Benefits - Health and Welfare Plan

(Hourly)

Dental

Dental coverage provides a wide range of dental services—including routine, major, and orthodontia.

Dental benefits will not be paid for any expense that is the responsibility of a third party. Some examples would be WCB, ICBC or other insurers or individuals.

Pre-Approval of Dental Expenses
When you visit the Dentist, be sure to show him/her your Plan identity card. Before beginning your treatment, you should always discuss (with your Dentist or specialist) the services that he or she recommends and the cost of these services. The Dentist or specialist will then submit these recommended services to the insurer for pre-approval.

What is the purpose of pre-approval?
Through an eligibility check your Dentist can determine:

• whether or not you and your Dependents are covered;

• whether or not the proposed services are considered Eligible Expenses within the
  fee structure of the Plan; and

• whether or not you have reached any financial maximums or other limitations.

Eligible Dental Expenses
The following charts provide a general summary of the expenses covered by your Dental Benefit. Covered expenses are the reasonable and necessary charges for the following items when provided by a licensed Dentist.

Routine Treatment (Plan A)

Diagnostic Services:

• Examinations, consultations and other diagnostic aids (e.g., X-rays)

• 1 standard oral examination every 6 months for Dependents 16 and under; For Members and Dependents over16, 1 standard oral examination every 9 months

• 1 standard set of bite wing X-rays every 12 months for Dependents 16 and under; For Members and Dependents over 16, 1 standard set of bite wing X-rays every 18 months

• 1 complete oral exam and full mouth X-rays every 3 years

Preventive Services:

• Scaling of teeth, prophylaxis, topical fluoride application (standard oral examination schedule applies)

• Space maintainers for non-orthodontic purposes

Surgical Services:

• Extractions and other surgical procedures normally performed by a general practicing Dentist

Endodontic Services (root canals):

• Treatment of disease of the pulp chamber and pulp canal

Periodontic Services:

• Treatment of gum disease and the bones surrounding and supporting the teeth

Restorative Services:

• Fillings and stainless steel crowns

Major Restorative Services:

• Inlays, onlays, and gold foils (only when other materials cannot be used)

Prosthetic Repair Services and Relines:

• Repair of fixed appliances

• Repair or reline of removable appliances (relines covered once every 24 months)

Major Treatment (Plan B)

• Crowns (once every 5 years)

• Bridges (once every 5 years)

• Dentures (once every 5 years)

Orthodontia (Plan C)

• Orthodontia treatments must be approved in advance by the insurer

• Supplies and professional services used to bring teeth into proper alignment

Coordination of Benefits
Dental expenses recoverable under any other plan will be coordinated with payment from this Plan so that the total reimbursement will not exceed the actual cost of treatment.

Limitations and Exclusions
Dental coverage has various limitations and exclusions. Some examples of items generally excluded from coverage are:

• expenses for oral hygiene instruction;

• expenses for Dental treatment for cosmetic purposes;

• expenses for Dental treatment as a result of self-inflicted injury, committing an unlawful act, or any act of war; or

• expenses for treatment as a result of an injury or an accident for which a third party is liable.

If you plan on making a non-routine Benefit claim, we recommend that you check with the Administration Office in advance.

Termination of Benefits
Dental coverage typically terminates at the earlier of the end of the month in which you cease to be an Employee, the end of the month in which Regular Full-Time Employment ends, the day your employer ceases to participate in the Plan or the day this benefit ends. Once your coverage terminates, there may be advantages in converting your Dental coverage to an individual plan. To be eligible, you must apply within 60 days following termination. For further information, please contact the Administration Office.

FIA Disclosure

The Interior Lumbermen's Health and Welfare Plan exists for the sole purpose of providing employee life and health benefits to eligible members and their covered dependents. The Plan is not an insurance company, and the extended health, dental, weekly indemnity and long-term disability benefits provided through the Plan are not insured by an insurance company regulated under the British Columbia Financial Institutions Act or the Alberta Insurance Act  The Plan is exempt from the regulatory requirements of both these statutes.