Dental Plan for W.A.N.T.E. members
Blue-Cross Cancellation Request Form
Active Health and Dental Booklet – January 2021
(NB: Retirees do not have Dental coverage)
For those members on our Extended Health or Dental Plan, our carrier is Blue Cross. Once you have been enrolled you should receive a benefit card from Blue Cross in the mail. The only time you can opt out of the plan is within 90 days of a life event. If you have any questions please contact Benefits at Winnipeg School Division 204-775-0231 or contact the W.A.N.T.E. office.
What are Life Events?
- You must notify your employer and Manitoba Blue Cross within 90 days of change in your own or your dependents’ status resulting from marriage, divorce, separation, termination of conjugal relationship, death, change of residence, birth or legal adoption.
- The majority of status changes may be reported using the “Notice of Change” form available from your employer.
- If you have opted out of the plan due to alternate group coverage that subsequently terminates, you must advise your employer and Manitoba Blue Cross within 90 days of losing coverage if you wish to be covered under this plan. This does include when the loss of coverage is due to a retirement.
Note: Once enrolled in this group plan, you will not be permitted to opt out while still employed by your employer except in the event of alternate group coverage. If this situation arises, your request to cancel must be received by Manitoba Blue Cross within 90 days of the effective date of the new plan.
Effective September 1, 2021, your eligible dependents can continue their current Health and Dental coverage for up to 24 months, with premium, in the event of your death. Your dependents will be contacted to complete the necessary forms if they wish to take advantage of survivor benefits.
Dental premiums effective September 1, 2021 have increased for Active and Active over 65. The rates are:
- Single $ 33.36 (Increase of $0.96)
- Couple $ 66.48 (Increase of $1.92)
- Family $120.24 (Increase of $3.48)
The 12 month premiums have been averaged over 10 months for all members in the plan.
You will need to know your Blue Cross Contract Number . The Dental Plan will provide coverage for you and your eligible dependents. You will not be required to pay a deductible. The plan will reimburse 80% of the cost of eligible expenses up to $1000.00 per person.
- The plan will provide coverage for basic dental services including:
- Recall examinations (check-up), two per calendar year
- Bitewing x-rays, twice per calendar year
- Routine diagnostic and laboratory procedures
- One unit of light scaling and one unit of polishing, twice per calendar year
- Fluoride treatment, two per calendar year
- Oral hygiene instruction, initial plus one recall
- Fillings, retentive pins and pit and fissure sealants. (Certain limitations may apply.)
- Full mouth x-rays, one every 2 calendar year
- Minor surgical procedures and extractions
- Denture repairs, relines and rebases. (Certain limitations may apply.)
- Periodontal services for treatment of diseases of the gums and supporting tissue. (Certain limitations may apply.)
- Endodontic services including root canals and therapy, root amputation, apexifications and periapical services. (Root canals and therapy are limited to the initial treatment plus one re-treatment per tooth, per lifetime.)
Reimbursement will be based on reasonable and customary expenses as outlined in the current Manitoba General practitioners dental fee guide.
If you have questions or concerns that cannot be answered by Blue Cross or through your booklet, please contact: Carla Paul, President, W.A.N.T.E.