Program: There are no out-of-pocket expenses if you see a network dentist, but Plan limits apply. You may switch from one network dentist to another at any time.
Plan Overview
This information provides the highlights of the Dental Benefit Plan and is applicable to all three optional programs unless otherwise noted.
Increased allowances for implants and associated services as well as certain previously non-covered services have been added to the Plan effective October 1, 2023. Complete details are available in the updated Summary Plan Description.
Eligibility and Participation
You are eligible after 26 weeks of work. Once under full employment, you must be working full time for a contributing employer for 26 consecutive weeks immediately prior to incurring a reimbursable expense. If you were unemployed during any or all of this period, you must be registered for employment in order to be eligible for Plan benefits. If you are unemployed and registered for employment, you remain eligible for coverage for up to 39 weeks.
If you retire on an Early Standard, Standard, or Disability Pension from the Pension Plan (PHBP Trust Fund), you remain eligible for benefits under this Dental Plan. This benefit applies to your eligible dependents as well.
Dependent Eligibility
You can cover your spouse and children. As a participant, you are able to cover your lawful spouse and children (adopted or biological). Stepchildren may be covered by purchasing COBRA.
Dependents Over Age 19
Plan provides coverage for your unmarried children from birth up to their 19th birthday. However, unmarried full-time dependent students attending approved institutions of higher learning shall be covered up to age 26.
An original letter from the registrar’s office of the applicable institution shall be required as proof of current college or school attendance after each spring and fall semester commences. Dental expenses incurred during the months of July and August will be processed after receiving the necessary documentation of a child’s full-time student status for the next semester.
Covered Services
Smile, we’ve got you covered. The Plan programs cover a wide range of services, including but not limited to basic and preventative care, prosthetics and orthodontic services. Refer to the Summary Plan Description for a schedule of maximum allowances under the Anthem Blue Cross and Blue Shield (fka Empire BlueCross BlueShield) Fee-For-Service Program.
Pre-Certification
No pre-certification is needed for Empire Managed Network or DDS options.
Under the Empire Fee-For-Service Program, pre-certification of benefits is required for all prosthetic and orthodontic procedures before treatment begins, but not for basic preventative services.