Common use of Dental Benefits Clause in Contracts

Dental Benefits. The following provides a general description of the benefits available to you and your eligible dependents under this dental plan. A complete list of the specific procedures (and applicable limitations) can be found in the Master Contract held by your Employer. Payment for eligible benefits will be based on the monetary rates shown in the Dental Association Fee Guide applicable to your group plan. Refer to your Summary of Benefits for information regarding any deductible, co-payment or maximum benefit amounts. BENEFITS BASIC SERVICES Examinations - includes complete and recall oral examinations twice per calendar year for persons up to and including age 12 and once every 9 months for persons over age 12. Consultations - with patient or with a member of the profession Radiographs - includes complete series intra oral films once every 24 months, panoramic films, and bitewing films twice per calendar year for persons up to and including age 12 and once every 9 months for persons over age 12. Diagnostic Services - includes bacteriologic tests, biopsy and cytological tests Preventive Services - space maintainers (for dependent children); pit and fissure sealants; scaling; fluoride treatment; polishing (one unit of time twice per calendar year for persons up to and including age 12 and one unit of time every 9 months for persons over age 12). The following benefits are provided twice per calendar year for persons up to and including age 12 and once every 9 months for persons over age 12: preventive recall packages, oral hygiene instruction and reinstruction Fillings Extractions - includes root extractions Anesthesia Endodontic Services - includes root canal therapy, surgical and emergency services Periodontic Services - includes periodontal surgery, root planning and occlusal equilibration Denture Repairs, Adjustments, Relining/Rebasing Surgical Services - includes surgical incision/ excision and frenectomy In-office and Commercial Laboratory Charges - when applicable to the covered Benefits MAJOR SERVICES Complete and/or Partial Dentures - (once every 4 years) Restorative Services - includes post/core, crowns, inlays/ onlays Fixed Prosthodontic Services - (once every 5 years) - includes bridgework In-office and Commercial Laboratory Charges - when applicable to the covered benefits. ORTHODONTIC SERVICES (for dependent children to age 18) Orthodontic Services - includes observation, adjustments, orthodontic appliances and major orthodontic treatment In-office and Commercial Laboratory Charges - when applicable to the covered benefits. Orthodontic Treatment Prior to the commencement of orthodontic treatment, your dentist must prepare a report outlining the details with respect to malocclusion, diagnosis, proposed treatment and applicable fees. This treatment plan must be forwarded to Manulife Financial for review to establish the extent of the payable benefit. PREDETERMINATION OF BENEFITS AND ALTERNATE BENEFIT PROVISION - Crowns, Bridgework, Dentures Prior to beginning dental treatment which will involve the use of crowns, bridges and/or dentures and which is expected to cost $300 or more, you should obtain from your dentist and submit to Manulife Financial a treatment plan outlining the procedures and charges. Your dentist may be requested to submit any relevant x-rays. Approval of the treatment plan should be obtained from Manulife Financial prior to commencement of treatment. After reviewing the plan, you will be advised of the amount payable by Manulife Financial. Where a range of fees, individual consideration or laboratory charges are included, Manulife Financial will determine the amount payable. The approved estimate will be honoured for a period of twelve months from the date of approval. There are many ways to treat a particular dental problem or condition and the cost of different procedures, services, courses of treatment and materials may vary considerably. Manulife Financial may determine that payment for a less expensive procedure, which will provide satisfactory results, may be made towards the cost of a procedure selected by you and your dentist. The difference between the amount payable by Manulife Financial and the dentist's charge is your responsibility. If you do not submit a treatment plan, Manulife Financial reserves the right to pay benefits based on the less expensive procedure, which will provide satisfactory results. Benefits are not payable for:

Appears in 3 contracts

Samples: Collective Agreement, Collective Agreement, Collective Bargaining Agreement

AutoNDA by SimpleDocs

Dental Benefits. The following provides a general description of the benefits available to you and your eligible dependents under this dental plan. A complete list of the specific procedures (and applicable limitations) can be found in the Master Contract held by your Employer. Payment for eligible benefits will be based on the monetary rates shown in the Dental Association Fee Guide applicable to your group plan. Refer to your Summary of Benefits for information regarding any deductible, co-payment or maximum benefit amounts. BENEFITS BASIC SERVICES Examinations - includes complete and recall oral examinations twice per calendar year once every six (6) months for persons up to and including age 12 and once every 9 nine (9) months for persons over age 12. Consultations - with patient or with a member of the profession Radiographs - includes complete series intra oral films once every 24 twenty-four (24) months, panoramic films, and bitewing films twice per calendar year once every six (6) months for persons up to and including age 12 and once every 9 nine (9) months for persons over age 12. Diagnostic Services - includes bacteriologic tests, biopsy and cytological tests Preventive Services - space maintainers (for dependent children); pit and fissure sealants; scaling; fluoride treatment; polishing (one unit of time twice per calendar year once every six (6) months for persons up to and including age 12 and one unit of time every 9 nine (9) months for persons over age 12). The following benefits are provided twice per calendar year once every six (6) months for persons up to and including age 12 and once every 9 nine (9) months for persons over age 12: preventive recall packages, oral hygiene instruction and reinstruction Fillings Extractions - includes root extractions Anesthesia Endodontic Services - includes root canal therapy, surgical and emergency services Periodontic Services - includes periodontal surgery, root planning and occlusal equilibration Denture Repairs, Adjustments, Relining/Rebasing Surgical Services - includes surgical incision/ excision and frenectomy In-office and Commercial Laboratory Charges - when applicable to the covered Benefits MAJOR SERVICES Complete and/or Partial Dentures - (once every 4 years) Restorative Services - includes post/core, crowns, inlays/ onlays Fixed Prosthodontic Services - (once every 5 years) - includes bridgework In-office and Commercial Laboratory Charges - when applicable to the covered benefits. ORTHODONTIC SERVICES (for dependent children to age 18) Orthodontic Services - includes observation, adjustments, orthodontic appliances and major orthodontic treatment In-office and Commercial Laboratory Charges - when applicable to the covered benefits. Orthodontic Treatment Prior to the commencement of orthodontic treatment, your dentist must prepare a report outlining the details with respect to malocclusion, diagnosis, proposed treatment and applicable fees. This treatment plan must be forwarded to Manulife Financial for review to establish the extent of the payable benefit. PREDETERMINATION OF BENEFITS AND ALTERNATE BENEFIT PROVISION - Crowns, Bridgework, Dentures Prior to beginning dental treatment which will involve the use of crowns, bridges and/or dentures and which is expected to cost $300 or more, you should obtain from your dentist and submit to Manulife Financial a treatment plan outlining the procedures and charges. Your dentist may be requested to submit any relevant x-rays. Approval of the treatment plan should be obtained from Manulife Financial prior to commencement of treatment. After reviewing the plan, you will be advised of the amount payable by Manulife Financial. Where a range of fees, individual consideration or laboratory charges are included, Manulife Financial will determine the amount payable. The approved estimate will be honoured for a period of twelve months from the date of approval. There are many ways to treat a particular dental problem or condition and the cost of different procedures, services, courses of treatment and materials may vary considerably. Manulife Financial may determine that payment for a less expensive procedure, which will provide satisfactory results, may be made towards the cost of a procedure selected by you and your dentist. The difference between the amount payable by Manulife Financial and the dentist's charge is your responsibility. If you do not submit a treatment plan, Manulife Financial reserves the right to pay benefits based on the less expensive procedure, which will provide satisfactory results. Benefits are not payable for:

