The Penn Faculty Practice Dental Plan for University Retirees - General Information

As a retired member of the University community, you can continue to enjoy high-quality dental care at a reasonable cost through the Penn Faculty Practice Dental Plan for University Retirees. The Penn Faculty Practice Dental Plan is a program of comprehensive dental coverage with the Penn Faculty Practice of the University of Pennsylvania School of Dental Medicine. All covered services are performed by members of the Practice at its office locations on the Penn campus and in the Philadelphia metropolitan area.

The Penn Faculty Practice Dental Plan for University Retirees offers many advantages, including: convenience, no forms to fill out, and a guarantee of affordable access to the highest quality care that can be provided.

Here's how the Penn Faculty Practice Dental Plan can work for you:

Quality Care
The Penn Faculty Practice has been providing care to members of the University community since 1979. All treatment is provided by dentists and specialists who have faculty appointments at the School of Dental Medicine. In addition to general practice dentists, the Practice includes periodontists, who specialize in the treatment of gum disease; endodontists, who specialize in treatment of teeth with nerve damage; and prosthodontists, who specialize in complex restorations. Other members of the Practice are specialists in oral surgery and implantology.

Convenience
Patients may receive their care at any of the office locations of the Penn Faculty Practice:

Penn Dental at the Robert Schattner Center 240 South 40th Street, 3rd Floor Philadelphia, PA 19104-6030 215-898-4615 Hours of operation: 8 a.m. to 5 p.m. Monday through Friday 8 a.m. to 5 p.m. two Saturdays per month Directions Practitioners at this office

Penn Dental Center at Bryn Mawr 711 Lancaster Avenue Bryn Mawr, PA 19010 610-520-4600 Hours of operation: 8 a.m. to 5 p.m. Monday, Tuesday, and Friday 8 a.m. to 9 p.m. Wednesday and Thursday 8 a.m. to 1 p.m. two Saturdays per month Directions Practitioners at this office

Penn Dental Center at University City 3401 Market Street Philadelphia, PA 19104 215-573-8400 Hours of operation: 8 a.m. to 5 p.m. Monday through Friday 8 a.m. to 5 p.m. two Saturdays per month Directions Practitioners at this office

A full range of services is available from the Practice, so patients never need to go elsewhere for specialty treatment.

To begin receiving care, all you will need to do is call for an appointment when you are ready for a check-up or when you have a problem. You will be scheduled with a specific dentist of your choice. All patients are encouraged to find a dentist they feel comfortable with and to maintain continuity of care with that dentist. When you arrive for your appointment, report your name to the receptionist. No claims forms are required to receive care under the Penn Faculty Practice Dental Plan.

Comprehensive Benefits
The Penn Faculty Practice Dental Plan for University Retirees provides full coverage for basic and preventive and restorative services and coverage at substantially reduced rates for other services. Please note there is an annual max of $1,000 per plan year. The following coverage is provided:

· Type I Services - 100% Coverage
Diagnostic, including routine examinations and consultations and radiographs (x-rays).

Preventive, including fluoride applications; prophylaxis; oral hygiene counseling; and nutritional counseling.

Simple Restorations, including amalgam and tooth-colored fillings.

Oral Surgery (out of hospital only), including extractions; incision and drainage of abscesses; alveolectomy and alveoplasty; removal of oral cysts and tumors; and other routine oral surgical procedures performed in the office.

Emergency Treatment, including palliative treatment for the relief of pain or discomfort. .

· Type II Services - 60% Coverage
Periodontics, including subgingival curettage, root planing, and scaling; surgical periodontics; and occlusal adjustment.

Endodontics, including pulp treatment; root canal therapy; and apicoectomy.

Space Maintainers (prosthetic devices used in children to maintain the gap created by a missing tooth until the permanent tooth emerges).

· Type III Services - 50% Coverage
Major Restorations, including inlays, crowns (when determined by the dentist to be necessary), and bridges.

Dentures, including complete upper or lower dentures; partial dentures; and relining and repair of dentures requiring laboratory work.

Repairs and Adjustments, including recementation of inlays, crowns, and bridges; and relining and repair of dentures not requiring laboratory work

For all services, you will be asked to make your copayment, if any, at the time of your visit. Arrangements can be made for periodic payment of lump sum copayments, such as those for crown and bridge work.

Emergency care is available on a 24-hour basis. If an emergency occurs outside of normal business hours, call any Network office for referral to the resident on call. If an emergency occurs when you are more than 50 miles away, palliative treatment--treatment that alleviates the immediate discomfort--from a non-plan dentist is covered by the Plan. Examples of emergencies are pain, fever, swelling, bleeding, severe discomfort, or loss of a tooth. Treatment from a non-plan dentist should be limited to palliative treatment. Follow-up care must be provided by the Penn Faculty Practice.

Eligibility
The Penn Faculty Practice Dental Plan for University Retirees is open only to retired Penn faculty and staff who are covered by COBRA as of 6/30/05. Eligible retirees who enroll in the Plan also have the option to enroll dependents. Eligible dependents include spouses; same-sex domestic partners (that meet the requirements for same-sex partners as set forth in University policy and as designated by the retiree on a form provided by the University Benefits office); unmarried dependent children under the age of 19; full-time college students under the age of 23; and unmarried stepchildren, foster children, and legally adopted children under the age of 19 who depend upon the retiree for support and maintenance.

Enrollment in the Plan
University retirees must enroll in the Plan within 30 days of the termination of dental coverage being purchased under the provisions of the Consolidated Omnibus Reconciliation Act of 1986 (COBRA). Retirees are not permitted to enroll in the Plan outside of this time period.

Dependents must be enrolled at the same time as the University retiree, with the exception of additions resulting from a change in family status, such as marriage. Newly eligible dependents must be added within 30 days of becoming eligible.

The effective date of coverage under the Plan will be the first day of the month following enrollment.

Monthly Premium
Payment for coverage is made on a monthly basis. The amount of the premium is subject to change annually. Subscribers will receive a bill each month and make their payments directly to the Penn Faculty Practice Dental Plan Office.

Termination of Coverage
Coverage for you and any listed dependents will terminate on your request or upon discontinuation of your monthly premium. In the event of death of the University retiree, coverage can be continued for a spouse or other eligible dependent currently covered.

Go to Plan Document and Summary Plan Description for the Penn Faculty Practice Dental Plan for University Retirees.