Reimbursement:
Provincial Fee Guide of employee’s home province for the year determined from time to time by the Trustees.
Deductible:
Nil
Percentage Payable:
Basic Procedures:100%
Major Procedures:100%
Calendar Year Maximum for Basic and Major:
Procedures combined
$3,000 per individual
Limits:
1 complete examination every 24 months
1 full mouth x-ray every 24 months
1 recall or specific examination every 6 months
2 treatments of Prophylaxis in 12 months
Bitewing x-rays limited to 6 films every 6 months
Tests and laboratory examinations (procedure codes 04101-04401) once per year
8 units of scaling or root planning per calendar year
8 units of occlusal equilibration per calendar year
Oral Hygiene once every 6 months under age 15
Denture Relines/Rebases/Repairs once every 24 months
Bridges and Crowns must be 5 years old to be replaced
Study Casts once per calendar year
Topical application of sodium or stannous fluoride to dependents under 19 years of age, limited to 2 treatments in 12 months
Orthodontic Benefit:
Treatment 50% Payable
Lifetime Maximum:
$2,000
Must be under age 21 to claim Orthodontic benefit.
Limit of one Orthodontic treatment plan per lifetime.