Appears in 3 contracts

Samples: Collective Agreement, Collective Agreement, Collective Agreement

Dental Benefits. The following provides a general description of the benefits available to you and your eligible dependents under this dental plan. A complete list of the specific procedures (and applicable limitations) can be found in the Master Contract held by your Employer. Payment for eligible benefits will be based on the monetary rates shown in the Dental Association Fee Guide applicable to your group plan. Refer to your Summary of Benefits Plan Document for information regarding any deductible, co-payment or maximum benefit amounts. BENEFITS BASIC SERVICES Examinations - includes complete and recall oral examinations twice per calendar year once every six (6) months for persons up to and including age 12 and once every 9 nine (9) months for persons over age 12. Panoramic films once every 9 months. Consultations - with patient or with a member of the profession Radiographs - includes complete series intra oral films once every 24 twenty-four (24) months, panoramic films, and bitewing films twice per calendar year once every six (6) months for persons up to and including age 12 and once every 9 nine (9) months for persons over age 12. Panoramic films once every 9 months. Diagnostic Services - includes bacteriologic tests, biopsy and cytological tests Preventive Services - space maintainers (for dependent children); pit and fissure sealants; scaling; fluoride treatment; polishing (one unit of time twice per calendar year once every six (6) months for persons up to and including age 12 and one unit of time every 9 nine (9) months for persons over age 12). The following benefits Preventive recall packages are provided twice per calendar year once every six (6) months for persons up to and including age 12 and once every 9 nine (9) months for persons over age 12: preventive recall packages, oral . Oral hygiene instruction and reinstruction once every (9) months. Fillings Extractions - includes root extractions Anesthesia Endodontic Services - includes root canal therapy, surgical and emergency services Periodontic Services - includes periodontal surgery, root planning and occlusal equilibration Denture Repairs, Adjustments, Relining/Rebasing Surgical Services - includes surgical incision/ excision and frenectomy In-office and Commercial Laboratory Charges - when applicable to the covered Benefits MAJOR SERVICES Complete and/or Partial Dentures - (once every 4 years) Restorative Services - includes post/core, crowns, inlays/ onlays Fixed Prosthodontic Services - (once every 5 years) - includes bridgework In-office and Commercial Laboratory Charges - when applicable to the covered benefits. ORTHODONTIC SERVICES (for dependent children to age 18) Orthodontic Services - includes observation, adjustments, orthodontic appliances and major orthodontic treatment In-office and Commercial Laboratory Charges - when applicable to the covered benefits. Orthodontic Treatment Prior to the commencement of orthodontic treatment, your dentist must prepare a report outlining the details with respect to malocclusion, diagnosis, proposed treatment and applicable fees. This treatment plan must be forwarded to Manulife Financial for review to establish the extent of the payable benefit. PREDETERMINATION OF BENEFITS AND ALTERNATE BENEFIT PROVISION - Crowns, Bridgework, Dentures Prior to beginning dental treatment which will involve the use of crowns, bridges and/or dentures and which is expected to cost $300 or more, you should obtain from your dentist and submit to Manulife Financial a treatment plan outlining the procedures and charges. Your dentist may be requested to submit any relevant x-rays. Approval of the treatment plan should be obtained from Manulife Financial prior to commencement of treatment. After reviewing the plan, you will be advised of the amount payable by Manulife Financial. Where a range of fees, individual consideration or laboratory charges are included, Manulife Financial will determine the amount payable. The approved estimate will be honoured for a period of twelve months from the date of approval. There are many ways to treat a particular dental problem or condition and the cost of different procedures, services, courses of treatment and materials may vary considerably. Manulife Financial may determine that payment for a less expensive procedure, which will provide satisfactory results, may be made towards the cost of a procedure selected by you and your dentist. The difference between the amount payable by Manulife Financial and the dentist's charge is your responsibility. If you do not submit a treatment plan, Manulife Financial reserves the right to pay benefits based on the less expensive procedure, which will provide satisfactory results. Benefits are not payable for:

Appears in 2 contracts

Samples: Collective Agreement, Collective Agreement

Dental Benefits. The following provides a general description of the benefits available to you and your eligible dependents under this dental plan. A complete list of the specific procedures (and applicable limitations) can be found in the Master Contract held by your y our Employer. Payment for eligible benefits will be based on the monetary rates shown in the Dental Association Fee Guide applicable to your group plan. Refer to your Summary of Benefits for information regarding any deductible, co-payment or maximum benefit amounts. BENEFITS BASIC SERVICES Examinations - includes complete and recall oral examinations twice per calendar year once every six (6) months for persons up to and including age 12 and once every 9 months for persons over age 12. Consultations - with patient or with a member of the profession Radiographs - includes complete series intra oral films once every 24 months, panoramic films, and bitewing films twice per calendar year once every six (6) months for persons up to and including age 12 and once every 9 months for persons over age 12. Panoramic films once every 9 months. Diagnostic Services - includes bacteriologic tests, biopsy and cytological tests Preventive Services - space maintainers (for dependent children); pit and fissure sealants; scaling; fluoride treatment; polishing (one unit of time twice per calendar year once every six (6) months for persons up to and including age 12 and one unit of time every 9 months for persons over age 12). The following benefits Preventative recall packages are provided twice per calendar year once every six (6) months for persons up to and including age 12 and once every 9 months for persons over age 12: preventive recall packages, oral hygiene instruction and reinstruction are provided once every 9 months. Fillings Extractions - includes root extractions Anesthesia Endodontic Services - includes root canal therapy, surgical and emergency services Periodontic Periodontal Services - includes periodontal surgery, root planning and occlusal equilibration Denture Repairs, Adjustments, Relining/Rebasing Surgical Services - includes surgical incision/ excision and frenectomy In-office and Commercial Laboratory Charges - when applicable to the covered Benefits MAJOR SERVICES Complete and/or Partial Dentures - (once every 4 5 years) Restorative Services - includes post/core, crowns, inlays/ onlays Fixed Prosthodontic Services - (once every 5 years) - includes bridgework In-office and Commercial Laboratory Charges - when applicable to the covered benefits. ORTHODONTIC SERVICES (for dependent children to age 18) Orthodontic Services - includes observation, adjustments, orthodontic appliances and major orthodontic treatment In-office and Commercial Laboratory Charges - when applicable to the covered benefits. Orthodontic Treatment Prior to the commencement of orthodontic treatment, your dentist must prepare a report outlining the details with respect to malocclusion, diagnosis, proposed treatment and applicable fees. This treatment plan must be forwarded to Manulife Financial for review to establish the extent of the payable benefit. PREDETERMINATION OF BENEFITS AND ALTERNATE BENEFIT PROVISION - Crowns, Bridgework, Dentures Prior to beginning dental treatment which will involve the use of crowns, bridges and/or dentures and which is expected to cost $300 or more, you should obtain from your dentist and submit to Manulife Financial a treatment plan outlining the procedures and charges. Your dentist may be requested to submit any relevant x-rays. Approval of the treatment plan should be obtained from Manulife Financial prior to commencement of treatment. After reviewing the plan, you will be advised of the amount payable by Manulife FinancialManulife. Where a range of fees, individual consideration or laboratory charges are included, Manulife Financial will determine the amount payable. The approved estimate will be honoured for a period of twelve months from the date of approval. There are many ways to treat a particular dental problem or condition and the cost of different procedures, services, courses cours es of treatment and materials may vary considerably. Manulife Financial Maritime Life may determine that payment for a less expensive procedure, procedure which will provide satisfactory results, may be made towards the cost of a procedure selected by you and your dentist. The difference between the amount payable by Manulife Financial and the dentist's charge is your responsibility. If you do not submit a treatment plan, Manulife Financial reserves the right to pay benefits based on the less expensive procedure, procedure which will provide satisfactory results. Benefits are not payable for: - Services or supplies not listed under Benefits. - Services or supplies for cosmetic purposes. - Charges for procedures or appliances connected with implants. - Services or supplies related to Temporomandibular Joint problems. - Charges incurred as a result of conditions arising from war, whether or not war was declared, from participation in any civil commotion, insurrection or riot, or while serving in the armed forces. - Charges incurred as a result of self-inflicted injury. - Charges incurred while committing, or attempting to commit, directly or indirectly, a criminal act under legislation in the jurisdiction where the act was committed. - Charges for the completion of claim forms or other documentation, or charges incurred for failing to keep a scheduled appointment or for transfer of medical files. - Charges for procedures in excess of those stated in the Fee Guide for General Practitioners, as shown on your Identification Certificate. - Services or supplies covered by any government plan. - Services completed after termination of coverage. APPENDIX “C” - INCOME PROTECTION PLAN This Plan is comprised of two parts:

