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Dental

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.

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.

IMPORTANT! Please submit a pre-determination/pre-authorization to the insurance carrier prior to treatment of specialist services and any treatment plan exceeding $300.

Reimbursement is at 80% up to a maximum of $600 per benefit year.

Basic Services
• Recalls include exams, bitewing X-rays, fluoride treatments and cleanings once every 12 months, based on first paid claim.
• Complete, general or comprehensive oral exams, full mouth x-rays and panoramic x-rays, once every 3 years based on first paid claim.
• Basic restorations, fillings and inlays.
• Extractions and surgical services. General anaesthetics and intravenous sedation only when done in conjunction with eligible extraction(s) and/or oral surgery. Sleep dentistry is not eligible.

Comprehensive Basic Services
• Endodontic treatment including standard root canal therapy, excluding retreatments.
• Periodontal treatment including scaling and/or root planning, 3 time units every 12 months based on first paid claim.
• Occlusal equilibration - selective grinding of tooth surfaces to adjust a bite, 2 time units every 12 months based on first paid claim.
• Standard denture services once every 3 years based on first paid claim. Including relining and rebasing of dentures plus denture adjustments after 3 months from installation.

Limitations
a) Laboratory charges must be completed in conjunction with other services and will be limited to the Co-pay of such services. Laboratory charges that are in excess of 40% of the dentist's fee in the current General Practitioners Fee Guide will be reduced accordingly; co-insurance is then applied.

b) Reimbursement will be made according to standard and/or basic services, supplies or treatment. Related expenses beyond the standard and/or basic services, supplies or treatment will remain your responsibility.

c) When more than one surgical procedure is performed during the same appointment in the same area of the mouth, only the most comprehensive procedure will be eligible for reimbursement.

d) Reimbursement will be pro-rated and reduced accordingly, when time spent by the dentist is less than the average time assigned to a dental service procedure code in the General Practitioners Fee Guide.

e) Reimbursement for root canal therapy will be limited to payment once. The total fee for root canal includes all pulpotomies and pulpectomies performed on the same tooth.

f) Common surfaces on the same tooth/same day will be assessed as one surface. If individual surfaces are restored on the same tooth/same day, payment will be assessed according to the procedure code representing the combined surface. Payment will be limited to a maximum of 5 surfaces in any 36 month period.

g) The benefits payable for multiple restorative services in the same quadrant performed at one appointment may be reduced by 20% for all but the most costly service in the quadrant.

h) Root planing is not eligible if done at the same time as gingival curettage.

i) In the event of a dental accident, claims should be submitted under the health benefits plan before submitting them under the dental plan.

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