DENTALCARE Sample Clauses

DENTALCARE. A deductible may be applied before you are reimbursed. All expenses will be reimbursed at the level shown in the Benefit Summary. Benefits may be subject to plan maximums and frequency limits. Check the Benefit Summary for this information. The plan covers reasonable and customary charges to the extent they do not exceed the dental fee guide level shown in the Benefit Summary.
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DENTALCARE. ‌ A deductible may be applied before you are reimbursed. All expenses will be reimbursed at the level shown in the Benefit Summary. Benefits may be subject to plan maximums and frequency limits. Check the Benefit Summary for this information. The plan covers customary charges to the extent they do not exceed the dental fee guide level shown in the Benefit Summary. Denturist fee guides are applicable when services are provided by a denturist. Dental hygienist fee guides are applicable when services are provided by a dental hygienist practising independently. All covered services and supplies must represent reasonable treatment. Treatment is considered reasonable if it is recognized by the Canadian Dental Association, it is proven to be effective, and it is of a form, frequency, and duration essential to the management of the person's dental health. To be considered reasonable, treatment must also be performed by a dentist or under a dentist’s supervision, performed by a dental hygienist entitled by law to practise independently, or performed by a denturist. Your dentalcare coverage will not continue past the end of the day before the date you reach age . Treatment Plan • Before incurring any large dental expenses, ask your dental service provider to complete a treatment plan and submit it to Great-West Life. Great-West Life will calculate the benefits payable for the proposed treatment, so you will know in advance the approximate portion of the cost you will have to pay. Basic Coverage The following expenses will be covered: • Diagnostic services including: - one complete oral examination every 24 months - limited oral examinations , except that only one limited oral examination is covered in any 12-month period that a complete oral examination is also performed - limited periodontal examinations - consultation with the patient - complete series of x-rays every 24 months - intra-oral x-rays to a maximum of 15 films every 24 months and a panoramic x-ray every 36 months. Services provided in the same 12 months as a complete series are not coveredPreventive services including: - polishing - topical application of fluoride - scaling, limited to a maximum combined with periodontal root planing of A time unit is considered to be a 15-minute interval or any portion of a 15-minute interval - pit and fissure sealants on bicuspids and permanent molars every 60 months - space maintainers including appliances for the control of harmful habits - finishing restoration...
DENTALCARE. Payment Basis The dental fee guide in effect one year prior to the date treatment is rendered for the province in which treatment is rendered Deductible Individual $25 each calendar year $25 each calendar year Family $50 each calendar year $50 each calendar year The individual and family deductibles do not apply to Orthodontic expenses Reimbursement Levels Basic Coverage 100% 100% Major Coverage 50% 50% Orthodontic Coverage Not covered 50% Plan Maximums Orthodontic Treatment Not covered $1,500 lifetime Basic and Major Treatment If you were hired between January 1st - March 31st or after the 1st year of coverage $1,300 combined each calendar year Basic - Unlimited Major - $1,500 every 12 months If you were hired between April 1st - June 30th* $975 combined each calendar year Basic - Unlimited Major - $1,500 every 12 months If you were hired between July 1st - September 30th* $650 combined each calendar year Basic - Unlimited Major - $1,500 every 12 months If you were hired between October 1st - December 31st* $325 combined each calendar year Basic - Unlimited Major - $1,500 every 12 months *On the next calendar year you will have $1,300 combined each calendar year Late Applicant Restriction . - $100 for all eligible expenses for the first 12 months of coverage based on approval date, if you apply for coverage for yourself or your dependents more than 31 days after becoming eligible Covered expenses will not exceed customary charges This schedule serves as a summary only. Complete details of the benefits plan can be found in the benefits plan booklet which is governed by the contract with the insurance companies. SCHEDULE “C” PART-TIME BENEFITS SUMMARY Healthcare Covered expenses will not exceed customary charges Deductible Nil Reimbursement Level 100% In-Canada Prescription Drugs $50,000 lifetime Dispensing Fee Limit The covered expense for the dispensing fee portion of a prescription drug charge is limited to $9.99 Dentalcare Covered expenses will not exceed customary charges Payment Basis The dental fee guide in effect one year prior to the date treatment is rendered for the province in which treatment is rendered Deductibles Individual $25 each calendar year Family $50 each calendar year Reimbursement Levels Basic Coverage 80% Major Coverage 50% Plan Maximum If you were hired between January 1st – March 31st or after the 1st year of coverage $1,300 each calendar year If you were hired between April 1st – June 30th or after the 1st year of coverage $975 e...
DENTALCARE. Deductible may be applied before you are reimbursed. All expenses will be reimbursed at the level shown in the Schedule of Benefits. Benefits may be subject to plan maximums and frequency limits. Check the Schedule of Benefits for this information. The plan covers reasonable and customary charges to the extent they do not exceed the dental fee guide level shown in the schedule of Benefits. CO-INSURANCE PERCENTAGE Covered dental services will be paid at the co-insurancepercentages shown in the Schedule of Benefits.
DENTALCARE. A deductible may be applied before you are reimbursed. All expenses will be reimbursed at the level shown in the Benefit Summary. Benefits may be subject to plan maximums and frequency limits. Check the Benefit Summary for this information. The plan covers reasonable and customary charges to the extent they do not exceed the dental fee guide level shown in the Benefit Summary. Treatment Plan • Before you begin any course of dental treatment expected to cost more than $200, ask your dentist to complete a treatment plan and submit it to Great-West Life. Great-West Life will calculate the benefits payable for the proposed treatment, so you know in advance the portion of the cost you will have to pay. The calculation is valid for 90 days. Routine Treatmentoral examinations, cleaning teeth, topical application of fluoride solutions and bite- wing x-rays, twice in any calendar year but not more than once in any 5-month period • full mouth series of x-rays once every 24 months • extractions and alveolectomy at the time of tooth extraction • amalgam, silicate, acrylic and composite fillings • dental surgery • general anaesthesia and diagnostic x-ray and laboratory procedures required in relation to dental surgery • periodontal scaling and root planingnecessary treatment for relief of dental pain • cost of medication and its administration when provided by injection in the dentist's office • space maintainers for missing primary teeth and habit-breaking appliances • consultations required by the attending dentist • stainless steel crowns Major Treatment • crowns (other than stainless steel crowns) • installation of an initial appliance (bridgework or dentures) if such appliance is required because at least one additional natural tooth was necessarily extracted after the effective date of coverage for the individualreplacement of existing dentures or bridgework only when

