Common use of Health Care Facilities Clause in Contracts

Health Care Facilities. The Company maintains throughout the plant First Aid Stations, staffed by Qualified First Aid Attendants for treatment of on-the-job injuries. It also utilizes the services of a local Physician for pre-employment medicals, annual medicals and return-to-work medicals. In the event you are injured or become ill at work, report to your xxxxxxx. All accidents or injuries, regardless of their severity must be reported. ANY EMPLOYEE SEEKING MEDICAL ATTENTION FOR A WORK RELATED INJURY OR ILLNESS MUST REPORT IT TO THEIR XXXXXXX AND OBTAIN THE PROPER FORMS FROM THE GATEHOUSE PRIOR TO ATTENDING THE MEDICAL FACILITY. ONTARIO HOSPITALIZATION INSURANCE PLAN (O.H.I.P.) Ontario Health Insurance Coverage is available for all employees through the local Ontario Health Insurance Plan Office. Contact your local office for more information. GREEN SHIELD EXTENDED HEALTH SERVICES U-5 PLAN (WITH OUT-OF-PROVINCE COVERAGE) Services shown below will be eligible if they are usual, reasonable and customary, and are medically necessary for the treatment of an illness or injury. Please contact your benefit representative, broker/consultant, or the Green Shield Customer Service Centre at 0-000-000-0000 to determine benefit eligibility and coverage details. DRUG $ A co-payment of $1.00 applies to each prescription $ The Ontario Drug Benefit co-pay/deductible for seniors is not a benefit $ Generic equivalent drug substitution applies Benefits include legally prescribed drugs, needles, syringes and a wide range of over-the-counter drugs. Serums and vitamins are ineligible unless injected. New drugs that are introduced into the Canadian marketplace after February 22, 1999 are subject to an evaluation process by Green Shield Canada Medical and Pharmacy Consultants. New drugs are either added to the plan for all employees, not added to the plan, or approved on an individual basis if specific criteria are met and Special Authorization Forms are completed by the Physician. Those drugs that require specific criteria be met and completed Special Authorization Forms are called Conditional Benefits. You may contact Green Shield Canada Customer Service Centre at 0-000-000-0000 for information regarding whether or not any rejected drug is a Conditional Benefit or non benefit. A Special Authorization Form can be obtained for any Conditional Benefit by calling the Customer Service Centre and the completed forms should be sent to Green Shield Canada, Attention: Special Authorizations, for review. HEALTH SERVICES $ Your co-insurance for Health Services is 100%. EMERGENCY TRANSPORTATION $ Ambulance Transportation, for land or air ambulance to the nearest hospital equipped to provide the required treatment up to a maximum of $100 per trip. ACCIDENTAL DENTAL BENEFITS $ Accidental Dental benefits for treatment by a dentist. A dental accident report form must be submitted immediately following the accident. ACCOMMODATION SEMI PRIVATE $ Semi-Private Room in public general hospital. PRIVATE $ Private room in public general hospital up to a lifetime maximum of $1,000 NURSING HOME $ Long Term Care (LTC) Facility. Prior approval is necessary. (Please call Greenshield for up to date information on limits and maximums) AUDIO $ Reimbursement will be made for standard hearing aids, repairs or replacement parts up to a lifetime maximum $ Batteries are not eligible (Please call Greenshield for up to date information on limits and maximums) MEDICAL ITEMS Prosthetic Appliances and Durable Medical Equipment as well as replacements, repairs, fittings and adjustments of such devices. Contact the Customer Service Centre to verify eligibility of a particular benefit. PARAMEDICAL SERVICES $ Physiotherapist $ Speech Therapist/Pathologist $ Registered Massage Therapist (medical referral required) $ Clinical Psychologist Benefits $ Private Duty Nursing Benefits $ PSA/CA 125 Test $ Chiropractic (Please call Greenshield for up to date information on limits and maximums) VISION $ Your Vision Benefit carries a maximum of $250 every 24 months for prescription eye glasses and/or contact lenses or $250 every 24 months for medically necessary contact lenses provided they are dispensed by an Optometrist, an Optician or an Ophthalmologist. Alternatively, employees may apply the value of their vision benefits towards the cost of laser eye surgery. Eye examinations are covered to a maximum of $50 every 24 months. DENTAL $ Your lifetime maximum for Orthodontic