Retirees Dental Plan Details

Plan details for the first 12 months of services

Plan details after the first 12 months of services


Plan Details For The First 12 Months of Services

Services shown below will be eligible if they are usual, reasonable and customary, and are medically necessary for the treatment of an illness or injury.

Reimbursement will be made by one of the following methods:
a) Direct deposit to your personal bank account, when requested;
b) A reimbursement cheque; or
c) Direct payment to the provider of services, when applicable.

DENTAL

  • You have no deductible ($ Nil).
  • Your overall Dental maximum is unlimited.
  • Your co-insurance is 70% for Basic Services, 70% for Comprehensive Basic Services.
  • Basic Services cover: recalls 1 every 9 months, other exams and full mouth x-rays once every 3 years.
  • Comprehensive Basic covers denture relines 1 every 3 years.
  • Applicable lab, drug and other expenses are eligible to a maximum of 40% of the professional fee.
  • Your eligible claims are reimbursed at the level stated above and in accordance with the Current Provincial Dental Association Fee Guide for General Practitioners.

BASIC SERVICES

  • Recalls include exams, bitewing x-rays, cleanings and fluoride treatments.
  • Complete, general or comprehensive oral exams, full mouth x-rays and panoramic x-rays.
  • Basic restorations including fillings and inlays.
  • Extractions and surgical services including general anesthetics and intravenous sedation.

COMPREHENSIVE BASIC SERVICES

  • Endodontic treatment including root canal therapy.
  • Periodontal treatment including scaling and/or root planing.
  • Standard denture services including relining and rebasing of dentures plus denture adjustments after 3 months from installation.

General Information

LIMITED BENEFIT CLAUSE
Green Shield will determine the amount of benefits payable, giving consideration to limited procedures, services or courses of treatment that may be performed to accomplish the desired result. The attending physician/dentist and the patient have the option of which procedure to use, although payment for the procedure may be based on the "limited treatment" principle. The Limited Benefit Clause is a financial limitation and not intended as a comment regarding any treatment recommended or preformed by a physician/dentist.

PREDETERMINATION
If the cost of any proposed treatment is expected to exceed $300.00, submit to Green Shield a detailed treatment plan from your provider before your treatment begins. If a description of the procedures to be performed and an estimate of the charges are not submitted in advance, Green Shield reserves the right to make a determination of benefits payable, taking into account alternate procedures, services or course of treatment, based on accepted standards of medical/dental practice.

GENERAL OVERALL EXCLUSIONS
Eligible Services do not include and reimbursement will not be made when we are aware of or have been apprised of:

1. Services or supplies received as a result of disease, illness or injury due to any of:

  • intentionally self-inflicted injury while sane or insane
  • an act of war, declared or undeclared
  • participation in a riot or civil commotion
  • committing a criminal offence

2. Failure to keep a scheduled appointment with a licensed medical/dental practitioner.

3. Services or supplies which are cosmetic in nature.

4. The completion of any claim forms and/or insurance reports.

5. Services or supplies which do not meet accepted standards of medical/dental/opthalmic practice, including charges for services or supplies which are experimental in nature.

6. Services or supplies normally paid through any provincial government health plan, Workers' compensation Board, the Assistive Devices Program or any other Government Agency, or which would have been payable under such a plan had proper application for benefits been made, or had proper and timely claims submission been made.

7. Services or supplies from any governmental agency which are obtained without cost by compliance with laws or regulations enacted by a federal, provincial, municipal or other governmental body.

8. Services or supplies which are not recommended or approved by the attending physician/dentist.

9. Services or supplies that you are not obligated to pay for or for which no charge would be made in the absence of benefits.

10. Services or supplies which are legally prohibited by the government.

11. The replacement of lost, missing or stolen items, or items which are damaged due to negligence.

12. Services or supplies which arise out of an automobile accident, and you are entitled to benefits under the no fault benefit schedule of your automobile insurance policy, or under an applicable Insurance Act.


CO-ORDINATION OF BENEFITS (COB)
Where you or your dependants have benefits with more than one carrier, claims shall be coordinated so that reimbursement from all services shall not exceed 100% of the actual claim. Ask for our COB brochure for information on how your family can receive this service

SUBROGATION
Green Shield retains the right to subrogation if benefits have or should have been paid or provided by a third party. In cases of third party liability, you must advise your lawyer of these rights.

GROUP CONVERSION PACKAGE
If your group service terminates, you are eligible to continue benefits on an individual basis. You must apply within 60 days after the date your group benefits have been terminated.

ADDITIONAL BENEFITS
As a Green Shield plan member, you have access to our national preferred provider vision network arrangement where all Green Shield plan members are eligible to receive a discount on eyewear and laser eye surgery.

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Plan Details After The First 12 Months of Services

Services shown below will be eligible if they are usual, reasonable and customary, and are medically necessary for the treatment of an illness or injury.