Appears in 2 contracts

Samples: Collective Agreement, Collective Agreement

Dental Benefits. The following provides a general description of the benefits available to you and your eligible dependents under this dental plan. A complete list of the specific procedures No deductible • Fee Guide - Current, less one (and applicable limitations1) can be found in the Master Contract held by your Employer. Payment for eligible benefits will be based on the monetary rates shown in the year Ontario Dental Association Fee Guide applicable for General Practitioners, effective February 1st each year. • 100% reimbursement of eligible charges, up to your group plan. Refer to your Summary of Benefits the amount specified in the Fee Guide for information regarding any deductible, co-payment or maximum benefit amounts. BENEFITS BASIC SERVICES the following: Examinations - includes complete oral examinations once every two (2) years and recall oral examinations twice per calendar year for persons up to and including age 12 and once every 9 nine (9) months for persons over age 12. adults* Consultations - with patient or with a member of the profession Radiographs - includes complete series intra oral films once every 24 monthstwo (2) years, panoramic filmsfilms once every two (2) years, and bitewing films twice per calendar year for persons up to and including age 12 and once every 9 5 months for persons over age 12. Diagnostic Services - includes bacteriologic tests, biopsy and cytological tests Preventive tests; Preventative Services - includes scaling and/or polishing once every six (6) months, {to a maximum of twelve (12) units per year}, preventative recall packages once every nine (9) months*, fluoride treatments, oral hygiene instruction and re-instruction once every nine (9) months*, space maintainers (and pit & fissure sealants for permanent molar teeth of dependent children); pit and fissure sealants; scaling; fluoride treatment; polishing (one unit of time twice per calendar year for persons children up to and including age 12 and fifteen (15) {only one unit of time replacement sealant per tooth} *once every 9 six (6) months for persons over age 12)dependent children Fillings Periodontic Services - includes periodontal surgery, root planing and occlusal equilibration Surgical Services - includes extractions, surgical incision/excision and frenectomy Anaesthesia In-Office & Commercial Laboratory Charges - when applicable to the covered benefits. The following benefits are provided twice per calendar year for persons • 60% reimbursement of eligible charges up to and including age 12 and once every 9 months the amount specified in the Fee Guide, for persons over age 12the following: preventive recall packages, oral hygiene instruction and reinstruction Fillings Extractions - includes root extractions Anesthesia Endodontic Services - includes root canal therapy, surgical and emergency services Periodontic Services Complete and/or Partial Dentures - includes periodontal surgery, root planning and occlusal equilibration once every three (3) years Major Denture Adjustments Denture Repairs, AdjustmentsMinor Adjustments {after 3 months from insertion, Reliningonce every thirty-six (36) months} Restorative Services includes post/Rebasing Surgical core, crowns, inlays/onlays and gold foil restorations Fixed Prosthodontic Services - once every three (3) years - includes surgical incision/ excision bridgework and frenectomy repairs In-office and & Commercial Laboratory Charges - when applicable to the covered Benefits MAJOR SERVICES Complete and/or Partial Dentures - (once every 4 years) Restorative benefit • 50% reimbursement of eligible charges up to the amount specified in the Fee Guide, for the following: Orthodontic Services - includes post/coreobservation, crownsadjustments, inlays/ onlays Fixed Prosthodontic Services - (once every 5 years) - includes bridgework orthodontic appliances, major orthodontic treatment, preventative space maintainers In-office and & Commercial Laboratory Charges - when applicable to the covered benefits. ORTHODONTIC SERVICES (for dependent children to age 18) Orthodontic Services - includes observationbenefit LETTER OF UNDERSTANDING #2: Health and Safety If by January 15th, adjustments, orthodontic appliances and major orthodontic treatment In-office and Commercial Laboratory Charges - when applicable to 2001: • there is agreement between the covered benefits. Orthodontic Treatment Prior to the commencement of orthodontic treatment, your dentist must prepare a report outlining the details with respect to malocclusion, diagnosis, proposed treatment and applicable fees. This treatment plan must be forwarded to Manulife Financial for review to establish the extent of the payable benefit. PREDETERMINATION OF BENEFITS AND ALTERNATE BENEFIT PROVISION - Crowns, Bridgework, Dentures Prior to beginning dental treatment which will involve the use of crowns, bridges and/or dentures and which is expected to cost $300 or more, you should obtain from your dentist and submit to Manulife Financial a treatment plan outlining the procedures and charges. Your dentist may be requested to submit any relevant x-rays. Approval of the treatment plan should be obtained from Manulife Financial prior to commencement of treatment. After reviewing the plan, you will be advised of the amount payable by Manulife Financial. Where a range of fees, individual consideration or laboratory charges are included, Manulife Financial will determine the amount payable. The approved estimate will be honoured for a period of twelve months from the date of approval. There are many ways to treat a particular dental problem or condition employee groups and the cost of different procedures, services, courses of treatment and materials may vary considerably. Manulife Financial may determine that payment for a less expensive procedure, which will provide satisfactory results, may be made towards the cost of a procedure selected by you and your dentist. The difference between the amount payable by Manulife Financial and the dentist's charge is your responsibility. If you do not submit a treatment plan, Manulife Financial reserves the right to pay benefits based Board on the less expensive procedurenew Terms of Reference for the Joint Health & Safety Committee, which • training of on-site workers who will provide satisfactory results. Benefits are not payable for:perform inspections has been completed, and • the Joint Health and Safety Committee determines that the new inspection model currently being developed has been successfully implemented, the time assigned in Article 4.03.4 shall be five (5) days for the semester, effective February 5th, 2001, and three (3) days per semester thereafter.