Benefits is $1,800 effective March 1, 2004. $ Your co-insurance is $100% for Basic Services, 100% for Comprehensive Basic Services, 50% for Major Restorative Services and 50% for Orthodontic Services $ Basic Services cover: recalls once every 9 months, other exams and full mouth x-rays every 3 years. $ Comprehensive Basic cover denture relines and rebasing once every 3 years; denture cleaning once every 9 months $ Major Restorative Services cover dentures once every 5 years $ Applicable lab, drug and other expenses are eligible to a maximum of 40% of the professional fee $ Your eligible claims are reimbursed at the level stated above and in accordance with the Current Ontario Dental Association Fee Guide for General Practitioners BASIC SERVICES $ Recalls include exams, bitewing X-rays, cleanings and fluoride treatments. $ Complete, general or comprehensive oral exams, full mouth x-rays and panoramic x-rays. $ Basic restorations including fillings and inlays. $ Extractions and surgical services including general anesthetics and intravenous sedation. $ Mouth guard appliance limited to 1 per year COMPREHENSIVE BASIC SERVICES $ Endodontic treatment including root canal therapy. $ Periodontal treatment including scaling and/or root planing. $ Standard denture services including relining and rebasing of dentures. MAJOR RESTORATIVE SERVICES $ Dentures, complete, immediate and partial plus denture adjustments after 3 months from installation. ORTHODONTIC SERVICES $ Orthodontic services require a treatment plan to be submitted by your Dentist/Orthodontist for prior approval of coverage eligibility. TRAVEL BENEFITS $ You must receive pre-authorization from your provincial government health plan and Green Shield prior to the commencement of any referral treatment. Your provincial government health plan may cover this referral benefit entirely. You must provide Green Shield with a letter from your attending physician stating the reason for the referral, and a letter from your provincial government health plan outlining their liability. Failure to comply in obtaining pre-authorization may result in non-payment. $ Hospital and medical services are eligible only if your provincial government health plan provides payment toward the cost of services received. Green Shield must be contacted by phone within 48 hours of commencement of treatment. Green Shield, through consultation with the Assistance Medical Team, reserves the right to repatriate the patient for treatment upon medical verification of the tolerance for travel. Carry your Green Shield identification card with you when traveling. $ Hospital services and accommodation up to a standard xxxx rate in a public general hospital. $ Medical/surgical services $ Emergency Air ambulance to your province of residence (including a medical attendant when necessary)

Health Care Facilities. The Company maintains throughout the plant a First Aid Stations, Station in proximity to the gatehouse at both locations staffed by Qualified qualified First Aid Attendants for treatment of on-the-job injuries. It also utilizes the services of a local Physician for pre-employment medicals, annual medicals and return-to-return to work medicals. In the event you are injured or become ill at work, report to your xxxxxxxsupervisor. All accidents or injuries, regardless of their severity must be reported. ANY EMPLOYEE SEEKING MEDICAL ATTENTION FOR A WORK RELATED INJURY OR ILLNESS MUST REPORT IT TO THEIR XXXXXXX AND OBTAIN THE PROPER FORMS FROM THE GATEHOUSE PRIOR TO ATTENDING THE MEDICAL FACILITY. ONTARIO HOSPITALIZATION INSURANCE PLAN (O.H.I.P.) Ontario Health Insurance Coverage is available for all employees through the local Ontario Health Insurance Plan Office. Contact your local office for more information. GREEN SHIELD EXTENDED HEALTH SERVICES U-5 PLAN (WITH OUT-OF-PROVINCE COVERAGE) HAIRNETS Hairnets and xxxxx snoods must be worn within the plant food grade production areas to minimize the potential for product contamination. OUTLINE OF BENEFITS Services shown below will be eligible if they are usual, reasonable and customary, and are medically necessary for the treatment of an illness or injury. Please contact your benefit representative, broker/consultant, or the Green Shield Customer Service Centre at 01-000888- 711-000-0000 1119 to determine benefit eligibility and coverage details. DRUG $ • A co-payment of $1.00 applies to each prescription $ • The Ontario Drug Benefit co-pay/deductible for seniors is not a benefit $ • Generic equivalent