Welfare Summary Plan Description

9.6 ALTERNATE BENEFIT PROVISION

In many cases, there is more than one method of satisfactory treatment or material that may be utilized to correct a dental condition. Under the provisions of this Plan, Covered Dental Expenses are limited to those services or supplies which are customarily employed in dental treatment, and which are recognized by the dental profession to be appropriate according to broadly accepted national standards of practice. The Plan takes into account the overall dental condition of the Participant.

You may choose a more costly custom or precision dental procedure. However, if you do, you will be responsible for paying the difference between the charges for the more elaborate procedure and the Dental Care Benefit paid by the Plan. All treatment decisions rest with you and your dentist.

Some examples of how the Alternate Benefit Provision may be applied:

  • If a tooth can be satisfactorily restored with a resin, amalgam, or silicate filling, this is the covered expense. You may apply this covered expense toward a more elaborate or precision restoration that you and your dentist choose.
  • If a standard partial denture will satisfactorily restore a case, the Plan permits you to apply the covered expense for that procedure toward a more complicated custom or precision case that you and your dentist may choose.
  • Implants are held to the allowable "partial bridge" coverage.