Appears in 1 contract

Samples: Collective Agreement

Dental Benefits. The following provides Dental Benefits claims have a general description deadline of 12 months from the benefits available date of service. There are three levels of eligible expenses for dental benefits, they are generally outlined below: Plan A – Basic - eligible expenses are reimbursed at 90%. This covers services for the care and maintenance of teeth, including procedures to you restore teeth to natural or normal function. This includes but is not limited to: • Preventative services such as polishing, fluoride treatments and your eligible dependents under dental exams. Generally adults or children 20 and older claim this dental planservice every 9 months. A complete list of the specific procedures (and applicable limitations) can be found in the Master Contract held by your Employer. Payment for eligible benefits will be based on the monetary rates shown in the Dental Association Fee Guide applicable to your group plan. Refer to your Summary of Benefits for information regarding any deductible, co-payment or maximum benefit amounts. BENEFITS BASIC SERVICES Examinations - includes complete and recall oral examinations twice per calendar year for persons Children up to and including age 12 and once every 9 months for persons over age 12. Consultations - with patient or with a member of the profession Radiographs - includes complete series intra oral films once every 24 months, panoramic films, and bitewing films twice 19 can claim this two times per calendar year for persons up to and including age 12 and once ( about every 9 months for persons over age 12. Diagnostic Services - includes bacteriologic tests, biopsy and cytological tests Preventive Services - space maintainers (for dependent children); pit and fissure sealants; scaling; fluoride treatment; polishing (one unit of time twice per calendar year for persons up to and including age 12 and one unit of time every 9 months for persons over age 12six months). The following benefits are provided twice per calendar year for persons up to • Diagnostics services such as examinations and including age 12 recall and once every 9 months for persons over age 12: preventive recall packages, oral hygiene instruction and reinstruction Fillings Extractions - includes root extractions Anesthesia Endodontic Services - includes root canal therapy, surgical and emergency services Periodontic Services - includes periodontal surgery, root planning and occlusal equilibration Denture Repairs, Adjustments, Relining/Rebasing Surgical Services - includes surgical incision/ excision and frenectomy In-office and Commercial Laboratory Charges - when applicable to the covered Benefits MAJOR SERVICES Complete and/or Partial Dentures - (once every 4 years) Restorative Services - includes post/core, crowns, inlays/ onlays Fixed Prosthodontic Services - (once every 5 years) - includes bridgework In-office and Commercial Laboratory Charges - when applicable to the covered benefits. ORTHODONTIC SERVICES (for dependent children to age 18) Orthodontic Services - includes observation, adjustments, orthodontic appliances and major orthodontic treatment In-office and Commercial Laboratory Charges - when applicable to the covered benefits. Orthodontic Treatment Prior to the commencement of orthodontic treatment, your dentist must prepare a report outlining the details with respect to malocclusion, diagnosis, proposed treatment and applicable fees. This treatment plan must be forwarded to Manulife Financial for review to establish the extent of the payable benefit. PREDETERMINATION OF BENEFITS AND ALTERNATE BENEFIT PROVISION - Crowns, Bridgework, Dentures Prior to beginning dental treatment which will involve the use of crowns, bridges and/or dentures and which is expected to cost $300 or more, you should obtain from your dentist and submit to Manulife Financial a treatment plan outlining the procedures and charges. Your dentist may be requested to submit any relevant x-rays. Approval All x-rays shall not exceed the dollar limit for a complete mouth series; some also have limits as to how often they will be covered. • Basic restorative services such as fillings (silver, white, primary or permanent teeth) all have per person per time frame (2 years) limits. Extractions, bruxing appliances (night guards) and root canals are also covered but have restrictions. See the PBC website for more details on the benefits coverage. Plan B – Major Restorative - eligible expenses are reimbursed at 70%. You are eligible when your dentist recommends replacement of your missing teeth or reconstruction of your teeth where basic restorative methods cannot be used satisfactorily. This includes but is not limited to: crowns, build-ups, veneers, inlays, a false tooth, abutments/retainers, complete Dentures, and partial dentures. Coverage has restrictions. See the PBC website for more details. Plan C- Orthodontic Services - eligible expenses are reimbursed at 55% and have a limit of $5000/per person per lifetime. This covers services provided to maintain, restore, or establish a functional alignment of the treatment plan should be obtained from Manulife Financial prior to commencement of treatmentupper and lower teeth. After reviewing the planInformation Appendix #2 - Reference Table – Health Benefits, you will be advised Sick Leave, Vacation & Pension (Note: Where there is conflict between terms of the amount payable by Manulife Financial. Where a range of feesCollective Agreement, individual consideration benefits carrier contract or laboratory charges are includedPension Plan and this table, Manulife Financial will determine the amount payable. The approved estimate will be honoured for a period of twelve months from the date of approval. There are many ways to treat a particular dental problem those documents shall have precedence.) Benefit or condition and the cost of different procedures, services, courses of treatment and materials may vary considerably. Manulife Financial may determine that payment for a less expensive procedure, which will provide satisfactory results, may be made towards the cost of a procedure selected by you and your dentist. The difference between the amount payable by Manulife Financial and the dentist's charge is your responsibility. If you do not submit a treatment plan, Manulife Financial reserves the right to pay benefits based on the less expensive procedure, which will provide satisfactory results. Benefits are not payable for:Leave Coverage What happens if....

