Common use of Vision Care Benefits Clause in Contracts

Vision Care Benefits. Charges for contact lenses, or for lenses and frames for eyeglasses, and their replacement, provided there is an actual need for a change in their magnifying strength. Sun glasses or safety glasses of any kind are excluded. Supplies must be prescribed, in writing, by an ophthalmologist or licensed optometrist and must be dispensed by a licensed optometrist or qualified optician. The maximum amount payable in any 12 month period is $200.00 for persons under age 18, or $200 in any 24 month period for persons over age 18. For contact lenses, only if vision can be improved to at least the 20/40 level, the maximum is $200 per lifetime. Eye examinations are covered for individuals over age 20, but younger than age 65, up to a maximum of $80 every 24 months. The lifetime maximum for Extended Health Care coverage is $1,000,000 per covered person. DENTAL BENEFITS: The Plan provides dental benefits up to the current year’s Ontario Dental Association (ODA) suggested fee guide. Percentage Payable Basic Dental Services are covered at 100% Major Dental Services are covered at 50% Orthodontic Services are covered at 50% Benefit Maximum Basic and Major Services – A combined maximum of $2,000 per calendar year. Orthodontic Services - $2,500 per lifetime per dependent child. Coverage terminates at retirement. Covered Charges Covered charges are the charges for needed dental care, services or supplies, as described below and received while the person is covered, for either a disease or injury that is non-occupational. Basic Dental Services Charges up to the benefit maximum for: - Oral exams, including scaling and cleaning of teeth, but not more than once every 6 months; - Periodontal scaling and/or root planning (limited to 10 units per year for all procedures combined); - Occlusal adjustments/equilibration (limited to 8 units per year); - Topical applications of sodium or stannous fluoride but not more than one application every 6 months; - Dental x-rays, except that bite-wing x-rays are limited to one set every 6 months; - Fillings; - Extractions; - Oral surgery, including excision of impacted wisdom teeth; - Antibiotic drug injections; - Anaesthesia and its administration in connection with oral surgery or other covered dental services; - Space maintainers, including stainless steel crowns for primary teeth that have several cavities which would otherwise require fillings or which are non-restorable using normal restorative dental material; - Repair, relining or rebasing of dentures; - Repair, resurfacing or recementing of crowns, inlays, onlays or bridges; - Periodontic treatment for disease of the bone and gums of the mouth, including tissue grafts and occlusal guards, but not athletic guards; - Endodontic treatment, including root canal therapy. Major Dental Services Charges up to the benefit maximum for: Dentures: - First installation, including adjustments of partial, permanent or full temporary or permanent removable dentures to replace 1 or more natural teeth extracted while the person is insured; - Denture adjustments that occur more than 3 months after installation; - Replacement of an existing partial or full removable dentures, if it;  was installed at least 5 years before and cannot be made serviceable; or  is a temporary full denture which replaces one or more natural teeth extracted while the person is covered and for which replacement by a permanent denture is required and takes place within one year from the date the temporary denture was installed; and  addition of teeth to an existing partial denture, if required to replace one or more natural teeth extracted while the person is covered. Crowns and Bridgework - Inlays, onlays, gold fillings and crowns; - First installation of fixed bridgework, including crowns to form abutments, to replace one or more natural teeth extracted while the person was insured. - Replacement of existing bridgework, but only if it was installed at least 5 years before and cannot be made serviceable; and - Addition of teeth to an existing fixed bridgework, if required to replace one or more natural teeth extracted while the person is covered. Orthodontics (Dependent Children Only) Charges up to the Benefit Maximum for: - Diagnostic procedures, including models - Therapy and appliances; and - Correction or malocclusion

