Effective April 1, 2019, OHIP+ will no longer provide drug coverage for individuals under the age of 25 who have access to private insurance. Therefore, prescription drug claims for children and youth 24 years of age and younger with private plan coverage will have to be submitted directly to their private plan. Click here for details!

Charges Not Eligible For Dental Insurance

Payment will not be made for any dental procedure required due to an injury or dental disease for which you, or your Dependent, were advised to receive treatment or for which treatment first began before the effective date for that dental procedure.

The following items are not considered as covered expenses:

  1. supplies or services which are not furnished by a legally qualified dentist or denturist acting within the scope of his license
  2. replacement of a lost or stolen prosthetic device
  3. charges for protective athletic appliances
  4. services and supplies that are partially or wholly cosmetic in nature
  5. services or supplies which are not medically necessary to the care and treatment of any existing or suspected injury or disease
  6. charges for completion of claim forms, broken appointments, counselling, travel, communication costs or for advice by telephone
  7. any dental examinations required by a third party
  8. any charges which would not normally have been made but for the presence of this insurance or for which you or your Dependent are not obligated to pay
  9. expenses incurred as a result of intentionally self-inflicted injuries (while sane or insane) or as a result of committing or attempting to commit a criminal offence
  10. expenses for treatment required as a result of war, (declared or not) or participation in a riot, insurrection or civil commotion
  11. expenses for services or treatment that are payable by Workplace Safety & Insurance Law (or Similar legislation) or any government plan, or which are received without charge or which a government health plan prohibits being paid
  12. services or supplies for implantology, including tooth implantation, transplantation and surgical insertion of fabricated implants
  13. services or supplies in connection with any procedures excluded as an eligible expense, such as crowns and bridgework
  14. any Hospital charges for board and room and related services and supplies
  15. dental treatment which is primarily experimental or for dietary planning, congenital or developmental malformation
  16. any dental procedure required due to teeth extracted, missing or fractured before the effective date of your coverage for that procedure except as specifically stated for appliance replacement above.
  17. Orthodontic services including the diagnosis, prevention management and correction of mal-relationships, irregularities and abnormalities of the teeth, jaw and face.
  18. Charges which were considered an insured service of any provincial government plan at the time this plan/benefit was issued and subsequently were modified, suspended or discontinued

 

This website describes the conditions of eligibility, coverage and claims procedures under the Teamsters and Toronto Ready Mix Producers Benefit Plan Fund. The Board of Trustees are solely responsible for establishing the eligibility rules of the Trust Fund.

Downloads

Claim Forms:

Brochures:

Others:

*Please note that some changes were made to the booklet after April 2018 and these have been highlighted in red for your information.

Teamsters and Toronto Ready Mix Producers Benefit Plan Fund
c/o Benefit Plan Administrators
90 Burnhamthorpe Road West, Suite 300
Mississauga, Ontario L5B 3C3