drug substitution applies Benefits include legally prescribed drugs, needles, syringes and a wide range of over-the-the- counter drugs. Serums and vitamins are ineligible unless injected. New drugs that are introduced into the Canadian marketplace after February 22, 1999 are subject to an evaluation process by Green Shield Canada Medical and Pharmacy Consultants. New drugs are either added to the plan for all employees, not added to the plan, or approved on an individual basis if specific criteria are met and Special Authorization Forms are completed by the Physician. Those drugs that require specific criteria be met and completed Special Authorization Forms are called Conditional Benefits. You may contact Green Shield Canada Customer Service Centre at 0-000-000-0000 for information regarding whether or not any rejected drug is a Conditional Benefit or non benefit. A Special Authorization Form can be obtained for any Conditional Benefit by calling the Customer Service Centre 0-000-000-0000 and the completed forms should be sent to Green Shield Canada, Attention: Special Authorizations, for review. HEALTH SERVICES $ • Your co-insurance for Health Services is 100%. % EMERGENCY TRANSPORTATION $ • Ambulance Transportation, for land or air ambulance to the nearest hospital equipped to provide the required treatment up to a maximum of $100 per trip. ACCIDENTAL DENTAL BENEFITS $ Accidental Dental benefits for treatment by a dentist. A dental accident report form must be submitted immediately following the accident. ACCOMMODATION SEMI PRIVATE $ Semi-Private Room in public general hospital. PRIVATE $ Private room in public general hospital up to a lifetime maximum of $1,000 NURSING HOME $ Long Term Care (LTC) Facility. Prior approval is necessary. (Please call Greenshield for up to date information on limits and maximums) AUDIO $ Reimbursement will be made for standard hearing aids, repairs or replacement parts up to a lifetime maximum $ Batteries are not eligible (Please call Greenshield for up to date information on limits and maximums) MEDICAL ITEMS Prosthetic Appliances and Durable Medical Equipment as well as replacements, repairs, fittings and adjustments of such devices. Contact the Customer Service Centre to verify eligibility of a particular benefit. PARAMEDICAL SERVICES $ Physiotherapist $ Speech Therapist/Pathologist $ Registered Massage Therapist (medical referral required) $ Clinical Psychologist Benefits $ Private Duty Nursing Benefits $ PSA/CA 125 Test $ Chiropractic (Please call Greenshield for up to date information on limits and maximums) VISION $ Your Vision Benefit carries a maximum of $250 every 24 months for prescription eye glasses and/or contact lenses or $250 every 24 months for medically necessary contact lenses provided they are dispensed by an Optometrist, an Optician or an Ophthalmologist. Alternatively, employees may apply the value of their vision benefits towards the cost of laser eye surgery. Eye examinations are covered to a maximum of $50 every 24 months. DENTAL $ Your lifetime maximum for Orthodontic Benefits is $1,800 effective March 1, 2004. $ Your co-insurance is $100% for Basic Services, 100% for Comprehensive Basic Services, 50% for Major Restorative Services and 50% for Orthodontic Services $ Basic Services cover: recalls once every 9 months, other exams and full mouth x-rays every 3 years. $ Comprehensive Basic cover denture relines and rebasing once every 3 years; denture cleaning once every 9 months $ Major Restorative Services cover dentures once every 5 years $ Applicable lab, drug and other expenses are eligible to a maximum of 40% of the professional fee $ Your eligible claims are reimbursed at the level stated above and in accordance with the Current Ontario Dental Association Fee Guide for General Practitioners BASIC SERVICES $ Recalls include exams, bitewing X-rays, cleanings and fluoride treatments. $ Complete, general or comprehensive oral exams, full mouth x-rays and panoramic x-rays. $ Basic restorations including fillings and inlays. $ Extractions and surgical services including general anesthetics and intravenous sedation. $ Mouth guard appliance limited to 1 per year COMPREHENSIVE BASIC SERVICES $ Endodontic treatment including root canal therapy. $ Periodontal treatment including scaling and/or root planing. $ Standard denture services including relining and rebasing of dentures. MAJOR RESTORATIVE SERVICES $ Dentures, complete, immediate and partial plus denture adjustments after 3 months from