Related to DENTALCARE

  • Dental specific medications for dental purposes, including fluoride medications (except for children less than five years of age with a non-fluorinated water supply);

  • Vision The University shall make available vision insurance to the staff members covered by this agreement to the same extent and in the same manner as is available to other University staff members, such as Faculty and the Executive, Administrative and Professional Staff members. It is the University's goal to have the same vision insurance plan(s) offered uniformly to all University staff member groups and staff members.

  • Dental Care a. Dental Care for Members over age 19 is limited to the following:

  • Orthodontics We Cover orthodontics used to help restore oral structures to health and function and to treat serious medical conditions such as: cleft palate and cleft lip; maxillary/mandibular micrognathia (underdeveloped upper or lower jaw); extreme mandibular prognathism; severe asymmetry (craniofacial anomalies); ankylosis of the temporomandibular joint; and other significant skeletal dysplasias. Procedures include but are not limited to: • Rapid Palatal Expansion (RPE); • Placement of component parts (e.g. brackets, bands); • Interceptive orthodontic treatment; • Comprehensive orthodontic treatment (during which orthodontic appliances are placed for active treatment and periodically adjusted); • Removable appliance therapy; and • Orthodontic retention (removal of appliances, construction and placement of retainers).

  • Health Care Benefits (a) Each regular full-time employee may elect coverage for himself and his eligible dependents* under one of the following health insurance plans:

