GENERAL INFORMATION
WELFARE PLAN
  BENEFIT HIGHLIGHTS
  ELIGIBLE DEPENDENTS
  DESCRIPTION OF BENEFITS
  LIFE INSURANCE
  ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS
  WEEKLY INDEMNITY
  LONG TERM DISABILITY
  MAJOR MEDICAL BENEFITS
  DENTAL BENEFITS
  EMERGENCY OUT OF PROVINCE
  MEMBER AND FAMILY ASSISTANCE PLAN
  GENERAL EXCLUSIONS
  COORDINATION OF BENEFITS
  GENERAL INFORMATION
  PAY-DIRECT COVERAGE
  EXTENSION OF MAJOR MEDICAL AND DEATH BENEFITS ON AN EMPLOYEES' DEATH
  EXTENTION OF MAJOR MEDICAL AND DENTAL BEFEFITS IF SICK OR DIABLED
  NO BREAK IN SERVICE ARRANGEMENT
  DESIGNATION OF A BENEFICIARY
  BENEFITS PERTAINING TO PENSIONERS
  TERMINATED FORMER EMPLOYEES
  HOW TO SUBMIT CLAIMS
  TERMINATION OF WELFARE COVERAGE
  FUTURE OF THE PLAN
PENSION PLAN
MEMBER BENEFIT BOOKLET
 

 

WELFARE AND PENSION PLANS

Welfare Plan

DESCRIPTION OF BENEFITS

 

Effective July 1, 2015: DENTAL BENEFITS

  • Major Dental (including Dental Implants)/Orthodontics combined maximum increases from $2,000 per year to $2,500 per calendar year.
  • Dental implants are no longer subject to the alternative treatment clause
  • Orthodontic treatment initiated for a child, who is at least 6 years, must commence before age 16 (formerly under age 14).


Dental Benefits (Employees and Dependents)

Reasonable and customary charges for the following dental services or supplies are payable, subject to any applicable deductible amount or benefit percentage, in accordance with the Dental Schedule of Fees adopted by the Trustees as per the Ontario Dental Fee Guide indicated in the Benefit Highlights section.

  1. 100% of fees allowed in the adopted Dental Fee Guide for the following services.
    1. Diagnostic services limited to:
    2. prophylaxis, including scaling and polishing teeth once every 6* months;
    3. full-mouth series of X-rays once every 12* months;
    4. oral examinations (full exam once every 24* months).

* Note:

Once every 6, 12 or 24 months means once during the period from the date on which a service is provided or a purchase is made until the same day 6, 12 or 24 months thereafter.

    1. Amalgam, silicate and acrylic fillings.
    2. Extractions, including surgical extractions of impacted teeth.
    3. Necessary palliative treatment of dental pain.
    4. Antibiotic medication.
    5. Topical application of fluoride solutions.
    6. Endodontics (root canal therapy).
    7. Periodontal therapy to eliminate acute symptoms.
    8. Provision of space-maintainers for missing primary teeth and provision of habit-breaking appliances.
    9. Consultations required by attending Dentist or Oral Surgeon.
    10. Surgical preparation of dental bridges for prosthetic appliances.
    11. Oral surgery and the provision of prosthetic appliances resulting from accidental injury to the jaw or natural teeth, provided that the treatment is performed and appliances supplied within 6 months of the accident, and subject to and part of the maximum in (2) below.
    1. Diagnostic X-rays and laboratory procedures required in relation to oral surgery.
    2. Anaesthesia.
  1. The following services are covered up to a maximum of $2,000 per calendar year:

 

    1. 80% of fees allowed for providing crowns, or dental implants (not to exceed the cost of a crown), bridges and partial or complete dentures, including denture repair and replacement, except in the case of lost, mislaid or stolen dentures.

Note: The replacement of existing prosthetic devices is not covered unless the existing prosthetic appliance is at least 5 years old and no longer serviceable.

    1. 80% of fees allowed for orthodontic treatment initiated for a child who is at least 6 years but less than 14 years of age at the time of the initial consultation with an Orthodontist.

Alternate Benefit Clause

When two or more covered dental procedures are separately suitable for the dental care of a specific condition, and both are consistent with good dental care, the Welfare Plan will provide benefits based on the least expensive service. For example: plan will only cover up to the cost of a metal filling, not porcelain filling on molar teeth.

Pre -determination of Benefits
It is recommended that a treatment plan, in the form of a report prepared by the Dentist, be submitted prior to commencement of treatment when the course of treatment is expected to cost more than $300.
The Employee will be advised of the amount payable under this Welfare Plan, before the dental work begins.
The following are not covered:

  1. Replacement of dentures that have been lost, mislaid or stolen.
  2. Temporary dental services.
  1. That portion of the expense of fixed bridgework in excess of the charge which would have been made if the replacement of teeth could have been accomplished by a partial denture.
  2. Dental check-ups or screening requested by an employer, a school or government.
  3. Oral hygiene instruction.
  4. An examination by, or the services of, a Dentist if required solely for the use of a third party.

 

 


 

   

READ CAREFULLY, BUT REMEMBER…

This is a general outline of the Plans and its purpose is to explain as briefly and clearly as possible each of the benefits to which you are entitled. The benefits outlined under the Plans are subject to the terms and conditions of the Plan documents and Group Master Policies. If there is any conflict between this outline and the Plan documents and Group Master Policies, the Plan documents and Group Master Policies will apply in all cases. Also remember that no benefits are guaranteed and that the benefits can be changed by the Trustees at any time.

 
FAQ's | Contacts | Table of Contents | Français