installation. ORTHODONTIC SERVICES $ Orthodontic services require a treatment plan to be submitted by your Dentist/Orthodontist for prior approval of coverage eligibility. TRAVEL BENEFITS $ You must receive pre-authorization from your provincial government health plan and Green Shield prior to the commencement of any referral treatment. Your provincial government health plan may cover this referral benefit entirely. You must provide Green Shield with a letter from your attending physician stating the reason for the referral, and a letter from your provincial government health plan outlining their liability. Failure to comply in obtaining pre-authorization may result in non-payment. $ Hospital and medical services are eligible only if your provincial government health plan provides payment toward the cost of services received. Green Shield must be contacted by phone within 48 hours of commencement of treatment. Green Shield, through consultation with the Assistance Medical Team, reserves the right to repatriate the patient for treatment upon medical verification of the tolerance for travel. Carry your Green Shield identification card with you when traveling. $ Hospital services and accommodation up to a standard xxxx rate in a public general hospital. $ Medical/surgical services $ Emergency Air ambulance to your province of residence (including a medical attendant when necessary).

Health Care Facilities. The Company maintains throughout the plant a First Aid StationsStation at the Gatehouse, staffed by Qualified First Aid Attendants for treatment of on-the-job injuries. It also utilizes the services of a local Physician for pre-employment medicals, annual medicals medical evaluation and return-to-to- work medicalsassessments. In the event you are injured or become ill at work, report to your xxxxxxxforeperson. All accidents or injuries, regardless of their severity must be reported. ANY EMPLOYEE SEEKING MEDICAL ATTENTION FOR A WORK RELATED INJURY OR ILLNESS MUST REPORT IT TO THEIR XXXXXXX AND OBTAIN THE PROPER FORMS FROM THE GATEHOUSE PRIOR TO ATTENDING THE MEDICAL FACILITYHAIRNETS Hairnets and xxxxx snoods must be worn within the plant food grade production areas to minimize the potential for product contamination. ONTARIO HOSPITALIZATION INSURANCE PLAN (O.H.I.P.) Ontario Health Insurance Coverage is available for all employees through the local Ontario Health Insurance Plan OfficeOffice at 0000 Xxxxxxxxx Xxxxxx, Windsor, Ontario (973-1385). Contact your local office for more information. GREEN SHIELD EXTENDED HEALTH SERVICES U-5 PLAN (WITH OUT-OF-PROVINCE COVERAGE) OUTLINE OF BENEFITS Services shown below will be eligible if they are usual, reasonable and customary, and are medically necessary for the treatment of an illness or injury. Please contact your benefit representative, broker/consultant, or the Green Shield Customer Service Centre at 01-000888-000711-0000 1119 to determine benefit eligibility and coverage details. DRUG $ • A co-payment of $1.00 applies to each prescription $ • The Ontario Drug Benefit co-pay/deductible for seniors is not a benefit $ until retirement • Generic equivalent drug substitution applies Benefits include legally prescribed drugs, needles, syringes and a wide range of over-the-counter drugs. Serums and vitamins are ineligible unless injected. New drugs that are introduced into the Canadian marketplace after February 22, 1999 are subject to an evaluation process by Green Shield Canada Medical Medial and Pharmacy Consultants. New drugs are either added to the plan for all employees, not added to the plan, or approved on an individual basis if specific criteria are met and Special Authorization Forms are completed by the Physician. Those drugs that require specific criteria be met and completed Special Authorization Forms are called Conditional Benefits. You may contact Green Shield Canada Customer Service Centre at 01-000888-000711-0000 1119 for information regarding whether or not any rejected drug is a Conditional Benefit or non benefit. A Special Authorization Form can be obtained for any Conditional Benefit by calling the Customer Service Centre and the completed forms should be sent to Green Shield Canada, Attention: Special Authorizations, for review. HEALTH SERVICES $ • Your co-insurance for Health Services is 100%. % EMERGENCY TRANSPORTATION $ • Ambulance Transportation, for land or air ambulance to the nearest hospital equipped to provide the required treatment up to a maximum of $100 per trip. ACCIDENTAL DENTAL BENEFITS $ Accidental Dental benefits for treatment by a dentist. A dental accident report form must be submitted immediately following the accident. ACCOMMODATION SEMI PRIVATE $ Semi-Private Room in public general hospital. PRIVATE $ Private room in public general hospital up to a lifetime maximum of $1,000 NURSING HOME $ Long Term Care (LTC) Facility. Prior approval is necessary. (Please call Greenshield for up to date information on limits and maximums) AUDIO $ Reimbursement will be made for standard hearing aids, repairs or replacement parts up to a lifetime maximum $ Batteries are not eligible (Please call Greenshield for up to date information on limits and maximums) MEDICAL ITEMS Prosthetic Appliances and Durable Medical Equipment as well as replacements, repairs, fittings and adjustments of such devices. Contact the Customer Service Centre to verify eligibility of a particular benefit. PARAMEDICAL SERVICES $ Physiotherapist $ Speech Therapist/Pathologist $ Registered Massage Therapist (medical referral required) $ Clinical Psychologist Benefits $ Private Duty Nursing Benefits $ PSA/CA 125 Test $ Chiropractic (Please call Greenshield for up to date information on limits and maximums) VISION $ Your Vision Benefit carries a maximum of $250 every 24 months for prescription eye glasses and/or contact lenses or $250 every 24 months for medically necessary contact lenses provided they are dispensed by an Optometrist, an Optician or an Ophthalmologist. Alternatively, employees may apply the value of their vision benefits towards the cost of laser eye surgery. Eye examinations are covered to a maximum of $50 every 24 months. DENTAL $ Your lifetime maximum for Orthodontic Benefits is $1,800 effective March 1, 2004. $ Your co-insurance is $100% for Basic Services, 100% for Comprehensive Basic Services, 50% for Major Restorative Services and 50% for Orthodontic Services $ Basic Services cover: recalls once every 9 months, other exams and full mouth x-rays every 3 years. $ Comprehensive Basic cover denture relines and rebasing once every 3 years; denture cleaning once every 9 months $ Major Restorative Services cover dentures once every 5 years $ Applicable lab, drug and other expenses are eligible to a maximum of 40% of the professional fee $ Your eligible claims are reimbursed at the level stated above and in accordance with the Current Ontario Dental Association Fee Guide for General Practitioners BASIC SERVICES $ Recalls include exams, bitewing X-rays, cleanings and fluoride treatments. $ Complete, general or comprehensive oral exams, full mouth x-rays and panoramic x-rays. $ Basic restorations including fillings and inlays. $ Extractions and surgical services including general anesthetics and intravenous sedation. $ Mouth guard appliance limited to 1 per year COMPREHENSIVE BASIC SERVICES $ Endodontic treatment including root canal therapy. $ Periodontal treatment including scaling and/or root planing. $ Standard denture services including relining and rebasing of dentures. MAJOR RESTORATIVE SERVICES $ Dentures, complete, immediate and partial plus denture adjustments after 3 months from installation. ORTHODONTIC SERVICES $ Orthodontic services require a treatment plan to be submitted by your Dentist/Orthodontist for prior approval of coverage eligibility. TRAVEL BENEFITS $ You must receive pre-authorization from your provincial government health plan and Green Shield prior to the commencement of any referral treatment. Your provincial government health plan may cover this referral benefit entirely. You must provide Green Shield with a letter from your attending physician stating the reason for the referral, and a letter from your provincial government health plan outlining their liability. Failure to comply in obtaining pre-authorization may result in non-payment. $ Hospital and medical services are eligible only if your provincial government health plan provides payment toward the cost of services received. Green Shield must be contacted by phone within 48 hours of commencement of treatment. Green Shield, through consultation with the Assistance Medical Team, reserves the right to repatriate the patient for treatment upon medical verification of the tolerance for travel. Carry your Green Shield identification card with you when traveling. $ Hospital services and accommodation up to a standard xxxx rate in a public general hospital. $ Medical/surgical services $ Emergency Air ambulance to your province of residence (including a medical attendant when necessary).

