• Effective January 1st, 2019, a new Claim Submission Portal was launched! Plan members should visit https://mypbas.pbas.ca/user/theontariodentalplan, and use their certificate number to complete the registration form. Plan members will then be able to access exciting new features such as Claim Submission, Claims History, Benefit Balance, Direct Deposit registration and much more.
All other terms and conditions of the Plan will remain unchanged. If you have questions about the Plan, or the coverage it provides, you are asked to contact the Administrator, whose information follows.
UFCW Trusteed Dental Plan
Ontario 61 International Blvd.,
Suite 110 TO, ON,
1-800-461-4361 or firstname.lastname@example.org
To all Members from the Board of Trustees
The Trustees of the United Food and Commercial Trusteed Dental Fund – Ontario (“the Fund”) are pleased to announce the following enhancements to your Plan.
All other terms and conditions of the Plan will remain
unchanged. If you have questions about the Plan, or the
coverage it provides, you are asked to contact the
Administrator, whose information follows.
UFCW Trusteed Dental Plan
Ontario 61 International Blvd.,
Suite 110 Toronto, Ontario
United Food and Commercial Workers Trusteed Dental Plan - ONTARIO
EFFECTIVE DATE: July 1, 2012
All Members Board Of Trustees
The Board of Trustees is pleased to announce that, effective July 1, 2012, the following benefit improvements will take effect.
The per-person annual maximum, for Basic and Major dental services combined, will increase from $1,500 to $2,000 per calendar year.
The percentage of reimbursement for Basic dental services will be 95%.
All dental services will be reimbursed on the basis of the 2012 Ontario Dental Association (“ODA”) fee guide.
All other terms and conditions of the Plan will remain unchanged.
If you have questions about the Plan, or the coverage it provides, you are asked to contact the Administrator, whose information follows.
UFCW Trusteed Dental Plan – Ontario 61 International Blvd., Suite 110 Toronto, Ontario M9W 6K4 1-888-461-4361
1. How do I become eligible for my dental benefits?
Full-time employees must:
(i) be classified for full-time employment under the terms of the collective agreement pertaining to their employment;
(ii) have been employed for ninety (90) consecutive days commencing from, or after, the date at which their employer became a participating employer; and,
(iii) have had contributions made, continuously on their behalf, for all of their employment time on, and after, the date at which their employer became a participating employer.
Part-time employees must:
(i) be classified for part-time employment under the terms of the collective agreement pertaining to their employment;
(ii) have been employed for one-hundred and eighty (180) consecutive days from, or after, the date at which their employer became a participating employer; and,
(iii) have had contributions made, continuously, on their behalf, for all of their employment time on, or after, the date at which their employer became a participating employer.
Exception: coverage, for both full-time and part-time employees, begins on the date at which their employer becomes a participating employer if, immediately prior to that date, they had comparable dental-care coverage sponsored by that employer. However, employees of the same organization, hired after the date at which their employer became a participating employer, must fulfill the ninety (90) and one-hundred and eighty (180) consecutive days requirements, noted above.
You must have completed a registration card and have submitted it to the administrator. (Registration cards are available from the administrator, the participating employer, or the union office.) Regardless of the other requirements for eligibility, no benefits will be paid until the completed registration card is received and accepted by the administrator.
2. How do I add my spouse or dependent child?
Once you register on the new member claims and administration portal there are many features that will help you to make your Plan more accessible and easy to use, including claim submission, direct deposit registration, management of dependants, and access to claim history. Once you register your account on https://mypbas.pbas.ca/user/register, you will have the ability to add your dependants online.
Alternatively, there is space provided on the registration card for the addition of your dependants. This should be done when you first send a registration card to the office of the administrator. To add dependants after you join the Plan you must complete and remit a second registration card. (Registration cards are available from the administrator, the participating employer, or the union office.)
Note: part-time employees must qualify annually for dependent coverage.
3. What does my dental Plan cover?
Please refer to the plan booklet and insert on the home page of http://theontariodentalplan.ca/ or on your new member claims and administration portal.
4. How do I complete a claim form?
Dentists typically provide patients with a standard dental claim form. If you need assistance filling out your claim form please contact your plan administrator at: (416) 674-3350 (in Toronto) or 1-800-461-4361.
5. What is my group plan number and ID number?
Your group plan number is 1000 and your ID number is your 9-digit social insurance number. You will be issued a certificate number which should be used as your identification number on all claims.
6. Can I submit my claim online?
Once you register your account on https://mypbas.pbas.ca/user/register, you will have the ability to submit claims online and receive payment via direct deposit.
7. Is there a time limit on the submission of claims?
Yes. Claims must be submitted for payment within twelve (12) months of the date on which the expense was incurred.
8. Does my plan have electronic claims submission?
In addition to the online claims submission through the portal, you can submit claims by mail, by fax, or by email. Claims can be submitted as follows:
The Administrator, UFCW Trusteed Dental Plan - Ontario
Suite 110, 61 International Blvd
Toronto, ON M9W 6K4
Electronic Data Interchange (EDI) is not available for this plan.
9. How long does it take to process and pay my claim?
Short of any complications and assuming the claim form is properly completed, it will be paid within 3 business days following receipt by the administrator.