Vision Care Benefits. Charges for contact lenses, or for lenses and frames for eyeglasses, and their replacement, provided there is an actual need for a change in their magnifying strength. Sun glasses or safety glasses of any kind are excluded. Supplies must be prescribed, in writing, by an ophthalmologist or licensed optometrist and must be dispensed by a licensed optometrist or qualified optician. The maximum amount payable in any 12 month period is $200.00 for persons under age 18, or $200 in any 24 month period for persons over age 18. For contact lenses, only if vision can be improved to at least the 20/40 level, the maximum is $200 per lifetime. Eye examinations are covered for individuals over age 20, but younger than age 65, up to a maximum of $80 every 24 months. The lifetime maximum for Extended Health Care coverage is $1,000,000 per covered person. DENTAL BENEFITS: The Plan provides dental benefits up to the current year’s Ontario Dental Association (ODA) suggested fee guide. Percentage Payable Basic Dental Services are covered at 100% Major Dental Services are covered at 50% Orthodontic Services are covered at 50% Benefit Maximum Basic and Major Services – A combined maximum of $2,000 per calendar year. Orthodontic Services - $2,500 per lifetime per dependent child. Coverage terminates at retirement. Covered Charges Covered charges are the charges for needed dental care, services or supplies, as described below and received while the person is covered, for either a disease or injury that is non-occupational. Basic Dental Services Charges up to the benefit maximum for: - Oral exams, including scaling and cleaning of teeth, but not more than once every 6 months; - Periodontal scaling and/or root planning (limited to 10 units per year for all procedures combined); - Occlusal adjustments/equilibration (limited to 8 units per year); - Topical applications of sodium or stannous fluoride but not more than one application every 6 months; - Dental x-rays, except that bite-wing x-rays are limited to one set every 6 months; - Fillings; - Extractions; - Oral surgery, including excision of impacted wisdom teeth; - Antibiotic drug injections; - Anaesthesia and its administration in connection with oral surgery or other covered dental services; - Space maintainers, including stainless steel crowns for primary teeth that have several cavities which would otherwise require fillings or which are non-restorable using normal restorative dental material; - Repair, relining or rebasing of dentures; - Repair, resurfacing or recementing of crowns, inlays, onlays or bridges; - Periodontic treatment for disease of the bone and gums of the mouth, including tissue grafts and occlusal guards, but not athletic guards; - Endodontic treatment, including root canal therapy. Major Dental Services Charges up to the benefit maximum for: Dentures: - First installation, including adjustments of partial, permanent or full temporary or permanent removable dentures to replace 1 or more natural teeth extracted while the person is insured; - Denture adjustments that occur more than 3 months after installation; - Replacement of an existing partial or full removable dentures, if it;  • was installed at least 5 years before and cannot be made serviceable; or  • is a temporary full denture which replaces one or more natural teeth extracted while the person is covered and for which replacement by a permanent denture is required and takes place within one year from the date the temporary denture was installed; and  • addition of teeth to an existing partial denture, if required to replace one or more natural teeth extracted while the person is covered. Crowns and Bridgework - Inlays, onlays, gold fillings and crowns; - First installation of fixed bridgework, including crowns to form abutments, to replace one or more natural teeth extracted while the person was insured. - Replacement of existing bridgework, but only if it was installed at least 5 years before and cannot be made serviceable; and - Addition of teeth to an existing fixed bridgework, if required to replace one or more natural teeth extracted while the person is covered. Orthodontics (Dependent Children Only) Charges up to the Benefit Maximum for: - Diagnostic procedures, including models - Therapy and appliances; and - Correction or malocclusion

Vision Care Benefits. Charges for contact lenses, or for lenses and frames for eyeglasses, and their replacement, provided there is an actual need for a change in their magnifying strength. Sun glasses or safety glasses of any kind are excluded. Supplies must be prescribed, in writing, by an ophthalmologist or licensed optometrist and must be dispensed by a licensed optometrist or qualified optician. The maximum amount payable in any 12 month period is $200.00 for persons under age 18, or $200 in any 24 month period for persons over age 18. For contact lenses, only if vision can be improved to at least the 20/40 level, the maximum is $200 per lifetime. Eye examinations are covered for individuals over age 20, but younger than age 65, up to a maximum of $80 every 24 months. The lifetime maximum for Extended Health Care coverage is $1,000,000 per covered person. DENTAL BENEFITS: The Plan provides dental benefits up to the current year’s Ontario Dental Association (ODA) suggested fee guide. Percentage Payable Basic Dental Services are covered at 100% Major Dental Services are covered at 50% Orthodontic Services are covered at 50% Benefit Maximum Basic and Major Services – A combined maximum of $2,000 per calendar year. Orthodontic Services - $2,500 per lifetime per dependent child. Coverage terminates at retirement. Covered Charges Covered charges are the charges for needed dental care, services or supplies, as described below and received while the person is covered, for either a disease or injury that is non-non- occupational. Basic Dental Services Charges up to the benefit maximum for: - Oral exams, including scaling and cleaning of teeth, but not more than once every 6 months; - Periodontal scaling and/or root planning (limited to 10 units per year for all procedures combined); - Occlusal adjustments/equilibration (limited to 8 units per year); - Topical applications of sodium or stannous fluoride but not more than one application every 6 months; - Dental x-rays, except that bite-wing x-rays are limited to one set every 6 months; - Fillings; - Extractions; - Oral surgery, including excision of impacted wisdom teeth; - Antibiotic drug injections; - Anaesthesia and its administration in connection with oral surgery or other covered dental services; - Space maintainers, including stainless steel crowns for primary teeth that have several cavities which would otherwise require fillings or which are non-restorable using normal restorative dental material; - Repair, relining or rebasing of dentures; - Repair, resurfacing or recementing of crowns, inlays, onlays or bridges; - Periodontic treatment for disease of the bone and gums of the mouth, including tissue grafts and occlusal guards, but not athletic guards; - Endodontic treatment, including root canal therapy. Major Dental Services Charges up to the benefit maximum for: Dentures: - First installation, including adjustments of partial, permanent or full temporary or permanent removable dentures to replace 1 or more natural teeth extracted while the person is insured; - Denture adjustments that occur more than 3 months after installation; - Replacement of an existing partial or full removable dentures, if it;  was installed at least 5 years before and cannot be made serviceable; or  is a temporary full denture which replaces one or more natural teeth extracted while the person is covered and for which replacement by a permanent denture is required and takes place within one year from the date the temporary denture was installed; and  addition of teeth to an existing partial denture, if required to replace one or more natural teeth extracted while the person is covered. Crowns and Bridgework - Inlays, onlays, gold fillings and crowns; - First installation of fixed bridgework, including crowns to form abutments, to replace one or more natural teeth extracted while the person was insured. - Replacement of existing bridgework, but only if it was installed at least 5 years before and cannot be made serviceable; and - Addition of teeth to an existing fixed bridgework, if required to replace one or more natural teeth extracted while the person is covered. Orthodontics (Dependent Children Only) Charges up to the Benefit Maximum for: - Diagnostic procedures, including models - Therapy and appliances; and - Correction or malocclusion.