Human Resources - Employee Benefits

Dental Benefits

Purpose of the Dental Plan

The purpose of the Dental Plan is to protect eligible employees and their eligible family members from the financial hazard of large, unforeseen dental expenses; and to promote good dental health.

Basic Services
Exclusions
Fee Guide
Major Services
Orthodontics
Pre-Treatment Authorization
Reimbursement Maximums

For information relating to Claiming Benefits, Co-ordination of Benefits, Exclusions, Family Member Eligibility, e-service, etc. please go to the Health Benefits Home Page.

Reimbursement Maximums

AESES
Calendar Year Maximum for all Services: $1,500
Lifetime Maximum for Orthodontic Services: $1,600

IUOE
Calendar Year Maximum for all Services: $1,500
Lifetime Maximum for Orthodontic Services: $1,600

UWFA
Calendar Year Maximum for all Services: $1,500 (from January 1, 2009)
Lifetime Maximum for Orthodontic Services: $1,600

UWFA-Collegiate
Calendar Year Maximum for all Services: $1,600 (from July 22, 2010)
Lifetime Maximum for Orthodontic Services: $1,600

Excluded Support
Calendar Year Maximum for all Services: $1,500
Lifetime Maximum for Orthodontic Services: $1,600

Excluded Academic
Calendar Year Maximum for all Services: $1,500 (from January 1, 2009)
Lifetime Maximum for Orthodontic Services: $1,600

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Pre-Treatment Authorization

Pre-treatment authorization has been established primarily for your protection, having possible misunderstandings resolved before expensive dental work is actually carried out.

If the cost of all treatments planned is expected to exceed $500, it is recommended that Blue Cross approve the work in advance. After listing the work planned, the dentist submits the Claim Form with supporting X-rays to Blue Cross and he/she receives confirmation within about two weeks.

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Importance of the Fee Guide

Benefits paid by the Plan are based on a specific Dental Fee Guide established by the provincial Dental Association (excluding the Manitoba Northern Fee Guide). While they are not required to do so, the majority of dentists charge according to the rates set out in the Fee Guide.

For those employees going to a particular dentist for the first time, it is suggested that you ask the dentist how he/she sets rates before any work is carried out. If the dentist charges more than the Fee Guide, you are responsible for the excess. If the dentist charges less than the Fee Guide, it is to your advantage since the Plan will still pay a percentage of the Fee Guide. In no event will the Plan pay more than the dentist's actual charge.

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Basic Services Covered

The Plan covers 80% of eligible charges for the �Basic� dental services listed below:

Diagnostic:

Complete examination, once every 3 years.

Recall or oral examinations covered twice in each calendar year.

Periapical or bite-wing x-rays covered twice in each calendar year.

Full mouth x-rays or panorex x-rays once every 2 years if necessary.

Consultations required by attending dentist.

Preventative:

Combination of one and one-half units of Polishing and/or Scaling (the removal of deposits and stains from the tooth surface) twice in each calendar year.

Topical application of fluoride up to 2 applications in each calendar year.

Space maintainers (except when used for orthodontic purposes) and habit-breaking appliances.

Extractions:

Uncomplicated procedure for the removal of teeth which are beyond restoration.

Restorative:

Fillings made of amalgams, silicates, plastics and synthetic porcelains.

Endodontics:

The usual procedures required for pulpal therapy and root canal filling.

Periodontics:

The usual procedures for treatment of the diseases of the tissues and bones supporting the teeth.

Oral Surgery:

Extractions and complicated surgical procedures performed in the dentist's office, including general anesthesia and post�operative care.

Anesthesia:

General anesthesia or nitrous oxide analgesia, administered in the dentist's office.

Drugs:

Cost of medication and injections given in the dentists office.

Accidental Injury:

Major dental services as a result of an accident to a maximum of $1,000 per person. Treatment must commence within 90 days of the accident.

Habit Breaking Appliances

Laboratory Tests

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Major Services Covered

In addition to the �Basic� services listed previously, the Plan covers 60% of eligible charges for the following �Major� dental services:

Extensive Restorations:

Inlays and onlays (one tooth every 5 calendar years)

Jackets, crowns and bridges to rebuild and replace missing teeth. (Only one procedure per tooth every 5 calendar years).

Please Note: Blue Cross will not pay for a gold crown, or fixed bridge when another material or procedure would have been a reasonable substitute consistent with generally accepted dental practice. Where a reasonable substitute was possible, the covered expense is that of the customary substitute.

Dentures:

Partial or complete upper and lower dentures, provided by a dentist or licensed denturist. Each procedure is limited to once every 5 years. Allowances include all adjustments.

Prosthetic:

Repair of damaged dentures. Adding teeth to existing dentures, or relining or re-basing the dentures. Each procedure is limited to once every 3 years.

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Orthodontics

Orthodontic procedures are covered at 50% for dependent children under 17 years of age. Lifetime Benefit Maximum is $1,600.00 per child.

Dental Exclusions

The following exclusions and limitations are specific to the dental plan. For General Exclusions that are applicable to all health benefits, please refer to the Health Benefits Home Page.

Blue Cross will not pay for.

Charges for broken appointments.

Congenital malformations, e.g. cleft palate prosthesis.

Fees arising out of extra services arranged for privately between the patient and the dentist.

Implants.

Charges for oral hygiene instruction, plaque control program, nutritional counselling, or supervised fluoride brush-in (self-administered).

Charges for completion of claim forms.

Charges for appliances which have been lost, broken or stolen.

Gold, crown, fixed bridge, veneers, or other extensive treatment when another material or procedure would have been a reasonable substitute consistent with generally accepted dental practice. Where a reasonable substitute was possible, the covered expense is that of the customary substitute.

Services for Temporo-Mandibular Joint Dysfunction, including night guards.

Charges for treatment other than by a Dentist, except for treatment performed in a dentist office under the supervision and direction of a Dentist by a personnel duly licensed or certified to perform such treatment under applicable professional statutes and regulations.

Separate charges for general anaesthesia except in connection with office procedures as specified in the agreement.

Diagnostic Photographs.

Bleaching of teeth.

Precision Attachments.

Provisions for facilities in connection with general anaesthesia.

Hypnosis and Dental Psychotherapy.

Root Canal on a permanent tooth more than once per lifetime per tooth.

Polishing restorations.

Any procedure in connection with forensic dental.

Complete series of x-rays, panoramic and cephalometric x-rays more often than once every 2 calendar years.

Complete clinical examinations more often than once every 3 calendar years.

Application of fluoride, recall and oral examinations, and a combination of 1 1/2 units of polishing and/or scaling under Basic Services more than twice in any calendar year.

Orthodontic services other than as provided in the agreement, or services for orthodontic treatments rendered to eligible dependents who begin the treatment after their 17th birthday.