United Food & Commercial Workers Union Local 1518 Dental Division

If you have a question about your dental plan call: 1.888.818.3368

The United Food & Commercial Workers Union Local 1518 Dental Division helps cover the cost of dental care for you and your dependents. On your first visit, tell your dentist you are a member of the UFCW 1518 Dental Division (covered by Multi-Employer Benefits Services (MEBS)). The UFCW 1518 Dental Division is a result of Collective Bargaining between the United Food and Commercial Workers’ Union Local 1518 and your employer. The cost of this Dental Division is paid by your employer as a result of negotiations between the union and your employer.

The majority of UFCW Local 1518 members are covered by Collective Agreements requiring participation in the Dental Division. These include members employed in retail food and drugstores as well as many in warehousing and manufacturing operations, department stores and co-operatives. The UFCW Local 1518 Dental Division is a division under the UFCW Health and Welfare plan.

The Trustees of the Dental Division have selected Bilsland Griffith Benefit Administrators (BG) to act as the Administrator to look after the payment of dental benefits. Please read this booklet carefully. It contains valuable information on eligibility rules and what dental expenses are covered by this Dental Division.

Eligibility

Under the terms of the UFCW Local 1518 Dental Division, you become eligible for dental coverage once you meet the following requirements:

· complete and sign a Dental Division enrolment card and forward it to the Dental Division Administrator; AND

· accumulate at least 1,000 credited hours; AND

· accumulate and maintain at least 240 credited hours in three consecutive months.

Credited hours are the hours reported to the Dental Division Administrator by your employer. These include straight-time hours worked and work hours lost while on:

· maternity leave (maximum 17 weeks)

· parental leave (maximum 35 weeks)

· WorkSafeBC Wage loss benefits

· group weekly indemnity (WI) benefits.

To receive credited hours for Employment Insurance (EI) disability benefits (15 weeks maximum), you must provide proof of your EI claim to the Division Administrator.

YOU DO NOT RECEIVE CREDITED HOURS FOR LOST HOURS WHILE ON LONG TERM DISABILITY (LTD).

Identification Card

When you first become eligible under the Dental Division, your enrollment card will be forwarded to MEBS by the Dental Division Administrator. MEBS will issue you an identification card indicating your effective date of coverage and listing your eligible dependents.

Please check this card carefully when you receive it to make sure your eligible dependents are listed correctly.

Please note: You will be issued an I.D. card when you first become eligible and subsequent to that only when your dependent status changes. Your eligibility for coverage is in accordance with the eligibility rules of the Dental Division. Please ensure that your complete address is on the enrollment or change card so that an I.D. card can be mailed to you.

Eligible Dependents

Your dependents are:

· Your legal spouse; or

· A person who lives with you in a common-law relationship (including same-sex couples) and whom you have publicly represented as your spouse for at least one year. Only one common-law spouse will be accepted as a dependent in any 12-month period.

· Your unmarried dependent children under the age of 19, or under the age of 25 if in full-time attendance at a school or university recognized by MEBS

· Your unmarried mentally or physically handicapped dependent children over the age of 19 who are dependent on you and are living with you or your spouse.

Definition of Child

Any child who is living with you or your spouse and is mainly dependent upon you for maintenance and support and is:

· your natural child;

· your adopted child;

· your step-child;

· a child to whom you are a legal guardian; or

· a child of your common-law spouse.

A child may also include one for whom you are responsible to continue dental coverage pursuant to a court order or separation agreement.

Please note: You must be prepared to prove that persons claimed as dependents are actually dependent on you.

When Coverage Begins

After you accumulate 1000 credited hours and accumulate and maintain at least 240 credited hours in three consecutive months, you are entitled to dental coverage for basic and major services for two months after a one-month waiting period.

The one-month waiting period is required because credited hours are reported one month after they have been worked or earned.

As you earn credited hours, they are applied towards satisfying both the 1000-hour requirement and the 240-hour requirement at the same time.

The two-month coverage period continues as long as you continue to earn at least 240 credited hours in the three consecutive months preceding the one-month waiting period.

For example, assuming you have already accumulated the required 1000 credited hours, if you earn at least 240 hours in January, February and March, you are entitled to dental coverage in May and June, following the one-month waiting period (April).