  • Medical and Dental Benefits If Executive’s employment is subject to a Termination, then to the extent that Executive or any of Executive’s dependents may be covered under the terms of any medical or dental plans of the Company (or an Affiliate) for active employees immediately prior to the Termination Date, then, provided Executive is eligible for and elects coverage under the health care continuation rules of COBRA, the Company shall provide Executive and those dependents with coverage equivalent to the coverage in effect immediately prior to the Termination. For a period of twelve (12) months (18 months for a Termination during a Covered Period), Executive shall be required to pay the same amount as Executive would pay if Executive continued in employment with the Company during such period and thereafter Executive shall be responsible for the full cost of such continued coverage; provided, however, that such coverage shall be provided only to the extent that it does not result in any additional tax or other penalty being imposed on the Company (or an Affiliate) or violate any nondiscrimination requirements then applicable with respect to the applicable plans. The coverages under this Section 4(e) may be procured directly by the Company (or an Affiliate, if appropriate) apart from, and outside of the terms of the respective plans, provided that Executive and Executive’s dependents comply with all of the terms of the substitute medical or dental plans, and provided, further, that the cost to the Company and its Affiliates shall not exceed the cost for continued COBRA coverage under the Company’s (or an Affiliate’s) plans, as set forth in the immediately preceding sentence. In the event Executive or any of Executive’s dependents is or becomes eligible for coverage under the terms of any other medical and/or dental plan of a subsequent employer with plan benefits that are comparable to Company (or Affiliate) plan benefits, the Company’s and its Affiliates’ obligations under this Section 4(e) shall cease with respect to the eligible Executive and/or dependent. Executive and Executive’s dependents must notify the Company of any subsequent employment and provide information regarding medical and/or dental coverage available.

  • Medical Care The Parents must comply with the School Welfare Officer's recommendations which may include a reasonable decision to release the Pupil home or to his / her education guardian when s/he is unwell.

  • Leave for Medical and Dental Care Where it is not possible to schedule medical and/or dental appointments outside regularly scheduled working hours, reasonable time off for medical and dental appointments for employees or for dependent children shall be permitted, but where any such absence exceeds two (2) hours, the full-time absence shall be charged to the entitlement described in Clause 20.13. "Medical and/or dental appointments" include only those services covered by the B.C. Medical Services Plan, the Employer's Dental Plan, the Extended Health Benefit Plan and appointments with the Employee and Family Assistance Program.

  • Healthcare Section 1. Bargaining unit employees with one (1) year or more of service will be provided coverage for the duration of this contract through the “Full Coverage” Team Care Plan (“Team Care MM200”), which includes dental, vision, life, short term disability, medical and prescription drug benefits. Prior to January 1, 2020, bargaining unit employees with less than one (1) year of service will be provided coverage through the “Medical Only” plan. On January 1, 2020, all bargaining unit employees enrolled in the Medical Only plan shall be enrolled in the Full Coverage plan, and the Medical Only plan will eliminated. The rates for 2019 and a further description of the plan and rates are referenced

  • Dental Services The following dental services are not covered, except as described under Dental Services in Section 3: • Dental injuries incurred as a result of biting or chewing. • General dental services including, but not limited to, extractions including full mouth extractions, prostheses, braces, operative restorations, fillings, frenectomies, medical or surgical treatment of dental caries, gingivitis, gingivectomy, impactions, periodontal surgery, non-surgical treatment of temporomandibular joint dysfunctions, including appliances or restorations necessary to increase vertical dimensions or to restore the occlusion. • Panorex x-rays or dental x-rays. • Orthodontic services, even if related to a covered surgery. • Dental appliances or devices. • Preparation of the mouth for dentures and dental or oral surgeries such as, but not limited to, the following: o apicoectomy, per tooth, first root; o alveolectomy including curettage of osteitis or sequestrectomy; o alveoloplasty, each quadrant; o complete surgical removal of inaccessible impacted mandibular tooth mesial surface; o excision of feberous tuberosities; o excision of hyperplastic alveolar mucosa, each quadrant; o operculectomy excision periocoronal tissues; o removal of partially bony impacted tooth; o removal of completely bony impacted tooth, with or without unusual surgical complications; o surgical removal of partial bony impaction; o surgical removal of impacted maxillary tooth; o surgical removal of residual tooth roots; and o vestibuloplasty with skin/mucosal graft and lowering the floor of the mouth. Dialysis Services • The following dialysis services received in your home: o installing or modifying of electric power, water and sanitary disposal or charges for these services; o moving expenses for relocating the machine; o installation expenses not necessary to operate the machine; and o training in the operation of the dialysis machine when the training in the operation of the dialysis machine is billed as a separate service. • Dialysis services received in a physician’s office.

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