CUPE 2278

Dental Benefits for CUPE 2278 Employees

The UBC Dental Care plan provides coverage for a wide range of dental services, from your regular check-ups to major procedures such as root canals and crowns. These procedures may be provided by a licensed Dentist, Denturist, Dental Hygienist and Anaesthetist.

Dental Plan Premiums Group Number: 25205 You Pay UBC Pays Single — $50.28 Single plus dependant — $95.16 Family — $156.00

Rates are effective Jan. 1, 2013

Important note: This is only a brief overview of the plan. For complete details, refer to the Sun Life benefits booklet.

When coverage begins: the first of the month on or after your date of hire, or the first of the month on or after your application is received by Financial Services, if you did not enroll when you first became eligible.

When coverage ends: your coverage ends on the earliest of the following dates:

1) the date you elect to voluntarily cancel your coverage;

2) the last day of the month in which your employment ends or you choose to retire, if the date the employment status changed is between the 1st and the 15th of the month;

3) the last day of the month following the month in which your employment ends or you choose to retire, if the date the employment status changed is between the 16th and the last day of the month;

4) the Dec. 31st coincident with or following the date you turn age 71, if you are still working.

Lifetime Maximum: The maximum amount paid for orthodontic procedures in a person’s lifetime is $3,000. There is no maximum amount for Preventative, Basic and Major Restorative procedures.

Deductible: There is no deductible for this coverage.

Who Qualifies As Your Dependent:

Your dependent must be your spouse or your child and a resident of Canada or the United States.

• Your spouse by marriage or under any other formal union recognized by law, or your partner of the opposite sex or of the same sex who is publicly represented as your spouse.  You can cover only one spouse at a time.
• Your children, your spouse’s children (other than foster children), or children for whom you or your spouse is the primary caregiver and granted custody and control, if they are not married or in any other formal union recognized by law, and are under age 19.
• Your children, your spouse’s children (other than foster children), or children for whom you or your spouse is the primary caregiver and granted custody and control, if they are full-time students attending an educational institution recognized under the Income Tax Act (Canada) and entirely dependent on you for financial support, up to age 25.
• Your children, your spouse’s children (other than foster children), or children for whom you or your spouse is the primary caregiver and granted custody and control, if they become incapable of financial self-support because of a physical or mental disability. There is no age limit as long as your child is diagnosed with a disability before age 25 and entirely dependent on you for financial support and not married or in any other formal union recognized by law.

If you require proof that your dependent is covered under the UBC Dental Care Plan, please email us at benefitsinfo@hr.ubc.ca.

Disclaimer: This outline is a descriptive outline of the plan only; it is not a contract. All terms and conditions are governed by Contract Number 25205 with Sun Life Assurance Company of Canada. In the event of a discrepancy, benefits will be paid according to the official document and applicable legislation.

Reimbursement Level for Eligible Expenses

You will be reimbursed at the following levels. For orthodontic procedures, you will be reimbursed up to your lifetime maximum:

Preventative Procedures: 100%

Basic Procedures: 100%

Major Procedures: 70%

Orthodontic Procedures: 65%

Your reimbursement will be based on these percentage levels and the fee stated in the Dental Association Fee Guide, which is current at the time of the treatment.  If services are provided by a dental specialist, then the fee guide that will be used is the Dental Association Fee Guide, plus 10%.

If your Dental Care benefit ends, you will still be covered for procedures to repair natural teeth damaged in an accident if the accident occurred while you were covered, and the procedure is performed within six months after the date of the accident.

A. Preventative Procedures (100%)

What the Plan Covers

The plan will cover a wide range of procedures that a dentist performs regularly to help maintain good dental health. Some examples of these procedures include: complete oral examinations, x-rays, polishing and fluoride treatments, diagnostic models, and removing impacted teeth.

B. Basic Procedures (100%)

What the Plan Covers

Procedures to treat basic dental problems are also covered under the Plan. These include: fillings, tooth extraction, basic restorations such as temporary stainless steel crowns*, root canals, periodontics and oral surgery.

*Please note that permanent crowns are covered under Major Procedures.

C. Major Procedures (70%)

What the Plan Covers

In addition to preventative and basic procedures, treatment of some major dental conditions is also covered. For example: permanent crowns, inlays or onlays, and prosthodontics such as bridges or dentures.

D. Orthodontic Procedures (65%)

What the Plan Covers

The dental benefits plan includes procedures used to treat misaligned or crooked teeth; such as diagnostic services and appliances such as braces.

What the Plan Does Not Cover

The Dental Plan will not cover all expenses related to your dental care. Some of the things excluded from coverage under the Plan are: procedures primarily to improve appearance, replacing lost or stolen dental appliances, charges for completing forms, supplies intended for sport or home use, or experimental treatments.

Alternate Treatment Plan

When Sun Life is deciding to pay for a dental procedure, they will investigate if there is a viable alternate procedure. If the alternate procedure will result in an equivalent level of success, then payment will be made for the less expensive procedure. Sun Life will pay only the amount for the least expensive alternate procedure.

If you receive any temporary dental service, these costs will be included as part of the final dental procedure, and not as a separate procedure. That is, the fee for the permanent procedure will be used to determine the usual and reasonable charge for the dental work.

Claims

For more information on how to submit a UBC Dental Care claim, visit the Claims section of the UBC Benefits website.