The following table illustrates eligibility and the months of coverage:


If you meet the 1,000 credited hours and the 240 credited hours requirement in the months of:



Then you are covered for the two-month period of:


Jan Feb Mar May Jun
Feb Mar Apr Jun Jul
Mar Apr May Jul Aug
Apr May Jun Aug Sept
May Jun Jul Sept Oct
Jun Jul Aug Oct Nov
Jul Aug Sept Nov Dec
Aug Sep Oct Dec Jan
Sept Oct Nov Jan Feb
Oct Nov Dec Feb Mar
Nov Dec Jan Mar April
Dec Jan Feb Apr May

To be eligible for Orthodontic coverage, you or your dependent must be currently eligible for dental benefits and have been eligible for dental benefits for a minimum of 12 months in the 30 months prior to the date the orthodontic service is rendered.

Please note: If you have no credited hours for a period of 12 consecutive months, you must qualify for eligibility again (1,000/240 credited hours), unless you were receiving long-term disability benefits, in which case the 1,000 credited hour requirement will be waived once you return to work.

When Coverage Ends

Your dental coverage will end when you fail to meet the 240 credited hour test and shall occur on the last day of the month for which you had earned coverage.

If a common-law relationship ends, you must report the change in status immediately to the Dental Division Administrator. Coverage for your common-law spouse and common-law dependents will end on the last day of the month in which the relationship ended.

Coverage for your unmarried dependent children will end on the last day of the month of your dependent’s 19th birthday, unless he or she is in full-time attendance at a school or university and a written application for continued coverage is received by MEBS. Applications for continued coverage under the educational provision must be completed annually until the dependent reaches age 25 or is no longer a full-time student.

You do NOT receive notification if your coverage ends. Before making a dental appointment, please check your dental eligibility with the Dental Division Administrator at 1-888-818-3368.

Special Extensions of Dental Benefits

If your coverage ended because you failed to meet the eligibility requirements, the Dental Division will continue to provide dental services for 60 days if you (or your dependents) received a dental examination or started treatment for such services within the three-month period prior to the date your coverage ended.

Coverage for orthodontics will be continued for a maximum of 12 consecutive months from the date you were eligible for the first orthodontic payment.

Transfer Coverage From Another Plan

If you had coverage under another dental plan provided by an employer who is contributing or who is eligible to contribute to the Dental Division, you and your dependents will be entitled to basic and major dental coverage for a period of four months from the date of transfer.

The 1,000 credited hours requirement will be waived and any dental expenses paid by the Dental Division during the initial four months will be reduced by any amount paid or payable under the previous plan. In the fifth month and thereafter, the 240 credited hours test will apply in determining your eligibility.

Similarly, you will be eligible for orthodontic coverage if you were eligible for orthodontic coverage under the previous plan. Any qualifying period under the previous plan will be counted in determining eligibility for orthodontic coverage under the Dental Division. Benefits paid by the previous plan will be deducted from the lifetime maximum benefits payable by the Dental Division.

Adding and Deleting Dependents

To add or delete a dependent, you must complete and sign a change of coverage card, available from your employer or the Dental Division Administrator. New dependents should be added immediately. Please send the completed card to the Dental Division Administrator.

Please note: If you do not advise the Dental Division Administrator of the date that a dependent no longer qualifies for coverage and if claims for that dependent are subsequently paid, it will be your responsibility to reimburse the plan for such amounts paid

Basic Restorative and Preventive Services

The Dental Division will pay 90% of basic restorative and preventive services.

Diagnostic Services 
The basic procedures necessary to help the dentist evaluate existing conditions and determine the required dental treatment:

· Oral examinations – two per year.

· A complete oral examination once in any three calendar year period but not within six months of the last examination.

· X-rays including a Full Series up to the maximum established by MEBS for the calendar year. Full Series are limited to once in any three calendar year period.

· Consultations by a dentist other than the practitioner providing treatment.

Preventive Services
The basic procedures necessary to prevent oral disease, including:

· Prophylaxis and topical application of fluoride – 2 per year.

· Scaling.

· Band and loop space maintainers – to maintain space

Surgical Services
The basic procedures necessary for extractions and other basic surgical procedures normally performed by a dentist.

