Notifications
Posted June 5, 2023
There has been some wording changes to our Plan Benefits Document with regard to dental services and preauthorizations. PLEASE READ
Be in the Know. Protect yourself and control your out of pocket dental expenses.
Pre-authorizations are required for a number of specific dental treatment. The purpose of a pre-authorization is to ensure that the procedure is a necessary procedure for you and it is in your best interest as it informs you of any out of pocket expenses you may be responsible for BEFORE treatment begins. PLEASE remind your dentist that pre-authorization is required for the category of services indicated below. Please note, you have the option to request a pre-authorization for any dental services.
Posted February 1, 2023
Out-Of Network Dental Claims:
Please be advised that effective immediately, all dental benefit payments made on a claim for services rendered by an out-of-network dentist will be mailed and paid directly to you, the member. This includes payments for all services by general dentists, specialized dentists, orthodontists, etc.
Student Certification:
If a claim is denied for a 19-25 year old dependent, don’t worry. Check the EOB for the reason of denial. The denial is likely due to requiring updated student certification information. You can email your student certification documents to enrollments@tpgplans.com. This is required each year by August 31st for the fall semester and December 31st for the spring semester. Visit the Student Certifications page on this site for further information.
Offer expired but feel free to contact the dentist directly to see if other pricing is available to you. Dr. Thomas P. Stein and Associates, Creating Dental Excellence in Cornwall, NY. 845-534-3828
Posted November 16, 2022 - Special pricing for Sure Smile Aligner treatment offered to our PVCSD employees, retirees, and their immediate family. See the attached flyer for an announcement. (Orthodontic smile correction)
Details: PLEASE READ ALL information.
The dental office of Dr. Thomas P. Stein and Associates, Creating Dental Excellence in Cornwall, NY, is offering special pricing on Sure Smile Aligner services to all PVCSD employees, retirees and their immediate families.
The price is $5700 and includes free whitening! See the flyer below.
If you, the active employee/member or you, the retiree, decide to use the services of Dr. Stein for your Sure Smile Aligner treatment, remember this is NOT a reimbursable benefit to you from the Welfare Trust Fund or any other insurance provided to you from PVCSD. Your fees are paid by you to the dentist. No claim forms are necessary and you will not receive any payments for your Sure Smile Aligner service or for the teeth whitening service.
Orthodontic benefits are available to your under 19 year old dependent. If you use Dr. Stein for your under 19 year-old dependent's orthodontic treatment, and you have been a member of the PVFT Welfare Trust Fund for 1 full year, you will be entitled to receive the $3500 lifetime orthodontic benefit for each dependent. All fees and payment schedules outlined in our Plan Documents will be followed for each eligible dependent.
To discuss the offer and the process, please contact Creating Dental Excellence, The Office of Dr. Thomas P. Stein and Associates, directly. See the flyer below for contact details.
This offer must be accepted and in progress with Creating Dental Excellence before June 30, 2023. After June 30, regular pricing will be in effect. Contact Creating Dental Excellence, The Office of Dr. Thomas P. Stein and Associates, directly to discuss and accept the offer.
In order to receive the discount, be sure to let the office know that you are using the special offer for Putnam Valley.
Dr. Stein Putnam Valley Schools Promotion Nov 22-June 23 page 1.pdfDr. Stein Putnam Valley Schools Promotion Nov 22-June 23 page 2.pdfPosted June 29, 2022 - VERY IMPORTANT INFORMATION
CLAIM SUBMISSIONS AND ORTHODONTIC REIMBURSEMENT UPDATE
CLAIM SUBMISSIONS
PLEASE do not send any DENTAL claims to The Preferred Group office in Albany. ALL dental claims must go to Anthem. The proper address is on our claim form which can be found on our Claim Forms page AND on the Home Page of this site.
Any claim that is sent to The Preferred Group (TPG) will be denied and the EOB with the denial information will be sent to you, the member, effective immediately. If your dental provider submitted the claim on your behalf, you must contact your provider and tell them to resubmit the claim properly.
If you sent the claim to TPG, please resubmit using the CLAIM FORM that you can find here.
If you are wondering if your claim was filed improperly, it probably was. There are 147 members who have either submitted clams improperly or their provider has submitted improperly on your behalf. Please confirm with your dentist on your next visit! Save yourself time on a reimbursement.
ORTHODONTIC REIMBURSEMENT UPDATE
Special new information regarding Orthodontic reimbursements:
Effective July 1, 2022
Orthodontia reimbursement will be paid based upon the schedule below:
$500 for placement to the orthodontist
$250 payment per month for 12 months to the orthodontist
In total, $3500 will be paid for these services
If the orthodontist has completed their services and the member has not receive the full $3500 benefit:
The member must include all EOB's and payment information showing the contracted amount, payments made, and/or balance due. After the appeal is reviewed and approved by the Trustees, a payment will be sent directly to the member for the remaining amount.
If the member does not submit an appeal, your provider will continue to receive their $250 each month for their services (until the balance due is paid in full or up to the maximum benefit of 3500)
See, "How to Submit an Appeal" on the Home Page of this site.
Posted March 11, 2020
Welcome to our new Welfare Trust Fund Website. Designed similarly to the old site. BOOKMARK this page please.
New for 2022 - After analyzing the data from a recent poll to our active members, conversations with Raymond resulted in this new option to help members with their dependent's vision needs. Raymond is offering our members a new package to help defer the costs of the vision needs for our member's dependents. The cost of an exam and eyeglasses package has been reduced to $100. That is a $50 savings and can be used for any number of your dependents in a calendar year. This is not an increase or change to your vision benefits.
Please note, you must have used your $300 member benefit before your additional dependents are eligible for this benefit.
Here is how it works: Once you have used your $300 vision benefit, your spouse and children can get and eye exam and glasses for $100 each at Raymond Optician.
Click here to browse the VISION page and the Raymond Flyers.
Posted 1/17/2022
Welcome to our Welfare Trust Fund representatives and some exciting new claim procedures.
For general inquiries on benefits, to verify eligibility for a member or dependent, or inquire about offered benefits:
email benefits@tpgplans.com
Be sure to include "PVFT Welfare Trust Fund" in the email
For student certification of enrollment:
email a PDF or screenshot of document showing dependent name, school attending, and stating full-time status to enrollments@tpgplans.com. Be sure to include your name, your dependent's name in the email.
Sample documents include a student schedule showing 12 or more hours AND the school name, or a student verification form found on school websites showing full-time status
No longer a full-time student - email enrollments@tpgplans.com for COBRA information within 30 days of non full-time student status.
Welcome to our new Trustee Karen Weise. Feel free to reach out to her with questions or email wtf@pvtrustfund.org directly.
Posted 1/17/2022
Notifications prior to January 2022 can be found on our old site until removed by vendor. click here for direct link. Notifications prior to 1/1/22