D.A. Townley  -  Plan Administrators Iron Workers Union Local 97 International Association of Bridge, Structural, Ornamental and Reinforcing Iron Workers 
 

health
benefits

        
 
 
 
 
 
 
 
 
 
 
 
   
   
   
 
 
 
 
   
 
 
 
 
 
   
 

Dental

 


General
Eligible Members and their registered* dependents are entitled to the following Dental services when performed by a Dentist:

*Spouse of an Insured Person, and unmarried dependent children to age 21, unless the dependent child is attending a recognized school, college or university on a full-time basis, in which case the maximum age will be 25. A child is not a dependent if he/she is eligible for or entitled to benefits under this Plan as a Member.

 

 
PLAN A - Basic Services
The following services are eligible for reimbursement on the lesser of 90% of the amount charged or 90% of the current B.C. College of Dental Surgeons’ Fee Guide.

  1. Diagnostic Services:
    All necessary procedures to assist the Dentist in evaluating the existing conditions to determine the required dental treatment, including: 
    Recall oral examinations (one during any period of 6 consecutive months for dependent children under the age of 19, one during any period of 9 consecutive months for adults). 
    Complete oral examination only once every 3 years. 
    Consultations 
    X-rays (complete mouth X-ray will be covered only once in a 3-year period).
  2. Preventive Services:
    All necessary procedures to prevent the occurrence of oral disease, including:
    Scaling and root planing, 16 units per calendar year
    Topical application of fluoride (one during any period of 6 consecutive months for dependent children under the age of 19, one during any period of 9 consecutive months for adults).
    Fixed space maintainers
  3. Surgical Services:
    All necessary procedures for extractions and other surgical procedures normally performed by a Dentist.
  4. Restorative Services:
    All necessary procedures for filling teeth with amalgam, synthetic porcelain, or plastic; and stainless steel crowns. Gold will be provided as a filling material only when teeth cannot be restored with the above filling materials.
  5. Prosthetic Repairs:
    All necessary procedures required to repair or reline fixed or removable appliances.
  6. Endodontia: (Root Canals)
    All necessary procedures required for pulpal therapy and root canal filling. Root canal therapy for permanent teeth will be limited to one course of treatment per tooth. Repeat treatment is covered only if the original treatment fails after the first 18 months.
  7. All necessary procedures for the treatment of tissues supporting the teeth.
  8. General anaesthesia required in relation to oral surgery.

 


PLAN B - Prosthetic Appliances and Crown and Bridge Procedures
The cost of the following items will be eligible for reimbursement on the lesser of 50% of the amount charged or 50% of the B.C. College of Dental Surgeons’ Fee Guide:

  1. Crowns and Bridges;
  2. Partial and/or complete dentures but not more often than once in two years. 
    Dentures lost, broken or stolen will not be replaced. 
    Charges made by a licensed Denturist will be recognized for payment, in accordance with a separate Schedule of Allowances.
  3. Replacement: When a crown or bridge has been paid for under this Plan, replacement will not be paid for in less than 5 years from the previous date of service.
A maximum payment of $2,700.00 per calendar year per individual family member is available for Basic services and Prosthetic Appliances and Crown and Bridge procedures combined.


 


PLAN C - Orthodontics
50% will be paid by the Plan and 50% by the Member covered for dependent children to their 19th birthday. Payment of claims to be paid on the basis of eligibility and work completed. 

Appliances lost, broken or stolen will not be replaced. 

The maximum lifetime benefit for Orthodontic treatment will be $4,000.00 per patient.

 


Emergency Dental Care Anywhere in the World 
In an EMERGENCY if you require Dental Care while you are traveling or on vacation outside of British Columbia you are entitled to the services of a duly qualified Dentist and will be reimbursed up to the amount that would have been paid had the service been rendered in British Columbia.

 


Exclusions

  1. Treatment of congenital malformations.
  2. Cosmetic Surgery or dentistry for purely cosmetic reasons.
  3. Services for treatment of endodontia and periodontia in process at the effective date of your coverage.
  4. Charges for broken appointment.
  5. Services which are paid for by the Medical Services Plan of British Columbia, Workers’ Compensation Board or any tax supported agency.
  6. Charges for any treatment where it is established that a third party is liable at law to make payment.
  7. Replacement of an existing denture which, in the opinion of the Attending Dentist, is or can be made satisfactory.
  8. Charges in excess of the College of Dental Surgeons of British Columbia Fee Guide.
  9. Orthodontia, (straightening of teeth, etc.) except for dependent children to their 19th birthday.

 


How a Claim is Made

  1. On the first visit to the Dentist advise the receptionist that a completed dental claim form will be required.
  2. Submit the completed form to the Administration Office within 90 days of incurring expense along with the Dentist’s bill or receipt. Please ensure that the Member's name, address, Social Insurance Number and Local Union are clearly shown.
  3. If the dentist's bill was paid in full then the cheque issued will be payable to the Member. If the dentist's bill was not paid, then the cheque will be payable to the Dentist and mailed to him. The Member will be responsible for the difference between the Dentist’s charge and the amount paid by the Plan.



Form Links
Dental Claim Form
 

related Links
Filing a Dental Claim
Printable Version of the Health & Welfare Plan Booklet

 
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