Restorative Services 
The basic procedures necessary for fillings: amalgam, silicate, plastics and synthetic porcelain, as well as stainless steel crowns. Inlays, onlays and gold foils will be covered only when other materials cannot be used satisfactorily. Patients choosing gold where other materials would suffice will be responsible for the difference in cost. X-rays and study models may be required by MEBS before treatment begins.

Prosthetic Repairs 
The basic procedures required to repair or reline fixed or removable appliances. Repairs to complete upper and/or lower dentures may be performed by either a licensed dentist or a duly licensed dental mechanic.

Enddontics 
The basic procedures necessary for pulpal therapy and root canal filling.

Periodontics 
The basic procedures necessary for the treatment of diseases of the tissues and the bone surrounding and supporting the teeth.

 Major Services

The Dental Division will pay

75% of the Dental Fee Schedule for crowns and/or bridges.

90% of the Dental Fee Schedule for partial dentures – provided by a dentist, or for complete upper and lower dentures – provided by a dentist or duly licensed dental mechanic.

For major dental work, it is advisable to obtain a treatment plan from your dentist and submit this to MEBS before treatment starts. A treatment plan will outline the nature of the work required, the cost and the expected date of completion.

Orthodontic Services

The Dental Division will pay

75% of the Dental Fee Schedule for orthodontic services.

Before treatment begins, a completed orthodontic treatment plan must be sent to MEBS for approval.

The lifetime maximum is $2,250 per person except for members under the age of 19 and dependent children under the age of 19 in which case the lifetime maximum is $3,000.

Replacement of lost, broken or stolen appliances are not covered.

To be eligible for orthodontic coverage, you or your dependent must be currently eligible for dental benefits and must have been eligible for dental benefits for a minimum of 12 months in the 30 months prior to the date the orthodontic service is rendered.

Services not Covered by the Dental Division

· Services which are not routinely performed by a dentist or a dental mechanic

· Services which are provided under the Medical Services Act of British Columbia, the WorkSafeBC or other similar agency, or services for which any third party is liable

· Services which relate to or are necessary because of:

» war or any act of war or participation in a riot or civil insurrection

» an injury which was intentionally self-inflicted, whether sustained or suffered while sane or insane

» a criminal offence other than an offence related to the operation of a motor vehicle

· Services purely cosmetic in nature or with respect to congenital malformations, temporary dentistry, oral hygiene instruction or tissue grafts

· Drugs and/or medicines.

· Implants for dentures and bridgework.

· Charges for unkept appointments.

· Charges for completing dental forms.

· Charges necessary as a result of a change of dentist or dental mechanic unless otherwise authorized by the Trustees or MEBS

· Charges for general anaesthetics (the dentist does not charge for local anaesthetics)

· Charges for services which began before the effective date of coverage. If you are in doubt about coverage of certain services, it is advisable that you or your dentist contact MEBS before treatment starts

Emergency Dental Care Anywhere

In an emergency, if you require dental care while travelling outside 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 services been rendered in British Columbia.

How to Submit a Claim

On your first visit, tell your dentist that you are a member of the UFCW Local 1518 Dental Division, MEBS Group No. UFCW1518 and show your dentist your identification card.

Your dentist may elect to bill MEBS directly or may choose to bill you. You are responsible for the portion of services not covered under the Dental Division.

Should your dentist choose to bill MEBS directly, you will not need to submit a claim.

Should your dentist choose to bill you, you will need to obtain a standard dental claim form from your dentist indicating to “please pay patient.”

Co-ordination of Benefits

If you or any of your eligible dependents have coverage under the Dental Division or another plan that provides similar benefits, please indicate the name of the insurer and both identification numbers on all claim forms. Claims will be co-ordinated so that benefits paid from all plans are not greater than the actual eligible expense.

Further Information / Contact Information

If you have a question about your dental plan call

UFCW Local 1518 Dental Division
Bilsland Griffith Benefit Administrators
501 – 4445 Lougheed Hwy
Burnaby, BC V5C 0E4
Telephone: Toll free at 1-888-818-3368
Fax: (604) 433-8894

Please note: Your Social Insurance Number is your identity number. Your group number is UFCW1518. Please provide both numbers with all your correspondence and inquiries.

This outline is for information purposes only. All terms and conditions are governed by the Dental Division Text and the Contract between the Trustees and MEBS. In the event of a discrepancy, benefits will be paid according to the terms of the official documents.

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