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!

Covered Dental Expenses

The percentage payable and the Calendar Year Maximum are specified in the “SUMMARY OF BENEFITS”.   Charges for reasonable and customary services and supplies specified below shall be considered covered expenses when incurred by you or a covered Dependent.  Eligible expenses include Basic and Preventive Treatment, Endodontics, Periodontics, Oral Surgery, Major Restorative and limited Prosthodontics.  An expense is eligible to the extent that coverage is not prohibited by provincial health insurance plans or because of other limitations described below or in the “SUMMARY OF BENEFITS”.

Diagnostic and Preventative Procedures:

  1. oral hygiene instruction to the frequency specified in “SUMMARY OF BENEFITS
  2. oral examinations including scaling and cleaning of teeth to the frequency specified in “SUMMARY OF BENEFITS
  3. topical application of sodium or stannous fluoride to the frequency specified in “SUMMARY OF BENEFITS
  4. dental x-rays: single diagnostic x-rays; complete series or equivalent
  5. consultations
  6. full coverage restorations for primary teeth
  7. passive space maintainers, those that do not move the teeth, and pit and fissure sealants for Dependent
  8. Children under the age of 18 only
  9. study casts to the frequency specified in “SUMMARY OF BENEFITS
Major Restorative Procedures:
  1. Metal inlays and crowns, used to restore natural teeth to their normal functions where the tooth, as a result of extensive caries or fracture, cannot be restored with a filing.   When a tooth can be restored with silver amalgam, silicate or synthetic restorations, benefits will be determined based on the usual costs of such a restoration.
  2. initial installation of fixed bridgework
  3. bridge repairs and recementation
  4. replacement of existing fixed bridgework providing:
    • the existing fixed prosthetic device is at least 5 years old and cannot be made serviceable; or,
    • the replacement is required because of extraction, loss or fracture of one or more sound natural teeth after the individual became insured under this plan; or
    • A temporary bridge is considered to be permanent if not replaced within 12 months from the date the temporary bridge was inserted.

Minor Restorative Procedures:

  1. extractions
  2. amalgam, acrylic, silicate or composite fillings (amalgam only on molar teeth)
  3. anaesthesia where reasonably and customarily required in connection with other covered procedures
  4. occlusal equilibration to the frequency specified in “SUMMARY OF BENEFITS
  5. retentive pins
  6. caries, trauma and pain control

Endodontic and Periodontic Procedures:

  1. treatment of periodontal and other diseases of gums and tissues of the mouth,(special periodontal appliances)
  2. emergency endodontic procedures and root canal therapy

Oral Surgery:

  1. oral surgery including excision of impacted teeth

Dentures:

  1. repairing, relining and rebasing of dentures to the frequency specified in the “SUMMARY OF BENEFITS"
  2. denture adjustments
  3. initial installation of partial or full removable dentures
  4. replacement of existing partial or full removable denture(s) providing:
    i. the existing appliance is at least 5 years old and cannot be made serviceable; or,
    ii. the existing appliance is replaced as a result of the initial placement of an opposing denture.
    Replacement of lost or stolen dentures, the duplication of dentures and personalization or characterization of dentures is not covered.  A temporary appliance is considered to be permanent if not replaced within 12 months from the date the temporary appliance was inserted.

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