DENTAL BENEFITS
Dental Benefits includes Plans B, C, and D, for eligible members and dependents enrolled.
Plan 'B' - Basic Benefits
Calculated at 90% of the prevailing Fee Guide as set out by the Dental Association for General Practitioners in the province or your residence, excluding the Northern Manitoba Fee Guide, for the following:
1.Diagnostic
All necessary procedures to assist the Dentist in evaluating the existing conditions to determine the required dental treatment including:
• Complete examination once every 3 calendar years (Normally for new patients).
• Recall or oral examinations; twice in each calendar year.
• Periapical X-rays.
• Full mouth or panorex X-rays once each two calendar years.
2. Preventive
•1 ½ unit of polishing twice in each calendar year.
• Topical application of fluoride up to two applications in each calendar year.
• Space maintainers (except when used for orthodontic purposes).
3. Extractions
• Uncomplicated procedures for the removal of teeth that are beyond restoration.
4. Restorative
• Fillings made of amalgams, silicates, plastics and synthetic porcelains.
• Repair of damaged dentures. Adding teeth to existing dentures. Relining or rebasing the dentures is limited to once every three years.
5. Endodontics
The usual procedures required for pulpal therapy and root canal filling.
6. Periodontal
The usual procedures for the treatment of the diseases of the tissues and bones supporting the teeth, including scaling.
7. Accidental Injury
Major dental services as a result of an accident up to a maximum of: $1,000 per year, per contract.
8. Consultations
Consultations required by attending Dentist, there is no benefit maximum for this coverage.
Plan 'C' - Major Services
Calculated at 70% of the prevailing Fee Guide for General Practitioners as set out by the Dental Association in the province of your residence, excluding the Northern Manitoba Fee Guide, for the following:
($1,500 maximum per patient per calendar year)
1. Oral Surgery
Complicated surgical procedures performed in the Dentist's office including post-operative care.
2. Extensive restorations
• Inlays and onlays (one per tooth every five (5) calendar years).
• Jackets, crowns, and bridges to rebuild and replace missing teeth (only one procedure per tooth every five calendar years).
Please refer to "Exclusions and Limitations".
3. Anesthesia
General anesthesia of nitrous oxide analgesia administered in the Dentist's office.
4. Prosthetic
Partial or complete upper and lower dentures provided by a Dentist or licensed Denturist. Each procedure limited to once every five calendar years. Allowances include all adjustments.
Plan 'D' - Orthodontics
Calculated at 50% of the prevailing Fee Guide for General Practitioners as set out by the Dental Association in the province of your residence, excluding the Northern Manitoba Fee Guide, for the following:
This benefit is provided for member's dependents only, and treatments must commence prior to their 17th birthday.
• $2,000 Lifetime Maximum..
Orthodontic services normally specify an initial fee, and monthly or quarterly fees for on-going treatment. You will receive reimbursement towards the initial fee, and on-going services as they are requested. You will not be reimbursed in advance for Orthodontic services not yet received.
Pre-Treatment Authorization
The pre-treatment authorization requirement has been established primarily to protect you by having possible misunderstanding resolved before expensive dental work is carried out.
If the cost of all treatments planned is expected to exceed $500, Manitoba Blue Cross must approve the work in advance. After listing the work planned, your Dentist will submit your claim form, with supporting x-rays, directly to Manitoba Blue Cross. A notice of assessment will be issued to you and your Dentist.
Importance of the Fee Guide
Benefits paid by the plan are based on a specific dental fee guide established by your provincial dental association. While they are not required to do so, the majority of Dentists charge according to the rates set out in the fee guide.
When going to a Dentist for the first time, it is suggested you inquire about how they set the rates before any work is carried out. If the Dentist charges more than the fee guide, you will be responsible for the excess. In no event will the plan pay more than the Dentist's actual charge.
Exclusions and Limitations
Manitoba Blue Cross will not pay for the following:
• Services purely cosmetic in nature , or for cosmetic purposes.
• Congenital malformations; i.e. cleft palate prosthesis.
• Fees arising out of extra services arranged for privately between the patient and the Dentist.
• Oral hygiene instruction and plaque control program.
• Charges for appliances which have been lost or stolen
• Gold, crown, fixed bridge, veneers or other extensive treatment when another material or procedure would have been a reasonable substitute consistent with generally accepted dental practice. Where a reasonable substitute was possible, the covered expense would be that of the customary substitute.
• Separate charges for general anesthesia except in conjunction with office procedures as specified in your plan.
• Bleaching of teeth.
• Root canal on a permanent tooth more than once per lifetime per tooth.
• Snoring or sleep apnea appliances
• Diagnostic photographs.
• Precision attachments.
• Hypnosis and dental psychotherapy
• Provision for facilities in connection with general anesthesia.
• Polishing restorations.
• Any procedure in connection with forensic dental.
• Services related to the treatment of Temporo-Mandibular Joint Dysfunction.
• Dental Implants.
• Charges for completing claim forms or missed appointments.
• Services covered or provided through WCB legislation, any government agency or a liable third party.
• Charges for services provided prior to the effective date of coverage.
Method of Obtaining Treatment
Present your Manitoba Blue Cross Identification card at your visit, which provides your Group and Contract numbers for claiming benefits.
Upon completion of treatment, be sure to sign the form to verify that you have received the indicated treatment, and whether benefits are to be assigned to the Dentist or yourself.
Treatment Received Outside your Province of Residence
Should you find it necessary to obtain treatment from a Dentist practicing outside the province of your residence, the Plan will reimburse on the basis of the Fee Schedule effective in the Province in which the work was rendered. Presentation of proof of treatment and a list of the services received must be made to the Plan's Administration office.
Any changes to the Schedule of Dental Benefits (Fee Guide); will be reported to the Plan's Administration office.
Prairie Teamsters Administration Services Ltd.
209, 7260 - 12 St SE Calgary, Alberta T2H 2S5
Telephone 403-252-6924 - Toll Free1-877-817-7526 - Fax 403-253-3231