For Eligible Participants of the UFCW Local 1776 and Participating
Employers Health and Welfare Fund


ORTHODONTICS
Both the participating and non-participating dental schedules have lifetime allowances for orthodontic cases. The Fund will pay its allowance in installments upon submission of a claim. The Fund prorates the allowance for partial banding or other special cases. Also, certain appliances are counted towards your total orthodontic benefit. Therefore, the amount paid towards these appliances will be deducted from your total orthodontic benefit. Contact the Fund office for more information. The lifetime orthodontic allowance is not counted toward $1,500 per person calendar year maximum that the Dental Plan will pay for dental services; it is a separate benefit (see above under "Maximum Payments.") The Fund will pay its allowance in pre-set installments which are determined at the time the orthodontic service is pre-authorized.