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

PEDIATRIC DENTISTRY
If you enroll with a participating dentist and your child needs to be treated by a pediatric dentist, the Plan has participating pediatric dentists which your child may use, provided the following prerequisites are met:

Care must be performed on a patient under the age of four or on a developmentally disabled dependent child.

You must have a referral from your primary care dentist.

Care must be approved in advance by the dental consultant.

In these cases, the participating pediatric dentist will charge the same amount as the primary care dentist. However, if the above conditions are not met, the services will not be covered.