Download File - WA Health Maintenance

Benefit Schedule
Must attend one of the Network Dental
Offices located throughout the Greater
Toronto Area. (Can go to any Specialist with
referral by Network Dental Office)
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No Deductible
Unlimited maximum Benefit
Orthodontic lifetime maximum of $2,500
Benefit year: January 1 to December 31
Covered @ 80% if performed by Network Dentist
@ 50% if performed by Specialist
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Diagnostic (exams, x-rays)
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Preventive **
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Minor restorative (fillings)
Endodontics (root canal treatment for anteriors
& premolars)
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Periodontal ** ( non-surgical gum treatment)
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Oral Surgery (extractions)
** Note that benefit maximum coverage for all
scaling and/or root planning is 6 units per person per
calendar year.
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Covered @ 50% for certain specialty services
if performed by Network Dentist (General
Dentist Fee Guide)
 Molar endodontics, retreatments (3 canals
or more)
 Complex extractions and removal of
impacted teeth
Covered @ 50 % (treatment must be
performed in Network Dental Office)
 Crowns
 Dentures including denture repairs
 Bridgework
Covered @ 50%
 Orthodontics
(any dependent children under 19 years of
age)
Emergency coverage: up to $100 (to relieve pain) at any
dental office when you are traveling outside of the
Greater Toronto Area.
Coverage in accordance with the ODA General
Practitioner and Specialist Fee Guides based on the
current year.
Note:
If your spouse also has a dental plan, coordination of benefits are available only for treatment
rendered at our Network Dental Offices.
This is a summary of your dental coverage. All benefits
are subject to the terms of your dental benefits
agreement.
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Complete oral exam (once every three (3)
years)
Emergency exam limited to once in a benefit
year
Recall oral exam (once every 9 months)
Full mouth x-rays (once every three (3) years)
Bitewing x-rays (once every 9 months)
A member may change from the W A Health
Maintenance Dental Network to the insured
Fee-for-Service program, and visa versa, once
every three years. The member must notify
the Administrator in writing of this change
during November to be effective the following
January first.
A member changing from the insured Fee-forservice program to the W A Health
Maintenance Dental Network or a new
member will have a 12 month waiting period
for denture, bridge, crown and orthodontic
coverage. (only denture repairs & rebase
covered)
If you have any questions regarding your Managed
Dental Care Program,
Please contact:
W A Health Maintenance
90 Burnhamthorpe Road West, Suite 410
Mississauga, ON L5B 3C3
Phone #:
Fax #:
Email:
(905) 281-9948
(905) 281-2912
[email protected]
If my over age student dependent is
out of the area attending school, how
does he/she get coverage?
You
should attempt to make an
appointment when they return home
for a visit or holidays.
6.
If my spouse has other dental
coverage can we coordinate between
both plans? For this to work, all
dentistry must be performed at a
Network Dental Office.
Answers to these most commonly asked questions
may help you to better understand the W A Health
Maintenance Managed Dental Care Network.
1.
Limitations
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5.
Questions and Answers
Do I and my family have to attend a
Network office?
If you are eligible for dental coverage
and live within the listed postal codes
(the Greater Toronto Area) you and
your family must attend one of the
Network Dental Offices.
Dental Network Office Locations
(Subject to change)
2.
Can I attend any Dental Office in the
Network? Yes. When you become
eligible for coverage, you must
complete an enrolment card and
chose the dental office you wish to
attend.
3.
Can I switch my dental office if I
move or don’t like the dentist? Yes.
Simply notify W A Health
Maintenance and you will be
switched to another office of your
choice effective the first of the
following month. This can be done
once every 6 months
4.
Are evening / week-end appointments
available? Most of the Network
Dental
Offices
have
evening
appointments and many have
weekend appointments. It’s important
to remember that it takes much longer
to get an appointment if you require a
specific time as there are many other
members wanting the same times.