Appears in 1 contract

Samples: Collective Agreement

Dental Benefits. The following provides a general description of the benefits available to you and your eligible dependents under this dental plan. A complete list of the specific procedures < No deductible < Fee Guide - Current, less one (and applicable limitations1) can be found in the Master Contract held by your Employer. Payment for eligible benefits will be based on the monetary rates shown in the year Ontario Dental Association Fee Guide applicable for General Practitioners, effective February 1st each year. < 100% reimbursement of eligible charges, up to your group plan. Refer to your Summary of Benefits the amount specified in the Fee Guide for information regarding any deductible, co-payment or maximum benefit amounts. BENEFITS BASIC SERVICES the following: Examinations - includes complete oral examinations once every two (2) years and recall oral examinations twice per calendar year for persons up to and including age 12 and once every 9 nine (9) months for persons over age 12. adults* Consultations - with patient or with a member of the profession Radiographs - includes complete series intra oral films once every 24 monthstwo (2) years, panoramic filmsfilms once every two (2) years, and bitewing films twice per calendar year for persons up to and including age 12 and once every 9 5 months for persons over age 12. Diagnostic Services - includes bacteriologic tests, biopsy and cytological tests Preventive tests; Preventative Services - includes scaling and/or polishing once every six (6) months, {to a maximum of twelve (12) units per year}, preventative recall packages once every nine (9) months*, fluoride treatments, oral hygiene instruction and re- instruction once every nine (9) months*, space maintainers (and pit & fissure sealants for permanent molar teeth of dependent children); pit and fissure sealants; scaling; fluoride treatment; polishing (one unit of time twice per calendar year for persons children up to and including age 12 and fifteen (15) {only one unit of time replacement sealant per tooth} *once every 9 six (6) months for persons over age 12)dependent children Fillings Periodontic Services - includes periodontal surgery, root planing and occlusal equilibration Surgical Services - includes extractions, surgical incision/excision and frenectomy Anaesthesia In-Office & Commercial Laboratory Charges - when applicable to the covered benefits. The following benefits are provided twice per calendar year for persons < 60% reimbursement of eligible charges up to and including age 12 and once every 9 months the amount specified in the Fee Guide, for persons over age 12the following: preventive recall packages, oral hygiene instruction and reinstruction Fillings Extractions - includes root extractions Anesthesia Endodontic Services - includes root canal therapy, surgical and emergency services Periodontic Services Complete and/or Partial Dentures - includes periodontal surgery, root planning and occlusal equilibration once every three (3) years Major Denture Adjustments Denture Repairs, AdjustmentsMinor Adjustments {after 3 months from insertion, Reliningonce every thirty-six (36) months} Restorative Services includes post/Rebasing Surgical core, crowns, inlays/onlays and gold foil restorations Fixed Prosthodontic Services - once every three (3) years - includes surgical incision/ excision bridgework and frenectomy repairs In-office and & Commercial Laboratory Charges - when applicable to the covered Benefits MAJOR SERVICES Complete and/or Partial Dentures - (once every 4 years) Restorative benefit < 50% reimbursement of eligible charges up to the amount specified in the Fee Guide, for the following: Orthodontic Services - includes post/coreobservation, crownsadjustments, inlays/ onlays Fixed Prosthodontic Services - (once every 5 years) - includes bridgework orthodontic appliances, major orthodontic treatment, preventative space maintainers In-office and & Commercial Laboratory Charges - when applicable to the covered benefits. ORTHODONTIC SERVICES (for dependent children to age 18) Orthodontic Services - includes observation, adjustments, orthodontic appliances and major orthodontic treatment In-office and Commercial Laboratory Charges - when applicable to the covered benefits. Orthodontic Treatment Prior to the commencement of orthodontic treatment, your dentist must prepare a report outlining the details with respect to malocclusion, diagnosis, proposed treatment and applicable fees. This treatment plan must be forwarded to Manulife Financial for review to establish the extent of the payable benefit. PREDETERMINATION benefit LETTER OF BENEFITS AND ALTERNATE BENEFIT PROVISION - Crowns, Bridgework, Dentures Prior to beginning dental treatment which will involve the use of crowns, bridges and/or dentures and which is expected to cost $300 or more, you should obtain from your dentist and submit to Manulife Financial a treatment plan outlining the procedures and charges. Your dentist may be requested to submit any relevant x-rays. Approval of the treatment plan should be obtained from Manulife Financial prior to commencement of treatment. After reviewing the plan, you will be advised of the amount payable by Manulife Financial. Where a range of fees, individual consideration or laboratory charges are included, Manulife Financial will determine the amount payable. The approved estimate will be honoured for a period of twelve months from the date of approval. There are many ways to treat a particular dental problem or condition and the cost of different procedures, services, courses of treatment and materials may vary considerably. Manulife Financial may determine that payment for a less expensive procedure, which will provide satisfactory results, may be made towards the cost of a procedure selected by you and your dentist. The difference between the amount payable by Manulife Financial and the dentist's charge is your responsibility. If you do not submit a treatment plan, Manulife Financial reserves the right to pay benefits based on the less expensive procedure, which will provide satisfactory results. Benefits are not payable forUNDERSTANDING #3:

Appears in 1 contract

Samples: Collective Agreement

Dental Benefits. The following provides a general description of the benefits available to you and your eligible dependents under this dental plan. A complete list of the specific procedures (and applicable limitations) can be found in the Master Contract held by your Employer. Payment for eligible benefits will be based on the monetary rates shown in the Dental Association Fee Guide applicable to your group plan. Refer to your Summary of Benefits for information regarding any deductible, co-payment or maximum benefit amounts. BENEFITS BASIC SERVICES Examinations - includes complete and recall oral examinations twice per calendar year for persons up to and including age 12 and once every 9 months for persons over age 12. Consultations - with patient or with a member of the profession Radiographs - includes complete series intra oral films once every 24 months, panoramic films, and bitewing films twice per calendar year for persons up to and including age 12 and once every 9 months for persons over age 12. 12 Diagnostic Services - includes bacteriologic tests, biopsy and cytological tests Preventive Services - space maintainers (for dependent children); pit and fissure sealants; scaling; fluoride treatment; polishing (one unit of time twice per calendar year for persons up to and including age 12 and one unit of time every 9 months for persons over age 12). The following benefits are provided twice per calendar year for persons up to and including age 12 and once every 9 months for persons over age 12: preventive recall packages, oral hygiene instruction and reinstruction Fillings Extractions - includes root extractions Anesthesia Endodontic Services - includes root canal therapy, surgical and emergency services Periodontic Periodontal Services - includes periodontal surgery, root planning and occlusal equilibration Denture Repairs, Adjustments, Relining/Rebasing Surgical Services - includes surgical incision/ excision and frenectomy In-office and Commercial Laboratory Charges - when applicable to the covered Benefits MAJOR SERVICES Complete and/or Partial Dentures - (once every 4 5 years) Restorative Services - includes post/core, crowns, inlays/ onlays Fixed Prosthodontic Services - (once every 5 years) - includes bridgework In-office and Commercial Laboratory Charges - when applicable to the covered benefits. ORTHODONTIC SERVICES (for dependent children to age 18) Orthodontic Services - includes observation, adjustments, orthodontic appliances and major orthodontic treatment In-office and Commercial Laboratory Charges - when applicable to the covered benefits. Orthodontic Treatment Prior to the commencement of orthodontic treatment, your dentist must prepare a report outlining the details with respect to malocclusion, diagnosis, proposed treatment and applicable fees. This treatment plan must be forwarded to Manulife Financial for review to establish the extent of the payable benefit. PREDETERMINATION OF BENEFITS AND ALTERNATE BENEFIT PROVISION - Crowns, Bridgework, Dentures Prior to beginning dental treatment which will involve the use of crowns, bridges and/or dentures and which is expected to cost $300 or more, you should obtain from your dentist and submit to Manulife Financial a treatment plan outlining the procedures and charges. Your dentist may be requested to submit any relevant x-rays. Approval of the treatment plan should be obtained from Manulife Financial prior to commencement of treatment. After reviewing the plan, you will be advised of the amount payable by Manulife FinancialManulife. Where a range of fees, individual consideration or laboratory charges are included, Manulife Financial will determine the amount payable. The approved estimate will be honoured for a period of twelve months from the date of approval. There are many ways to treat a particular dental problem or condition and the cost of different procedures, services, courses of treatment and materials may vary considerably. Manulife Financial Maritime Life may determine that payment for a less expensive procedure, procedure which will provide satisfactory results, may be made towards the cost of a procedure selected by you and your dentist. The difference between the amount payable by Manulife Financial and the dentist's charge is your responsibility. If you do not submit a treatment plan, Manulife Financial reserves the right to pay benefits based on the less expensive procedure, procedure which will provide satisfactory results. Benefits are not payable for: - Services or supplies not listed under Benefits. - Services or supplies for cosmetic purposes. - Charges for procedures or appliances connected with implants. - Services or supplies related to Temporomandibular Joint problems. - Charges incurred as a result of conditions arising from war, whether or not war was declared, from participation in any civil commotion, insurrection or riot, or while serving in the armed forces. - Charges incurred as a result of self-inflicted injury. - Charges incurred while committing, or attempting to commit, directly or indirectly, a criminal act under legislation in the jurisdiction where the act was committed. - Charges for the completion of claim forms or other documentation, or charges incurred for failing to keep a scheduled appointment or for transfer of medical files. - Charges for procedures in excess of those stated in the Fee Guide for General Practitioners, as shown on your Identification Certificate. - Services or supplies covered by any government plan. - Services completed after termination of coverage. APPENDIX “C” - INCOME PROTECTION PLAN This Plan is comprised of two parts:

