Payment of dental benefits is based on the General Practitioners Dental Association suggested fee guide or the Insurance Reimbursement Rate set by the Canadian Life and Health Insurance Association Inc. (CLHIA) when a fee guide is not available. For services provided by a dental specialist, payment is based upon the General Practitioners Dental Association suggested fee guide.
Services are covered at rates outlined in the 1997 Alberta Dental Association Fee Guide for General Practitioners, plus inflationary adjustments as determined by the insurance carrier. Should your dentist charge fees in excess of the fee guide, the additional costs are not covered.
Alternate Benefit - When there are two or more courses of treatment available to adequately correct a dental condition, reimbursement may be based on the cost of the least expensive treatment, which provides adequate care to the Insured.
Select and Alternate Dental Providers
The dental benefits provided under the Select Dental Provider option are provided through a specific network of dental centres. If you choose one of the Select Dental Providers, your diagnostic & preventive dental benefits will be reimbursed at the level indicated below. Please contact the SA MacEwan Student Benefits Plan Office or use the "Find a Practitioner" option for a list of Select Dental Providers* where services can be received.
If you choose an Alternate Dental Provider (a dentist or dental centre not on the Select Dental Provider list) your diagnostic & preventive dental benefits will be reimbursed at the level indicated below.
*Please note: the list of Select Dental Providers may be subject to change.
If you need to cancel your dental appointment, 24 hours notice is expected. If you do not give 24 hours notice, the dental office may charge a fee which is not covered under the plan.
IMPORTANT! Please submit a pre-determination/pre-authorization to the insurance carrier prior to treatment of specialist services and any treatment plan exceeding $500.
Your plan covers up to a maximum of $750 per benefit year
Diagnostic & Preventative
Your plan covers 100% for Select Dentists or 70% for Alternate Dentists for diagnostic and preventative procedures including:
• recall examination, 1 per benefit year
• initial or complete examination, once per dentist in a lifetime
• complete series of x-rays, 1 in any period of 36 months
• bitewings, not more than 4 films per benefit year
• polishing, 1 unit per benefit year
• scaling, 2 units per benefit year
• fluoride, under 19 years of age, 1 treatment per benefit year
Your plan covers 80% for services associated with dental health restoration, including:
• pit and fissure sealants, under 19 years of age, 1 replacement per tooth, per lifetime, on permanent molars only
• space maintainers and maintenance, under 15 years of age
• amalgam and tooth coloured fillings, 1 per tooth in any period of 24 months
• stainless steel and plastic full coverage restorations, under 15 years of age, 1 per tooth in any period of 36 months
• denture adjustments and repairs
• relining, rebasing and tissue conditioning, one treatment in any period of 36 months
• recementation of fixed prosthesis
Your plan covers 50% for services associated with surgical extractions, including:
• extractions, not more than 2 wisdom teeth per benefit year
• anaesthesia, eligible when done in conjunction with Oral Surgery
• panoramic x-ray, 1 in any period of 36 months
Your plan covers 50% for endodontic services including:
• root canal therapy
Your plan covers 50% for periodontic services including:
• additional scaling and/or root planing, maximum 2 units per benefit year
Your plan covers 15% for major restorative services including:
Replacement of an existing crown, bridge or dentures is an eligible expense if the replacement is required to replace an existing crown, bridge or denture which was installed 5 years before the replacement.