health
benefits

Dental

• General
• Plan A - Basic Services
• Plan B - Prosthetic Appliances and Crown and Bridge Procedures
• Plan C - Orthodontics
• Emergency Dental Care Anywhere in the World
• Exclusions
• How a Claim is Made
   

General
Eligible Members and their registered* dependents are entitled to the following Dental services when performed by a Dentist:

*Spouse of an Insured Person, and unmarried dependent children to age 21, unless the dependent child is attending a recognized school, college or university on a full-time basis, in which case the maximum age will be 25. A child is not a dependent if he/she is eligible for or entitled to benefits under this Plan as a Member.

1. Diagnostic Services:
   All necessary procedures to assist the Dentist in evaluating the existing conditions to determine the required dental treatment, including: 
   Recall oral examinations (one during any period of 6 consecutive months for dependent children under the age of 19, one during any period of 9 consecutive months for adults). 
   Complete oral examination only once every 3 years. 
   Consultations 
   X-rays (complete mouth X-ray will be covered only once in a 3-year period).
2. Preventive Services:
   All necessary procedures to prevent the occurrence of oral disease, including:
   Scaling and root planing, 16 units per calendar year
   Topical application of fluoride (one during any period of 6 consecutive months for dependent children under the age of 19, one during any period of 9 consecutive months for adults).
   Fixed space maintainers
3. Surgical Services:
   All necessary procedures for extractions and other surgical procedures normally performed by a Dentist.
4. Restorative Services:
   All necessary procedures for filling teeth with amalgam, synthetic porcelain, or plastic; and stainless steel crowns. Gold will be provided as a filling material only when teeth cannot be restored with the above filling materials.
5. Prosthetic Repairs:
   All necessary procedures required to repair or reline fixed or removable appliances.
6. Endodontia: (Root Canals)
   All necessary procedures required for pulpal therapy and root canal filling.
7. All necessary procedures for the treatment of tissues supporting the teeth.
8. General anaesthesia required in relation to oral surgery.

1. Crowns and Bridges;
2. Partial and/or complete dentures but not more often than once in two years. 
   Dentures lost, broken or stolen will not be replaced. 
   Charges made by a licensed Denturist will be recognized for payment, in accordance with a separate Schedule of Allowances.

1. Treatment of congenital malformations.
2. Cosmetic Surgery or dentistry for purely cosmetic reasons.
3. Services for treatment of endodontia and periodontia in process at the effective date of your coverage.
4. Charges for broken appointment.
5. Services which are paid for by the Medical Services Plan of British Columbia, Workers’ Compensation Board or any tax supported agency.
6. Charges for any treatment where it is established that a third party is liable at law to make payment.
7. Replacement of an existing denture which, in the opinion of the Attending Dentist, is or can be made satisfactory.
8. Charges in excess of the College of Dental Surgeons of British Columbia Fee Guide.
9. Orthodontia, (straightening of teeth, etc.) except for dependent children to their 19th birthday.

1. On the first visit to the Dentist advise the receptionist that a completed dental claim form will be required.
2. Submit the completed form to the Administration Office within 90 days of incurring expense along with the Dentist’s bill or receipt. Please ensure that the Member's name, address, Social Insurance Number and Local Union are clearly shown.
3. If the dentist's bill was paid in full then the cheque issued will be payable to the Member. If the dentist's bill was not paid, then the cheque will be payable to the Dentist and mailed to him. The Member will be responsible for the difference between the Dentist’s charge and the amount paid by the Plan.