Your must choose a dental centre by completing an
enrolment card and mailing it to W A Health
Maintenance before you call the dental centre for
an appointment. If you require an enrolment card,
please call: W A Health Maintenance at 90
Burnhamthorpe
Road
West,
Suite
410,
Mississauga, ON
L5B 3C3 Phone # (905) 2819948
Centre # 06007
Lakeshore Dental Office
611 Lakeshore Road East
(Lakeshore & Cawthra)
Mississauga, ON L5G 1H9
Ph. # (905) 278-2913
Centre # 06010
Dr. B. Levine
City South Dental Office
7700 Hurontario Street, Street Level
(Highway 10 & Steeles)
Brampton, ON L6Y 4M3
Ph. # (905) 459-1742
Centre # 06048
Dr. J. Fingrut
2780 Jane Street, #102
(Jane & Eddystone)
Toronto, ON M3N 2J2
Ph. # (416) 748-3353
Centre # 06049
Dr. Anto Tedjo
King Forrest Dental Office
1960 Dundas Street West, #4
(Between Mississauga Rd. & Erin Mills Pkwy)
Mississauga, ON L5K 2R9
Ph # (905) 855-0076
Centre # 06050
Dr. Min Park
Mississauga Hanin Dental Clinic
333 Dundas Street East, #201
(Between Cawthra & Hurontario)
Mississauga, ON L5A 1X1
Ph. # (905) 281-2875
Centre # 06051
Dr. M.. Gopalkrishnan & Dr. Gupta
Warden Dental Clinic
2190 Warden Avenue #205
(Warden & Sheppard)
Scarborough, ON M1T 1V6
Ph. # (416) 491-9993
Centre # 06052
Dr. B. Petrovic
3101 Bloor Street West, #407
Toronto, ON M8X 2W2
Ph. # (416) 767-7779
Centre # 06054
Dr. V. Radevski
Danforth Dental Centre
658 Danforth Avenue #206
(Danforth & Pape)
Toronto, ON M4J 5B9
Ph. # (416) 466-7777
Centre # 06056
Dr. Marika Dekanoidze
Summerhill Gardens Dental
1246 Yonge Street, #201
(Yonge & Summerhill)
Toronto, ON M4T 1W5
Ph.# (416) 483-9600
Centre # 06068
Dentistry on Steeles
7007 Islington Avenue
(Steeles & Islington)
Woodbridge, ON L4L 4T6
Ph. # (905) 856-7999
Centre #06070
Dr. I. Kacur
2436A Bloor Street West
(Bloor & Jane)
Toronto, ON M6S 1P9
Ph. # (416) 604-4009
Your Smile is our Business
Centre # 06071
Dr. Gopalkrishnan
385 Silverstar Blvd, Suite 309
Scarborough, ON M1V 0E3
(Midland/Steeles)
Ph # (416) 491 4533
Managed Dental Care
Program Summary
for
Canadian Union Benefit
Trust Fund
Re: Hotel Workers
Rev. 08/2010 E & OE
Predetermination of Dental Costs
Centre # 06063
Dr. A Ouanounou
1017 Wilson Ave., #203
(Wilson & Keele)
Toronto, ON M3K 1Z1
Ph. # (416) 633-5721
Centre # 06074
Dr. Yong Lu
Dundas & University Dental
250 Dundas Street West, # 105
Toronto, ON M5T 2Z5
Ph. # (416) 916-8811
If your network dentist or a preferred specialist is
performing dentistry which may involve payment
from you, please send a predetermination from the
dentist to WA Health so you will know your cost
before any dentistry is performed.
333 A
Who is covered by this Plan?
If you are an eligible member this Plan
covers:
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You
Your Spouse
Your dependent unmarried children
who are under 21 years of age and
living in your household. (in the case
of a dependent child who is a fulltime student, coverage ends once he
or she reaches the age of 23.)
E & OE
Rev. 06 /2012