Reimbursement will be made by one of the following methods:
a) Direct deposit to your personal bank account, when requested;
b) A reimbursement cheque; or
c) Direct payment to the provider of services, when applicable.

DENTAL

  • You have no deductible ($ Nil).
  • Your overall Dental maximum is unlimited.
  • Your co-insurance is 80% for Basic Services, 80% for Comprehensive Basic Services, 50% for Major Restorative Services.
  • Basic Services cover: recalls 1 every 9 months, other exams and full mouth x-rays once every 3 years.
  • Comprehensive Basic covers denture relines 1 every 3 years.
  • Major Restorative Services cover dentures, crowns and bridges once every 5 years and to a maximum of $600.00 per person per year based on effective date of the subscriber.
  • Applicable lab, drug and other expenses are eligible to a maximum of 40% of the professional fee.
  • Your eligible claims are reimbursed at the level stated above and in accordance with the Current Provincial Dental Association Fee Guide for General Practitioners.

BASIC SERVICES

  • Recalls include exams, bitewing x-rays, cleanings and fluoride treatments.
  • Complete, general or comprehensive oral exams, full mouth x-rays and panoramic x-rays.
  • Basic restorations including fillings and inlays.
  • Extractions and surgical services including general anesthetics and intravenous sedation.

COMPREHENSIVE BASIC SERVICES

  • Endodontic treatment including root canal therapy.
  • Periodontal treatment including scaling and/or root planing.
  • Standard denture services including relining and rebasing of dentures plus denture adjustments after 3 months from installation.

MAJOR RESTORATIVE SERVICES

  • Dentures, complete, immediate, transitional and partial.
  • Crown restorations or onlays on natural teeth.
  • Repair or recementing of crowns, onlays and bridgework on natural teeth.
  • Bridges, including pontics, abutment retainers/crowns on natural teeth once every 5 years for the same tooth.

General Information

LIMITED BENEFIT CLAUSE
Green Shield will determine the amount of benefits payable, giving consideration to limited procedures, services or courses of treatment that may be performed to accomplish the desired result. The attending physician/dentist and the patient have the option of which procedure to use, although payment for the procedure may be based on the "limited treatment" principle. The Limited Benefit Clause is a financial limitation and not intended as a comment regarding any treatment recommended or preformed by a physician/dentist.

PREDETERMINATION
If the cost of any proposed treatment is expected to exceed $300.00, submit to Green Shield a detailed treatment plan from your provider before your treatment begins. If a description of the procedures to be performed and an estimate of the charges are not submitted in advance, Green Shield reserves the right to make a determination of benefits payable, taking into account alternate procedures, services or course of treatment, based on accepted standards of medical/dental practice.

GENERAL OVERALL EXCLUSIONS
Eligible Services do not include and reimbursement will not be made when we are aware of or have been apprised of:

1. Services or supplies received as a result of disease, illness or injury due to any of:

  • intentionally self-inflicted injury while sane or insane
  • an act of war, declared or undeclared
  • participation in a riot or civil commotion
  • committing a criminal offence

2. Failure to keep a scheduled appointment with a licensed medical/dental practitioner.

3. Services or supplies which are cosmetic in nature.

4. The completion of any claim forms and/or insurance reports

5. Services or supplies which do not meet accepted standards of medical/dental/opthalmic practice, including charges for services or supplies which are experimental in nature.

6. Services or supplies normally paid through any provincial government health plan, Workers' compensation Board, the Assistive Devices Program or any other Government Agency, or which would have been payable under such a plan had proper application for benefits been made, or had proper and timely claims submission been made.

7. Services or supplies from any governmental agency which are obtained without cost by compliance with laws or regulations enacted by a federal, provincial, municipal or other governmental body.

8. Services or supplies which are not recommended or approved by the attending physician/dentist.

9. Services or supplies that you are not obligated to pay for or for which no charge would be made in the absence of benefits.

10. Services or supplies which are legally prohibited by the government.

11. The replacement of lost, missing or stolen items, or items which are damaged due to negligence.

12. Services or supplies which arise out of an automobile accident, and you are entitled to benefits under the no fault benefit schedule of your automobile insurance policy, or under an applicable Insurance Act.


CO-ORDINATION OF BENEFITS (COB)
Where you or your dependants have benefits with more than one carrier, claims shall be co-ordinated so that reimbursement from all services shall not exceed 100% of the actual claim. Ask for our COB brochure for information on how your family can receive this service

SUBROGATION
Green Shield retains the right to subrogation if benefits have or should have been paid or provided by a third party. In cases of third party liability, you must advise your lawyer of these rights.

GROUP CONVERSION PACKAGE
If your group service terminates, you are eligible to continue benefits on an individual basis. You must apply within 60 days after the date your group benefits have been terminated.

ADDITIONAL BENEFITS
As a Green Shield plan member, you have access to our national preferred provider vision network arrangement where all Green Shield plan members are eligible to receive a discount on eyewear and laser eye surgery.

Back to top

E. & O. E.