Appears in 1 contract

Samples: Collective Agreement

AutoNDA by SimpleDocs

Dental Benefits. The following provides a general description of the benefits available to you and your eligible dependents under this dental plan. A complete list of the specific procedures (and applicable limitations) can be found in the Master Contract held by your Employer. Payment for eligible benefits will be based on the monetary rates shown in the Dental Association Fee Guide applicable to your group plan. Refer to your Summary of Benefits for information regarding any deductible, co-payment or maximum benefit amounts. BENEFITS BASIC SERVICES SERVI CES Examinations - includes complete and recall oral examinations twice per calendar year for persons up to and including age 12 and once every 9 months for persons over age 12. Consultations - with patient or with a member of the profession Radiographs - includes complete series intra oral films f1lms once every 24 months, panoramic films, and bitewing films f1lms twice per calendar year for persons up to and including age 12 and once every 9 months for persons over age 12. 12 Diagnostic Services - includes bacteriologic tests, biopsy and cytological tests Preventive Services - space maintainers (for dependent children); pit and fissure sealants; scaling; fluoride treatment; polishing (one unit of time twice per calendar year for persons up to and including age 12 and one unit of time every 9 months for persons over age 12). The following benefits are provided twice per calendar year for persons up to and including age 12 and once every 9 months for persons over age 12: preventive recall packages, oral hygiene instruction and reinstruction Fillings Extractions - includes root extractions Anesthesia Endodontic Services - includes root canal therapy, surgical and emergency services Periodontic Services - includes periodontal surgery, root planning and occlusal equilibration Denture Repairs, Adjustments, Relining/Rebasing Surgical Services - includes surgical incision/ excision and frenectomy In-office and Commercial Laboratory Charges - when applicable to the covered Benefits MAJOR SERVICES Complete and/or Partial Dentures - (once every 4 5 years) Restorative Services - includes post/core, crowns, inlays/ onlays Fixed Prosthodontic Services - (once every 5 years) - includes bridgework In-office and Commercial Laboratory Charges - when applicable to the covered benefits. ORTHODONTIC SERVICES (for dependent children to age 18) Orthodontic Services - includes observation, adjustments, orthodontic appliances and major orthodontic treatment In-office and Commercial Laboratory Charges - when applicable to the covered benefits. Orthodontic Treatment Prior to the commencement of orthodontic treatment, your dentist must prepare a report outlining the details with respect to malocclusion, diagnosis, proposed treatment and applicable fees. This treatment plan must be forwarded to Manulife Financial Maritime Life for review to establish the extent of the payable benefit. PREDETERMINATION OF BENEFITS AND ALTERNATE BENEFIT PROVISION - Crowns, Bridgework, Dentures Prior to beginning dental treatment which will involve the use of crowns, bridges and/or dentures and which is expected to cost $300 or more, you should obtain from your dentist and submit to Manulife Financial Maritime Life a treatment plan outlining the procedures and charges. Your dentist may be requested to submit any relevant x-rays. Approval of the treatment plan should be obtained from Manulife Financial Maritime Life prior to commencement of treatment. After reviewing the plan, you will be advised of the amount payable by Manulife FinancialMaritime Life. ' Where a range of fees, individual consideration or laboratory charges are included, Manulife Financial Maritime Life will determine the amount payable. The approved estimate will be honoured for a period of twelve months from the date of approval. There are many ways to treat a particular dental problem or condition and the cost of different procedures, services, courses of treatment and materials may vary considerably. Manulife Financial Maritime Life may determine that payment for a less expensive procedure, procedure which will provide satisfactory results, may be made towards the cost of a procedure selected by you and your dentist. The difference between the amount payable by Manulife Financial Maritime Life and the dentist's charge is your responsibility. If you do not submit a treatment plan, Manulife Financial Maritime Life reserves the right to pay benefits based on the less expensive procedure, procedure which will provide satisfactory results. Benefits are not payable for:: - Services or supplies not listed under Benefits. - Services or supplies for cosmetic purposes. - Charges for procedures or appliances connected with implants. - Services or supplies related to Temporomandibular Joint problems. - Charges incurred as a result of conditions arising from war, whether or not war was declared, from participation in any civil commotion, insurrection or riot, or while serving in the armed forces. - Charges incurred as a result of self-inflicted injury. - Charges incurred while committing, or attempting to commit, directly or indirectly, a criminal act under legislation in the jurisdiction where the act was committed. - Charges for the completion of claim forms or other documentation, or charges incurred for failing to keep a scheduled appointment or for transfer of medical files. - Charges for procedures in excess of those stated in the Fee Guide for General Practitioners, as shown on your Identification Certificate. - Services or supplies covered by any government plan.

