Your Dental Coverage
Your UA Local 67 Benefits Plan pays for a wide range of dental services and procedures intended to keep you and your family healthy. Maintaining good oral health is essential for overall physical and mental well-being — beyond your teeth and gums, it can even help reduce your risk of other types of health problems such as heart disease, stroke and respiratory disorders.
Dental Plan Information
Dental Plan Provider
GreenShield
Policy Number
UAPP
Deductible
None
Dental Fee Guide
Eligible claims are reimbursed up to the prior year’s provincial fee guide.
Eligible lab, drug and other expenses are limited to a maximum of 40% of the allowable professional fee.
Annual Maximum
$1,500 for basic, basic comprehensive, major, and orthodontic services combined – per member and per dependent
Combined Dental Maximum
Many of the dental services covered in the Welfare Plan share a combined limit within each calendar year.
What’s Included
Coverage Maximum
The Combined Dental Maximum applies to:
$1,500 per calendar year (per member and per dependent) for all dental services combined.
This maximum resets each January 1.
What’s NOT Included in the Combined Dental Annual Maximum:
Removable prosthodontics (dentures) and accidental dental have their own limits, as outlined below.
Coverage Details
Basic Services
What’s Included
Coverage
Includes services such as:
- Recall visits (recall exam, preventative scaling, fluoride treatments):
- once per calendar year, or
- twice per calendar year for children age 15 and under.
- Polishing (2 time units per calendar year)
- Bitewing X-rays (2 per calendar year)
- Complete, general or comprehensive oral exams, full mouth X-rays and panoramic x-rays (once every 3 calendar years)
- Basic restorations, fillings and inlays
- Extractions and surgical services
- General anaesthesia, deep sedation, and intravenous sedation in conjunction with eligible oral surgery
100% reimbursement of eligible services up to the combined maximum
Comprehensive Basic Services
What’s Included
Coverage
Includes services such as:
- Endodontic treatment (root canals), excluding retreatments
- Periodontal treatment including scaling and/or root planing up to:
- Age 16+: 7 time units per calendar year
- Age 15 & under: 6 time units per calendar year
- Denture relining or rebasing (6 months after installation, every 2 years)
- Denture adjustments (3 months after installation)
100% reimbursement of eligible services up to the combined maximum
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Major Services
What’s Included
Coverage
Includes services such as:
- Standard dentures: complete, immediate or partial (once every 5 years)
- Standard crown restorations or onlays on natural teeth (once every 5 years)
- Repair or recementing of crowns, onlays and bridgework on natural teeth
- Standard bridges, including pontics, abutment retainers/crowns on natural teeth (once every 5 years)
50% reimbursement up to the combined maximum
Orthodontics
What’s Included
Coverage
Orthodontic treatment and appliances
100% reimbursement up to the combined maximum
Do You or Your Dependents Require Orthodontics?
Find out the expected cost and number of years the treatment is required for. Where possible, use the tips below to plan effectively and have the most reimbursed from your benefits.
- If you or your dependent will need orthodontics in the near future, they should consider having any other dental treatment (basic, comprehensive basic, or major services) done in the prior year. This way they’ll have the full $1,500 maximum available for the year they’re getting orthodontic treatment.
- Also talk to your dentist about spreading orthodontic treatment over multiple years, since the $1,500 maximum resets each January 1.
- Remember that since the orthodontic benefit has a $750 monthly installment maximum, the full $1,500 maximum cannot be reimbursed all one month.
- Also keep in mind that your Health Care Spending Account can be used for eligible dental services that exceed the plan’s maximums.
Dentures
What’s Included
Coverage
Removable prosthodontics (dentures)
$300 maximum every five calendar years
This is separate from the calendar maximum of $1,500.
Accidental Dental
As part of your Extended Health benefits, you have Accidental Dental coverage.
Accidental Dental covers treatment to sound natural teeth following an external blow to the mouth (not an object placed in the mouth). These services are reimbursed at 100% of eligible costs, and are included in the $15,000 annual maximum for Extended Health and Prescription Drugs.
Accidental Dental claims do not count toward your $1,500 annual dental maximum.
To initiate a claim for Accidental Dental coverage, your dentist will need to first complete GreenShield’s Dental Accident Report form to confirm the details of your claim (for GreenShield’s prior approval). This benefit is designed to help you maintain your oral health and well-being, providing peace of mind in the event of an unexpected dental injury.
Consult the Benefits Booklet for more information on coverage specifics.
Plan Exclusions
Your Dental Plan does NOT cover: Oral hygiene instruction, gingival curettage, splinting/ligation, medical travel for dental, cancelled appointments, treatment of muscular dysfunctions such as TMJ, or any dental procedure for cosmetic purposes (e.g. bleaching or teeth whitening).
Coverage Considerations
Predetermination
Before undergoing significant dental procedures or starting orthodontic treatment, it’s strongly recommended that you first ask your dental provider to submit an estimate (predetermination) to GreenShield, for all proposed treatment for crowns, onlays, bridges, or any expensive services. This prior approval will help you avoid unexpected out-of-pocket costs.
How Alternative Treatments Affect Your Claims
There are often different ways to treat a particular dental problem or condition, and the cost can vary widely. The plan will reimburse claims based on the least expensive service or supply that provides satisfactory results. If you and your dentist decide on a different course of treatment, you will be required to pay any cost difference out-of-pocket, which can be submitted for reimbursement from your Health Care Spending Account (HCSA).
About the Dental Fee Guide
Every year the dental association for each province or territory publishes a suggested Fee Guide for each dental procedure.
Your dental plan covers eligible costs up to the amount listed in the current published fee guide for the province where the service took place (subject to the reimbursement percentage and maximum).
However each dentist sets their own rates and fees. If your dentist charges more than the current provincial fee guide, you would pay the difference out-of-pocket, so it’s important to discuss this with your dentist before starting any service. This out-of-pocket cost could be claimed through your Health Care Spending Account.
Additional Resources
Ontario Seniors Dental Care Program (OSDCP)
OSDCP is a government-funded dental care program. It provides free, routine dental services for low-income seniors who are 65 years of age or older. Find out more information at ontario.ca.
Have Questions About Your Coverage?
Refer to your Benefits Booklet for detailed coverage, limitations, and exclusions. For any other questions, reach out to the UA Local 67 Benefits team.