Welfare Summary Plan Description

9.4 PRE-TREATMENT ESTIMATES

A "treatment plan" is a dentist's written report explaining proposed treatment. Whenever you expect that your expenses for a treatment plan will be more than $500, a pre-treatment estimate is recommended. The pre-treatment estimate will tell you the total charges for a treatment plan and what part of those charges will be covered by the Plan. This way, before you begin treatment, you will know how much you will have to pay. Claims not submitted for a pre-treatment estimate are subject to retrospective review by the Plan's dental consultant(s).

For a pre-treatment estimate, send the treatment plan to the Administrative Office.