Health Care Facilities. The Company maintains throughout the plant a First Aid StationsStation at the Gatehouse, staffed by Qualified First Aid Attendants for treatment of on-the-job injuries. It also utilizes the services of a local Physician for pre-employment medicals, annual medicals medical evaluation and return-to-to- work medicalsassessments. In the event you are injured or become ill at work, report to your xxxxxxxforeperson. All accidents or injuries, regardless of their severity must be reported. ANY EMPLOYEE SEEKING MEDICAL ATTENTION FOR A WORK RELATED INJURY OR ILLNESS MUST REPORT IT TO THEIR XXXXXXX AND OBTAIN THE PROPER FORMS FROM THE GATEHOUSE PRIOR TO ATTENDING THE MEDICAL FACILITYHAIRNETS Hairnets and xxxxx snoods must be worn within the plant food grade production areas to minimize the potential for product contamination. ONTARIO HOSPITALIZATION INSURANCE PLAN (O.H.I.P.) Ontario Health Insurance Coverage is available for all employees through the local Ontario Health Insurance Plan OfficeOffice at 0000 Xxxxxxxxx Xxxxxx, Windsor, Ontario (973-1385). Contact your local office for more information. GREEN SHIELD EXTENDED HEALTH SERVICES U-5 PLAN (WITH OUT-OF-PROVINCE COVERAGE) OUTLINE OF BENEFITS Services shown below will be eligible if they are usual, reasonable and customary, and are medically necessary for the treatment of an illness or injury. Please contact your benefit representative, broker/consultant, or the Green Shield Customer Service Centre at 0-000-000-0000 to determine benefit eligibility and coverage details. DRUG $ • A co-payment of $1.00 applies to each prescription $ • The Ontario Drug Benefit co-pay/deductible for seniors is not a benefit $ until retirement • Generic equivalent drug substitution applies Benefits include legally prescribed drugs, needles, syringes and a wide range of over-the-counter drugs. Serums and vitamins are ineligible unless injected. New drugs that are introduced into the Canadian marketplace after February 22, 1999 are subject to an evaluation process by Green Shield Canada Medical Medial and Pharmacy Consultants. New drugs are either added to the plan for all employees, not added to the plan, or approved on an individual basis if specific criteria are met and Special Authorization Forms are completed by the Physician. Those drugs that require specific criteria be met and completed Special Authorization Forms are called Conditional Benefits. You may contact Green Shield Canada Customer Service Centre at 0-000-000-0000 for information regarding whether or not any rejected drug is a Conditional Benefit or non benefit. A Special Authorization Form can be obtained for any Conditional Benefit by calling the Customer Service Centre and the completed forms should be sent to Green Shield Canada, Attention: Special Authorizations, for review. HEALTH SERVICES $ • Your co-insurance for Health Services is 100%. % EMERGENCY TRANSPORTATION $ • Ambulance Transportation, for land or air ambulance to the nearest hospital equipped to provide the required treatment up to a maximum of $100 per trip. ACCIDENTAL DENTAL BENEFITS $ Accidental Dental benefits for treatment by a dentist. A dental accident report form must be submitted immediately following the accident. ACCOMMODATION SEMI PRIVATE $ Semi-Private Room in public general hospital. PRIVATE $ Private room in public general hospital up to a lifetime maximum of $1,000 NURSING HOME $ Long Term Care (LTC) Facility. Prior approval is necessary. (Please call Greenshield for up to date information on limits and maximums) AUDIO $ Reimbursement will be made for standard hearing aids, repairs or replacement parts up to a lifetime maximum $ Batteries are not eligible (Please call Greenshield for up to date information on limits and maximums) MEDICAL ITEMS Prosthetic Appliances