Benefit Programs





 

 

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CCPOA Dental Plans
Primary Dental & Western Dental

Supervisor



CCPOA Primary Dental

When you want a choice.
Go to any dentist, or choose from a provider network to save money.

CCPOA's Primary Dental Program is an indemnity, or fee-for-servicesup poster, plan and does not require you use a provider network though a provider network does exist. You may select any dentist anywhere in the world. Participants within the Primary Dental program are, however, encouraged to use CCPOA's Preferred Provider Organization Network Dentists.

The plan sets limits (usual and customary amounts) that it will pay for each type of dental treatment. You are responsible for paying any remaining balance that might be due based upon the type of dental treatment received. A premium co-payment is deducted from your monthly pay warrant.

Additionally within Primary Dental, First Dental Health is a cost saving network for Primary Dental members in certain participating areas. The Trust presently contracts 2 networks: EPO and PPO through First Dental Health.


 

PPO Network:
Preferred Provider Organization. FDH providers follow a contracted fee schedule for the service they provide.

EPO Network:
Exclusive Provider Organization. The EPO program, provides the patient with a greater reduced fee for service, in this smaller, exclusive network.

fdh

First Dental Health

Additionally within Primary Dental, First Dental Health is a cost saving network for Primary Dental members in certain participating areas.

The Trust presently contracts 2 networks: EPO and PPO.

Annual Deductible is WAIVED! More than 17,500 participating dentists in California!

If you use a First Dental Health dentist, the dentist has agreed to accept First Dental Health's usual and customary fee schedule as the cap for services. This amount is usually significantly less than what a dentist would charge under a normal indemnity or fee-for-service arrangement. If you are enrolled in CCPOA's Primary Dental Program, and are using a network provider, your annual 50/150 deductible is waived.

Contact First Dental Health
Mon-Fri 8am to 5pm PST.
Call us (800) 334-7244

Special website for CCPOA Primary Dental members:
http://ccpoabtf.firstdentalhealth.com
to find a FDH dentist in your plan.

What Does It Cost?

2014 CCPOA Primary Dental Monthly Contributions:

Supervisor Members
Member = $37.00
Member+1 = $79.00
Family = $135.00

Questions regarding your Dental coverage?

For more information please contact your Personnel Specialist

Benefit Trust Fund Primary Dental Plan
Non-Contracted Provider: First Dental Health Providers:

Calendar year maximum: $2000/ per person
Combined Dental & Orthodontic Deductible:

Per calendar year
Individual: $50
Family: $150
Deductible is waived on Preventive/Diagnostic Services
Services are payable based on CCPOA allowable amount

Calendar year maximum: $2000/per person
Deductible: None

Services are payable based on Contract Rate through First Dental Health EPO/PPO
PRIMARY DENTAL COVERAGE SCHEDULE
Preventive/Diagnostic Services
100%

Prophy: Three times in the calendar year (anytime.) - effective 1/1/14
Fluoride: Under age 15, twice in a calendar year
Sealants: No age limit, on permanent unrestored posterior molars only. 36-month limitation - effective 2/2/09
Bitewing: Unlimited, unless done with Panographic or more than 10 PA’s.
Panographic: Unlimited while taken alone.
FMX: Once every 36 months
Exams: Unlimited. First exam is payable under preventive, all subsequent exams are payable under the basic benefit with no deductible,
Space Maintainers
Emergency Palliative Treatment
Singles Crowns, Inlays, Onlays & Build-ups:
80% - PREP DATE
- Porcelain crowns placed on molars will be paid as a full cast crown.
5-year replacement limitation
Prosthodontic (Major) Services
50% - PREP DATE

Initial preparation & installation of bridges
Crowns attached to a bridge
Initial preparation & installation of partial or complete dentures (including repairs)
Prior extractions are covered - effective 1/1/02
5-year replacement limitation
Congenitally missing teeth are covered
Basic Services
90%

Restorative Services: Composite porcelain & silver amalgam fillings.
Effective 1/1/14 Composite fillings are no longer "downgraded" to amalgam.
Endodontic
Services: Root canal Therapy
Periodontal Services: Root Planning & Scaling: 24-month period. Perio charting is required. Pre-operative X-rays are necessary when pocket depths are under 4-mm.
Periodontal cleanings that are in conjunction with an active periodontal disease will be limited to two cleanings per year and only for the l8-month period following treatment of the periodontal disease.
Oral Surgery: Extraction of teeth & minor oral surgery
General Anesthesia. if provided in conjunction with a covered oral surgery procedure & only if determined by the Administrator to be Medically Necessary

Orthodontic Services: No age limit
50%
to lifetime benefit $l000
including adjustments & retainers

Services Not Covered
TMJ
Occlusal guards/Night guards
Implants
Analgesia/Nitrous oxide
Arestin

Coordination of Benefits: Standard
Pre-authorization is suggested over $300
Dependent children may be covered up to age 26 regardless of student status.
This is not a guarantee of payment but a summary of benefits available through the CCPOA Primary Dental Plan. Benefits are subject to eligibility, terms, conditions, and limitations of the participant’s dental coverage in force at the time the services are actually rendered.
Certain services are subject to review.