UA Local 447 Pipe Trades Trust Funds

Overview	The dental benefit is self-funded by the Plan and is available for all active plan participants. (Coverage for self-pay participants may be different.)

Pre-Certification Requirement	Pre-Certification is required by the Plan prior to dental work costing $500 or more; otherwise, benefits will not be paid for that work. To obtain Pre-Certification, your dentist must send the proposed treatment plan to the Administrative Office for approval before treatment begins.

Calendar Year Deductible:	$50 per person, 3 per family. The $50 deductible is waived for routine prophylaxis (teeth cleaning). If you obtain two cleanings per year, your per-person deductible will be waived on all covered dental services in the following year.

Calendar Year Maximum Benefit:	$3,000 per person

Orthodontia Lifetime Maximum Benefit:	$5,000 per child

Dental Service	In-Network	Out-Of-Network

Prophylaxis (Cleaning): two per calendar year 1	90% of contract rate, no deductible	70% of usual, customary & reasonable, no deductible

Other Preventive and Diagnostic: Fluoride Treatments, Exams, X-Rays, Bitewings (once every six months to age 18; once every twelve months ages 18 and over), Panoramic/Full Mouth X-Rays (once every three years)	90% of contract rate after deductible	70% of usual, customary & reasonable after deductible

Basic Services: fillings, extractions, root canals, periodontal work, oral surgery, anesthesia	90% of contract rate after deductible	70% of usual, customary & reasonable after deductible

Major Services: crowns, dentures, fixed bridges	90% of contract rate after deductible	70% of usual, customary & reasonable after deductible

Orthodontia (children under age 19 only)	90% of contract rate after deductible	70% of usual, customary & reasonable after deductible

1. A third cleaning in a twelve month period may be covered if approved in advance by the Plan.