DIRECT REIMBURSEMENT DENTAL PLAN TEETH WHITENING January 12, 2010
No. 1-10
Effective January 1, 2010, the Direct Reimbursement Dental Plan has added Teeth Whitening as an allowable benefit. The benefit is as follows: • • •
Teeth whitening is an allowable benefit once every three (3) years with a maximum of $200.00 per individual The $200.00 benefit is deducted from the annual $2,000.00 maximum Service must be performed by a license dentist in a dental office
The Direct Reimbursement Dental Plan will not pay for the following: • • • • • •
Take Home Supplies Gels Syringe(s) Whitening Strips Home Bleaching Trays Other Whitening Appliances
If you require additional details on Teeth Whitening, please call the Benefits Department at 213-977-9014, extension 2. Please note: Request for all Direct Reimbursement dental claims must be submitted to the UFLAC Benefits office within twelve (12) months of the service date accompany with a paid receipt. Failure to timely file will result in the denial of your claim. UFLAC Membership & Benefits