Appears in 1 contract

Samples: Collective Bargaining Agreement

Dental Benefits. The following provides a general description of the benefits available to you and your eligible dependents under this dental plan. A complete list of the specific procedures < No deductible < Fee Guide - Current, less one (and applicable limitations1) can be found in the Master Contract held by your Employer. Payment for eligible benefits will be based on the monetary rates shown in the year Ontario Dental Association Fee Guide applicable for General Practitioners, effective February 1st each year. < 100% reimbursement of eligible charges, up to your group plan. Refer to your Summary of Benefits the amount specified in the Fee Guide for information regarding any deductible, co-payment or maximum benefit amounts. BENEFITS BASIC SERVICES the following: Examinations - includes complete oral examinations once every two (2) years and recall oral examinations twice per calendar year for persons up to and including age 12 and once every 9 nine (9) months for persons over age 12. adults* Consultations - with patient or with a member of the profession Radiographs - includes complete series intra oral films once every 24 monthstwo (2) years, panoramic filmsfilms once every two (2) years, and bitewing films twice per calendar year for persons up to and including age 12 and once every 9 5 months for persons over age 12. Diagnostic Services - includes bacteriologic tests, biopsy and cytological tests Preventive tests; Preventative Services - includes scaling and/or polishing once every six (6) months, {to a maximum of twelve (12) units per year}, preventative recall packages once every nine (9) months*, fluoride treatments, oral hygiene instruction and re-instruction once every nine (9) months*, space maintainers (and pit & fissure sealants for permanent molar teeth of dependent children); pit and fissure sealants; scaling; fluoride treatment; polishing (one unit of time twice per calendar year for persons children up to and including age 12 and fifteen (15) {only one unit of time replacement sealant per tooth} *once every 9 six (6) months for persons over age 12)dependent children Fillings Periodontic Services - includes periodontal surgery, root planing and occlusal equilibration Surgical Services - includes extractions, surgical incision/excision and frenectomy Anaesthesia In-Office & Commercial Laboratory Charges - when applicable to the covered benefits. The following benefits are provided twice per calendar year for persons < 60% reimbursement of eligible charges up to and including age 12 and once every 9 months the amount specified in the Fee Guide, for persons over age 12the following: preventive recall packages, oral hygiene instruction and reinstruction Fillings Extractions - includes root extractions Anesthesia Endodontic Services - includes root canal therapy, surgical and emergency services Periodontic Services Complete and/or Partial Dentures - includes periodontal surgery, root planning and occlusal equilibration once every three (3) years Major Denture Adjustments Denture Repairs, AdjustmentsMinor Adjustments {after 3 months from insertion, Reliningonce every thirty-six (36) months} Restorative Services includes post/Rebasing Surgical core, crowns, inlays/onlays and gold foil restorations Fixed Prosthodontic Services - once every three (3) years - includes surgical incision/ excision bridgework and frenectomy repairs In-office and & Commercial Laboratory Charges - when applicable to the covered Benefits MAJOR SERVICES Complete and/or Partial Dentures - (once every 4 years) Restorative benefit < 50% reimbursement of eligible charges up to the amount specified in the Fee Guide, for the following: Orthodontic Services - includes post/coreobservation, crownsadjustments, inlays/ onlays Fixed Prosthodontic Services - (once every 5 years) - includes bridgework orthodontic appliances, major orthodontic treatment, preventative space maintainers In-office and & Commercial Laboratory Charges - when applicable to the covered benefits. ORTHODONTIC SERVICES benefit LETTER OF UNDERSTANDING #3: Computer Site Administrators Computer Site Administrators shall be compensated with forty (for dependent children 40) minutes per week to age 18) Orthodontic Services - includes observation, adjustments, orthodontic appliances and major orthodontic treatment In-office and Commercial Laboratory Charges - when applicable to the covered benefits. Orthodontic Treatment Prior to the commencement of orthodontic treatment, your dentist must prepare a report outlining the details with respect to malocclusion, diagnosis, proposed treatment and applicable fees. This treatment plan must be forwarded to Manulife Financial for review to establish the extent of the payable benefit. PREDETERMINATION OF BENEFITS AND ALTERNATE BENEFIT PROVISION - Crowns, Bridgework, Dentures Prior to beginning dental treatment which will involve the use of crowns, bridges and/or dentures and which is expected to cost $300 or more, you should obtain from your dentist and submit to Manulife Financial a treatment plan outlining the procedures and charges. Your dentist may be requested to submit any relevant x-rays. Approval of the treatment plan should be obtained from Manulife Financial prior to commencement of treatment. After reviewing the plan, you will be advised of the amount payable by Manulife Financial. Where a range of fees, individual consideration or laboratory charges are included, Manulife Financial will determine the amount payable. The approved estimate will be honoured for a period of twelve months from the date of approval. There are many ways to treat a particular dental problem or condition and the cost of different procedures, services, courses of treatment and materials may vary considerably. Manulife Financial may determine that payment for a less expensive procedure, which will provide satisfactory results, may be made towards the cost of a procedure selected by you and your dentist. The difference between the amount payable by Manulife Financial and the dentist's charge is your responsibility. If you do not submit a treatment plan, Manulife Financial reserves the right to pay benefits based on the less expensive procedure, which will provide satisfactory results. Benefits are not payable for:fulfill their duties.

Appears in 1 contract

Samples: Collective Agreement

Dental Benefits. The following provides a general description of the benefits available to you and your eligible dependents under this dental plan. A complete list of the specific procedures < No deductible < Fee Guide - Current, less one (and applicable limitations1) can be found in the Master Contract held by your Employer. Payment for eligible benefits will be based on the monetary rates shown in the year Ontario Dental Association Fee Guide applicable for General Practitioners, effective February 1st each year. < 100% reimbursement of eligible charges, up to your group plan. Refer to your Summary of Benefits the amount specified in the Fee Guide for information regarding any deductible, co-payment or maximum benefit amounts. BENEFITS BASIC SERVICES the following: Examinations - includes complete oral examinations once every two (2) years and recall oral examinations twice per calendar year for persons up to and including age 12 and once every 9 nine (9) months for persons over age 12. adults* Consultations - with patient or with a member of the profession Radiographs - includes complete series intra oral films once every 24 monthstwo (2) years, panoramic filmsfilms once every two (2) years, and bitewing films twice per calendar year for persons up to and including age 12 and once every 9 5 months for persons over age 12. Diagnostic Services - includes bacteriologic tests, biopsy and cytological tests Preventive tests; Preventative Services - includes scaling and/or polishing once every six (6) months, {to a maximum of twelve (12) units per year}, preventative recall packages once every nine (9) months*, fluoride treatments, oral hygiene instruction and re-instruction once every nine (9) months*, space maintainers (and pit & fissure sealants for permanent molar teeth of dependent children); pit and fissure sealants; scaling; fluoride treatment; polishing (one unit of time twice per calendar year for persons children up to and including age 12 and fifteen (15) {only one unit of time replacement sealant per tooth} *once every 9 six (6) months for persons over age 12)dependent children Fillings Periodontic Services - includes periodontal surgery, root planing and occlusal equilibration Surgical Services - includes extractions, surgical incision/excision and frenectomy Anaesthesia In-Office & Commercial Laboratory Charges - when applicable to the covered benefits. The following benefits are provided twice per calendar year for persons < 60% reimbursement of eligible charges up to and including age 12 and once every 9 months the amount specified in the Fee Guide, for persons over age 12the following: preventive recall packages, oral hygiene instruction and reinstruction Fillings Extractions - includes root extractions Anesthesia Endodontic Services - includes root canal therapy, surgical and emergency services Periodontic Services Complete and/or Partial Dentures - includes periodontal surgery, root planning and occlusal equilibration once every three (3) years Major Denture Adjustments Denture Repairs, AdjustmentsMinor Adjustments {after 3 months from insertion, Reliningonce every thirty-six (36) months} Restorative Services includes post/Rebasing Surgical core, crowns, inlays/onlays and gold foil restorations Fixed Prosthodontic Services - once every three (3) years - includes surgical incision/ excision bridgework and frenectomy repairs In-office and & Commercial Laboratory Charges - when applicable to the covered Benefits MAJOR SERVICES Complete and/or Partial Dentures - (once every 4 years) Restorative benefit < 50% reimbursement of eligible charges up to the amount specified in the Fee Guide, for the following: Orthodontic Services - includes post/coreobservation, crownsadjustments, inlays/ onlays Fixed Prosthodontic Services - (once every 5 years) - includes bridgework orthodontic appliances, major orthodontic treatment, preventative space maintainers In-office and & Commercial Laboratory Charges - when applicable to the covered benefits. ORTHODONTIC SERVICES (for dependent children to age 18) Orthodontic Services - includes observationbenefit LETTER OF UNDERSTANDING #2: Health and Safety If by January 15, adjustments, orthodontic appliances and major orthodontic treatment In-office and Commercial Laboratory Charges - when applicable to 2001: < there is agreement between the covered benefits. Orthodontic Treatment Prior to the commencement of orthodontic treatment, your dentist must prepare a report outlining the details with respect to malocclusion, diagnosis, proposed treatment and applicable fees. This treatment plan must be forwarded to Manulife Financial for review to establish the extent of the payable benefit. PREDETERMINATION OF BENEFITS AND ALTERNATE BENEFIT PROVISION - Crowns, Bridgework, Dentures Prior to beginning dental treatment which will involve the use of crowns, bridges and/or dentures and which is expected to cost $300 or more, you should obtain from your dentist and submit to Manulife Financial a treatment plan outlining the procedures and charges. Your dentist may be requested to submit any relevant x-rays. Approval of the treatment plan should be obtained from Manulife Financial prior to commencement of treatment. After reviewing the plan, you will be advised of the amount payable by Manulife Financial. Where a range of fees, individual consideration or laboratory charges are included, Manulife Financial will determine the amount payable. The approved estimate will be honoured for a period of twelve months from the date of approval. There are many ways to treat a particular dental problem or condition employee groups and the cost of different procedures, services, courses of treatment and materials may vary considerably. Manulife Financial may determine that payment for a less expensive procedure, which will provide satisfactory results, may be made towards the cost of a procedure selected by you and your dentist. The difference between the amount payable by Manulife Financial and the dentist's charge is your responsibility. If you do not submit a treatment plan, Manulife Financial reserves the right to pay benefits based Board on the less expensive procedurenew Terms of Reference for the Joint Health & Safety Committee, which < training of on-site workers who will provide satisfactory resultsperform inspections has been completed, and < the Joint Health and Safety Committee determines that the new inspection model currently being developed has been successfully implemented, the time assigned in clause 4.03.4 shall be five (5) days for the semester, effective February 5, 2001, and three (3) days per semester thereafter. Benefits are not payable for:LETTER OF UNDERSTANDING #3: Teacher Advisor Program (TAP)

