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Dental Claim |
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Use
Use the Dental Claim form if you've paid
your dentist the full cost of the services that are covered
under the Plan and you wish to be reimbursed. Many dentists
will bill the Plan directly for the portion payable under the
Plan using their own Standard Dental Claim Form. |
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Information Needed to Complete the Form
Your dentist must complete Part 1 of the form. You complete Part 2 and Part 3.
Part 2 is where your Member information is filled in, including
your Plan policy number, 9000. This
number is pre-printed on the form. (If your dentist uses a Standard Dental Claim Form, the above
Plan number must be included).
Part 3 is for patient information whether that is yourself,
your spouse, or one of your dependant children. Part 3 also collects
information about other Benefit or Insurance Plans that you
may be eligible to co-ordinate a claim from.
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Notes
The expenses must have been incurred by you or one of
the eligible dependents currently on file with the Plan Administrator.
If the cost of the Dental work will exceed $1000, you should
notify the Plan Administrator in
advance of the work to ensure that the Plan will
cover the expense. Costs not covered by the Plan must be paid
by you.
Completed forms should be forwarded to the Plan Administrator. |
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Frequently Asked Questions
My spouse also has dental coverage through work, how do I coordinate
my claim with my spouse's benefits plan?
- If a Member or any eligible Dependents are entitled to
receive similar benefits simultaneously under the Health Benefit Plan or any
other group insurance plan (including Provincial Plans), to prevent over
payment, benefits payable under this Plan would be co-ordinated with the other Plan.
For example: A Member's wife is covered under her employer's plan with
family coverage. The Member, his spouse and their three children are all covered
under both Plans. To determine which plan would be primarily responsible for the
dependent children: Between the Member and the spouse, whomever's birthday falls first in
the calendar year, their plan is responsible for the initial reimbursement of benefits
for the dependent children, then, any amounts that are not paid by that Plan are
submitted to the other parent's plan.
In the event that the Member's birthday is in April and the spouse's
birthday is in January. The spouse's plan would be primarily responsible for the spouse's
claims and the claims of the children. Any amounts not paid by the spouse's plan can be
submitted to the Member's Plan for reimbursement. Any amounts for the Member that are not
paid by the Member's Plan can be submitted to the spouse's plan for reimbursement.
Other questions on completing the form should be directed to the Plan Administrator.
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Plan Administrator
Millworkers Health & Welfare Plan (Unifor) Administrator
c/o D.A. Townley
4250 Canada Way
Burnaby, BC, V5G 4W6
Phone: 604-299-7482 or 1-800-663-1356
Fax: 604-299-8136
Email: Health
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PDF
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