and Durable Medical Equipment as well as replacements, repairs, fittings and adjustments of such devices. Contact the Customer Service Centre to verify eligibility of a particular benefit. PARAMEDICAL SERVICES $ Physiotherapist $ Speech Therapist/Pathologist $ Registered Massage Therapist (medical referral required) $ Clinical Psychologist Benefits $ Private Duty Nursing Benefits $ PSA/CA 125 Test $ Chiropractic (Please call Greenshield for up to date information on limits and maximums) VISION $ Your Vision Benefit carries a maximum of $250 every 24 months for prescription eye glasses and/or contact lenses or $250 every 24 months for medically necessary contact lenses provided they are dispensed by an Optometrist, an Optician or an Ophthalmologist. Alternatively, employees may apply the value of their vision benefits towards the cost of laser eye surgery. Eye examinations are covered to a maximum of $50 every 24 months. DENTAL $ Your lifetime maximum for Orthodontic Benefits is $1,800 effective March 1, 2004. $ Your co-insurance is $100% for Basic Services, 100% for Comprehensive Basic Services, 50% for Major Restorative Services and 50% for Orthodontic Services $ Basic Services cover: recalls once every 9 months, other exams and full mouth x-rays every 3 years. $ Comprehensive Basic cover denture relines and rebasing once every 3 years; denture cleaning once every 9 months $ Major Restorative Services cover dentures once every 5 years $ Applicable lab, drug and other expenses are eligible to a maximum of 40% of the professional fee $ Your eligible claims are reimbursed at the level stated above and in accordance with the Current Ontario Dental Association Fee Guide for General Practitioners BASIC SERVICES $ Recalls include exams, bitewing X-rays, cleanings and fluoride treatments. $ Complete, general or comprehensive oral exams, full mouth x-rays and panoramic x-rays. $ Basic restorations including fillings and inlays. $ Extractions and surgical services including general anesthetics and intravenous sedation. $ Mouth guard appliance limited to 1 per year COMPREHENSIVE BASIC SERVICES $ Endodontic treatment including root canal therapy. $ Periodontal treatment including scaling and/or root planing. $ Standard denture services including relining and rebasing of dentures. MAJOR RESTORATIVE SERVICES $ Dentures, complete, immediate and partial plus denture adjustments after 3 months from installation. ORTHODONTIC SERVICES $ Orthodontic services require a treatment plan to be submitted by your Dentist/Orthodontist for prior approval of coverage eligibility. TRAVEL BENEFITS $ You must receive pre-authorization from your provincial government health plan and Green Shield prior to the commencement of any referral treatment. Your provincial government health plan may cover this referral benefit entirely. You must provide Green Shield with a letter from your attending physician stating the reason for the referral, and a letter from your provincial government health plan outlining their liability. Failure to comply in obtaining pre-authorization may result in non-payment. $ Hospital and medical services are eligible only if your provincial government health plan provides payment toward the cost of services received. Green Shield must be contacted by phone within 48 hours of commencement of treatment. Green Shield, through consultation with the Assistance Medical Team, reserves the right to repatriate the patient for treatment upon medical verification of the tolerance for travel. Carry your Green Shield identification card with you when traveling. $ Hospital services and accommodation up to a standard xxxx rate in a public general hospital. $ Medical/surgical services $ Emergency Air ambulance to your province of residence (including a medical attendant when necessary).