Appears in 1 contract

Samples: Collective Agreement

Dental Benefits. The following provides a general description of the benefits available to you and your eligible dependents under this dental plan. A complete list of the specific procedures (and applicable limitations) can be found in the Master Contract held by your Employer. Payment for eligible benefits will be based on the monetary rates shown in the Dental Association Fee Guide applicable to your group plan. Refer to your Summary of Benefits for information regarding any deductible, co-payment or maximum benefit amounts. BENEFITS BASIC SERVICES SERVI CES Examinations - includes complete and recall oral examinations twice per calendar year for persons up to and including age 12 and once every 9 months for persons over age 12. Consultations - with patient or with a member of the profession Radiographs - includes complete series intra oral films once every 24 months, panoramic films, and bitewing films twice per calendar year for persons up to and including age 12 and once every 9 months for persons over age 12. 12 Diagnostic Services - includes bacteriologic tests, biopsy and cytological tests Preventive Services - space maintainers (for dependent children); pit and fissure sealants; scaling; fluoride treatment; polishing (one unit of time twice per calendar year for persons up to and including age 12 and one unit of time every 9 months for persons over age 12). The following benefits are provided twice per calendar year for persons up to and including age 12 and once every 9 months for persons over age 12: preventive recall packages, oral hygiene instruction and reinstruction Fillings Extractions - includes root extractions Anesthesia Anaesthesia Endodontic Services - includes root canal therapy, surgical and emergency services Periodontic Services - includes periodontal surgery, root planning and occlusal equilibration Denture Repairs, Adjustments, Relining/Rebasing Surgical Services - includes surgical incision/ excision and frenectomy In-office and Commercial Laboratory Charges - when applicable to the covered Benefits MAJOR SERVICES Complete and/or Partial Dentures - (once every 4 5 years) Restorative Services - includes post/core, crowns, inlays/ onlays Fixed Prosthodontic Services - (once every 5 years) - includes bridgework In-office and Commercial Laboratory Charges - when applicable to the covered benefits. ORTHODONTIC SERVICES (for dependent children to age 18) Orthodontic Services - includes observation, adjustments, orthodontic appliances and major orthodontic treatment In-office and Commercial Laboratory Charges - when applicable to the covered benefits. Orthodontic Treatment Prior to the commencement of orthodontic treatment, your dentist must prepare a report outlining the details with respect to malocclusion, diagnosis, proposed treatment and applicable fees. This treatment plan must be forwarded to Manulife Financial for review to establish the extent of the payable benefit. PREDETERMINATION OF BENEFITS AND ALTERNATE BENEFIT PROVISION - Crowns, Bridgework, Dentures Prior to beginning dental treatment which will involve the use of crowns, bridges and/or dentures and which is expected to cost $300 or more, you should obtain from your dentist and submit to Manulife Financial a treatment plan outlining the procedures and charges. Your dentist may be requested to submit any relevant x-rays. Approval of the treatment plan should be obtained from Manulife Financial prior to commencement of treatment. After reviewing the plan, you will be advised of the amount payable by Manulife FinancialManulife. Where a range of fees, individual consideration or laboratory charges are included, Manulife Financial will determine the amount payable. The approved estimate will be honoured for a period of twelve months from the date of approval. There are many ways to treat a particular dental problem or condition and the cost of different procedures, services, courses of treatment and materials may vary considerably. Manulife Financial Maritime Life may determine that payment for a less expensive procedure, procedure which will provide satisfactory results, may be made towards the cost of a procedure selected by you and your dentist. The difference between the amount payable by Manulife Financial and the dentist's charge is your responsibility. If you do not submit a treatment plan, Manulife Financial reserves the right to pay benefits based on the less expensive procedure, procedure which will provide satisfactory results. Benefits are not payable for: - Services or supplies not listed under Benefits. - Services or supplies for cosmetic purposes. - Charges for procedures or appliances connected with implants. - Services or supplies related to Temporomandibular Joint problems. - Charges incurred as a result of conditions arising from war, whether or not war was declared, from participation in any civil commotion, insurrection or riot, or while serving in the armed forces. - Charges incurred as a result of self-inflicted injury. - Charges incurred while committing, or attempting to commit, directly or indirectly, a criminal act under legislation in the jurisdiction where the act was committed. - Charges for the completion of claim forms or other documentation, or charges incurred for failing to keep a scheduled appointment or for transfer of medical files. - Charges for procedures in excess of those stated in the Fee Guide for General Practitioners, as shown on your Identification Certificate. - Services or supplies covered by any government plan. - Services completed after termination of coverage. APPENDIX “C” - INCOME PROTECTION PLAN‌ This Plan is comprised of two parts:

Appears in 1 contract

Samples: Collective Bargaining Agreement

Time is Money Join Law Insider Premium to draft better contracts faster.