10. What is a dental fee guide? When does it change and how?
Each year the dental associations in most provinces publish a fee guide of dental services and supplies. The related fees for each service can change from year to year. The Plan’s Board Of Trustees decides, each year, whether or not to adopt a more recent version of the fee guide. This decision is based on whether or not the plan has the financial resources to do so.
11. Why does the Plan not provide for assignment (direct payment to dentist)?
Some plans facilitate payment directly to dentists, many do not. The philosophy behind your Plan’s decision to ensure all payments go to you (the Plan member) is so that you are aware of what your dentist is charging for your visit. That way you can verify that the services listed on your claim are accurate. Not doing so could open the door for inaccurate billing or worse, fraud. These expenses ultimately erode the assets of your Plan, thereby leaving less money for benefits.
12. Why are certain deductions made to my payment, what do they mean?
Dentists use procedural codes to clarify the work that is being performed. All procedure codes are listed in the fee guide for the province and many have limitations and maximums. If you have a procedure completed that is not covered or partially covered, the deduction is noted with a message code. The explanation is provided in the message section of the website of Explanation of Benefits (EOB) noting why the deduction was made or on your reimbursement cheque if you submit a paper claim. See the illustration below for an example of deductions.
13. If my dependent child is over 19 years of age, can I still receive payment for their expenses?
Yes, if your dependent child is over age 19 they are still covered if they are attending full-time studies at a school. School means an institution that provides education, at the secondary or post-secondary level, of the types approved for general, public application within the jurisdiction of the government authority responsible for the particular school and/or school district.
14. What type of proof is required that my dependent child is in full-time school.
Your Plan will accept a letter from the school’s registrar office, noting the dates of enrolment;
15. What does the Plan require as proof of my common-law relationship?
Your Plan will accept confirmation of the date of cohabitation you enter on your Plan Registration Form. This means that your spouse will be eligible for claims payment one year after the date of cohabitation.
16. Where can I get a Plan Registration Card?
Plan Registration Cards are available from the administrator, your union office, or your employer. Please ensure that the registration card is completed in full and signed and dated in ink.
17. Can I make a self-payment?
Self-payments are voluntary and can be made:
following the first 12 months of disability leave, for up to an
additional 36 months; and,
during any approved leave of absence or temporary lay-off, for up to 36 months.
Failure to remit Self-payments during the above leaves will result in suspension of your Eligibility for benefit reimbursement.
18. How do I make a self-payment? Can it be deducted from my bank account or paid by Visa or MasterCard?
Self-payments are to be made to the administrator, by cheque or money order made payable to the United Food and Commercial Workers Trusteed Dental Fund – Ontario. We are unable at this time to accept payment by Visa and MasterCard.
The amount of the Self-payment changes from time to time, based on the operating costs of the Trust Fund and the Plan.
19. How do I receive my claim reimbursement?
For quick and easy reimbursement, you can register for direct deposit on the member claims and administration portal.
The benefits of this option are as follows.
Quicker turnaround time (you do not have to wait for your cheque
in the mail).
Reimbursement monies are deposited directly into your bank account.
Your explanation of benefits is emailed to you, (so no extra paper).
Alternatively, your reimbursement cheque will be sent to your address but may be received 10 - 14 days after your claim is received (based on average mail delivery). All claims are paid within 3 business days following receipt.
20. How do I sign up for direct deposit?
Once you register your account on https://mypbas.pbas.ca/user/register, you will have the ability to register for direct deposit. Alternately, to sign up for direct deposit, complete the direct deposit registration form and return it to the address noted in the bottom right corner. You will need to attach a void cheque, or have your financial institution complete the section on banking information. You must also provide a valid email address.
21. How secure is the banking information I provide to you?
The information is stored in your secure personal file and is used only for the purpose of direct deposit of dental claims payment.
22. How will I know how much is being deposited to my account and the details of my claim reimbursement?
You will receive an email confirming the amount of your deposit and the date on which it was made, along with an electronic explanation of benefits (EOB). The EOB details which items have been covered in full and any deductions. If something has not been covered, or not covered in full, the EOB will outline the reason; similar to the statement you currently receive with your cheque. You can also visit your online account and review your EOBs online.
23. What happens if I change my bank account?
You need to let us know if you change your bank account, prior to any future dental claims being paid. If you do not notify us of your new banking information, the direct deposit will not be successful (it will bounce back) and you will experience delays in receiving your payment until we can verify your new banking information. You can update your banking information online in the portal or fill out a paper form and send it in.
24. Why should I register on the member portal?
Once you register on the member portal there are many features that will help make your Plan more accessible and easy to use. Features include claim submission, direct deposit registration, management of dependants and changes of address, and access to claim history. Once you register your account on https://mypbas.pbas.ca/user/register, you will have the ability to access your plan in real time.
25. Can I view my claim history?
Your claim history is now available on the member portal and updated daily, so that you will always have the most up-to-date information regarding your submitted claims.
You have the option to print the explanation of benefits (EOB) for any claim that you have submitted. This highlights claim information, and payments made by your plan. Having this information accessible will make it easier for you to submit the information to any other insurance plan you or your spouse may have, or provide you access to the information you may require for your income tax filing.
26. How can I see how much I’ve claimed?
The option to view your benefit balances is now available on the member portal, under the claim center. Once registered, you will have access to view the remaining balance for you and your dependents. This option is particularly helpful when you have repeated treatments for a specific dental condition.