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Teamsters Local 631
Security Fund
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Teamsters Local 631 Security Fund for Southern
Nevada
P.O. Box 26509
Las Vegas, Nevada 89126-0509
Important Notice
Elimination of
Retrospective Reviews for Dental
Effective IMMEDIATELY, all dental
services that exceed $750.00 and were not pre-authorized will be denied.
On May 1, 2001, the level of dental charges requiring pre-authorization under
the Indemnity Dental Plan was increased from $500 to $750. Since then, many
dentists have chosen to ignore the pre-authorization process and the Plan has
allowed payment benefits for claims that were reviewed retrospectively. This
will no longer happen. Claims received without pre-authorization will now
be denied and any appeals will also be denied.
These are the current
requirements as stated in the Summary Plan Description (SPD):
Dental
Pre-Authorization
When you discuss dental work
with your dentist, discuss the total charges that are expected. If these
total charges are going to exceed $750.00, you must have your claim
pre-authorized. A description of the treatment plan must be submitted to the
Claims Administrator before treatment has begun. The dental consultant will
confirm that the proposed treatment is necessary and that it is the usual and
customary procedure for the condition being treated. You will then be provided
with an estimate of the benefits payable. A treatment plan is the Dentist’s
report that:
1. Itemizes the recommended services;
2. Shows the charge for each service; and
3. Is
accompanied by supporting x-rays.
The term “Course of
Treatment” means all treatment performed in the oral cavity during one or more
sessions as the result of the same diagnosis, including examinations, x-rays,
prophylaxis, and any complications arising during such treatment.
Note: When Claims are sent
in for pre-authorization, all x-rays billed must be submitted for payment of
benefits. NO BENEFITS will be paid when x-rays are of such poor quality that
they have no substantial diagnostic value. If x-rays need to be retaken to
determine allowable benefits, there will be no additional payment.
Important: You must
follow these rules for pre-authorization of benefits or your claim will be
denied.
Death Benefit Changes for Retirees
Effective July 1, 2003, the Trustees have revised the
wording for the Death benefits for Retirees to be:
Retirees are only eligible for this benefit if
the retiree is not eligible for Medicare.
The change is that the previous language only allowed
death benefits to be paid if the retiree paid the full current active rate,
which no longer exists. Retirees on Medicare will still no longer be eligible
for Death Benefits.
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