Effective April 1, 2019, OHIP+ will no longer provide drug coverage for individuals under the age of 25 who have access to private insurance. Therefore, prescription drug claims for children and youth 24 years of age and younger with private plan coverage will have to be submitted directly to their private plan. Click here for details!

Dental Care Benefits

Percentage Payable

The percentage payable is the maximum percentage of your costs that the plan will reimburse you, for you and your dependents’ Covered Expenses, after any deductible is satisfied. 

Deductible

The deductible is the amount of Covered Expenses which you must pay each calendar year before benefits are payable under this plan.   

Calendar Year Maximum

The Calendar Year Maximum is the maximum amount the plan will allow any one individual for Dental benefits in a single calendar year.

Lifetime Maximum

The Lifetime Maximum is the maximum amount allowed for any one individual for Dental benefits in their lifetime. 

Free Choice of Dentist

You may choose any licensed dentist or licensed denturist practicing within the scope of his or her profession.

What the Insurance Covers

The dental benefits described in this section apply to both the member and their eligible dependents.  The insurance covers work included in a comprehensive list of dental expenses, which appears later.  Many dental conditions can properly be treated in more than one way.  This Plan is designed to help pay your dental expenses but not on the basis of treatment that is more expensive than necessary for good dental care.  Thus, if a condition is being treated for which two or more services included in the list are suitable under customary dental practices, the benefit under the Plan will be based on the least expensive of the services.
The final choice of treatment is always between the patient and the dentist. You are financially responsible to your dentist for the cost of dental work performed. This plan will reimburse you to the limits described herein.

If a dental service is performed that isn't in the list, but the list contains one or more other services that under customary dental practices are suitable for the condition being treated, then for the purpose of the Plan, the least expensive of the suitable services listed will be considered to have been performed.  See "Charges Not Eligible for Dental Insurance" later in this section of the website for additional exclusions.

Pre-Determination of Benefits

Pre-determination of benefits permits the review of the proposed treatment in advance and allows for a solution of any questions before, rather than after, the work has been done.  Additionally, both you and the dentist will know in advance what the Plan will allow assuming you, or the dependent, remain covered.

A “Treatment Plan” is strongly recommended when dental work is expected to exceed $500.

A "Treatment Plan" is the dentist's report that (a) itemizes the dentist's recommended services, (b) shows the dentist's charge for each service, and (c) is accompanied by supporting X-rays, or a letter of expertise.

The "Treatment Plan" will be returned to the dentist showing the estimated benefits

Termination of Benefits

No benefits for Covered Dental Expenses will be paid for expenses incurred after the policy terminates, or after the individual’s coverage terminates.

The following exceptions apply only if the treatments specified are covered under this policy and there is no replacement dental insurance coverage after such termination:

  1. Where an impression for a denture, bridge or crown was taken or root canal therapy was started prior to the termination of insurance, dental expense in connection with these procedures and incurred within 30 days of termination will be considered as incurred prior to termination.
  2. Where Orthodontic Treatment has commenced and a treatment plan has been submitted in advance to the Insurer, dental expenses in connection with such treatment and incurred within 30 days of termination will be considered as incurred prior to termination.

Claim Forms

Brochures:

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Teamster Local Union 230 Members' Benefit Fund c/o Benefit Plan Administrators
90 Burnhamthorpe Road West, Suite 300 Mississauga, Ontario L5B 3C3