Dental Care Benefits are designed to help you pay for your family’s dental expenses, both for routine (basic and preventive) care and for expensive and unforeseen treatments (major restorative and orthodontic services).
To be considered as a “covered expense”, the charge for a particular service must be reasonable and customary for the service provided in the area where the expense is incurred, and will be limited to the maximum fee level of the 2016 suggested fee guide for dental services provided by General Practitioners of the Ontario Dental Association (increasing to the 2017 fee guide on January 1, 2018). Fee schedule adjustments are at the discretion of the Board of Trustees. Any amounts charged by the dentist which are in excess of the fee guide approved by the Trustees, must be borne by the member.
The Plan covers necessary dental treatment by a dentist, denturist, qualified dental hygienist, or any other qualified personnel under the direct supervision of dentist. If the treatment is going to cost more than $500, ask the dentist to prepare a treatment plan. You must submit this plan to Medavie Blue Cross before the treatment begins so you may find out exactly what the Plan will pay. You will need to submit a new treatment plan if you change dentists in the course of treatment.
If you are going to use the services of a denturist, check with the Denturist Society to ensure that the denturist is licensed and that he is practicing within the scope of his license. Coverage will be on the 2016 suggested fee guide provided by the Denturist Society of Ontario or The Ontario Association of Denture Therapists (increasing to the 2017 fee guide on January 1, 2018 and the 2017 fee guide on January 1, 2018).
DENTAL CARE BENEFITS
If you or a dependent should be totally disabled as a result of dental injury or disease when your Dental Care Benefits terminate, and if the attending dentist or doctor renders or prescribes dental treatment for the disabling condition which would have been paid had your coverage continued, your benefit payments with respect to Routine Treatment and Major Treatment expenses will continue until the earliest of the following dates:
- The date the disability ends, or
- The date which is three months after termination of your Dental Care benefit, or
- The date the Health Benefit Plan terminates.
If benefits for Orthodontic Treatment are in the process of being paid when the dependent’s coverage terminates, those benefits for Orthodontic Treatment will be continued during the three month period immediately following the termination of benefits.
COVERED EXPENSES AND MAXIMUM LIMITS
The Plan provides 100% reimbursement of routine treatments, 90% of major treatments and 75% of orthodontic treatment, subject to an annual maximum reimbursement of $2,000 per individual for routine and major services combined, and a lifetime maximum of $3,000 per individual for orthodontic treatment. Coverage for orthodontic treatment is limited to children over the age of 6 years and under the age of 18 years. The different treatments covered under each category are outlined below. Show these to your dentist before commencing any dental treatment.
DEPENDENTS ARE DEFINED AS
This benefit is provided to you and your eligible dependents. Eligible dependents are defined as:
- your legal or common-law spouse, and
- your unmarried children under 21 years of age, and
- your unmarried children aged 21 and over who were continuously covered under the Plan and who are full time students and under the age of 26 years or who are unable to support themselves because of mental or physical handicap,
- but excluding any children who are not financially dependent on you or a handicapped or unmarried child not covered under the Plan up to his/her 21st birthday. Your common-law spouse and dependents are eligible 6 months after notice of cohabitation is received by the Benefits Office.
MAKING A CLAIM
Reimbursement can be made electronically through CDA Net. Simply present your Local 46 Medavie Blue Cross ID card to your dentist. If your dentist cannot use the electronic transaction network, complete and submit a dental claim form with original receipts. You may use the claim form provided by Medavie Blue Cross or by your dentist. Mail the completed form to, or drop it off at, Medavie Blue Cross, or drop it off at the Benefits Office, with all receipts attached.
If more than one of you or your dependents is going to the dentist, complete a separate claim form for each individual.[widget type='CHILDREN'][/widget]