Grandfathered Fraternal Benefit Seniors' Basic Dental Care

The following benefits are provided to those senior Members who are eligible for this benefit through the Grandfathered Fraternal Benefits Seniors' Basic Dental Care and who do not qualify for coverage under the Bronze, Silver or Gold Levels. Members who are eligible will see only 'Grandfathered Fraternal Benefits' on Your Statement of Insurance Benefits with dental noted under the benefit description. AFBS pays the premium cost on behalf of the Member.

Annual Maximum $400.

Basic dental care expenses are reimbursed at 80% of the Member cost for the
following covered services:

• Recall examination, once every 9 months;
• Routine diagnostic and laboratory procedures (laboratory fees are limited to a maximum of 50% of the total cost of the dental procedure);
• Full mouth series x-rays or panoramic film, once every five years or if a new dentist is involved in your dental care;
• Prophylaxis, including scaling, 10 units/year;
• Bitewing x-rays, once per Benefit Year;
• Topical application of any anti-carcinogenic agent (e.g. stannous fluoride) or polishing of teeth, once every 9 months;
• Fillings (amalgam, silicate, acrylic and composite), retentive pins and pit and fissure sealants;
• Periodontal treatments classified as basic procedures under your province's dental fee guide.

Procedures and services not covered include:

• Any periodontal treatment which is not classified as a basic procedure;
• Endodontics;
• Oral surgical procedures;
• General anesthesia and x-rays, except as noted above;
• Inlays, onlays, crowns, fixed bridgework, space maintainers, complete or partial dentures or replacement or rebasing thereof;
• All other services classified as major restorative services in your province's fee guide and all orthodontic procedures.