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 $500.
Your plan covers up to a maximum of $750 per benefit year.
Diagnostic & Preventative
Your plan covers 80% of diagnostic and preventative procedures including:
• complete oral examinations once every 3 years
• emergency and specific oral examinations
• full series X-rays and panoramic X-rays once every 3 years
• bitewing X-rays once per benefit year
• recall examinations once per benefit year
• cleaning of teeth (up to 1 unit of polishing plus up to 1 unit of scaling) once per recall period
• topical application of fluoride twice per benefit year for covered persons 19 years of age and
under
• oral hygiene instruction once per lifetime
• denture cleaning once per recall period
• pit and fissure sealants on molars only, for covered persons 16 years of age and under
• space maintainers
• mouth guards once every 12 months
Minor Restorative
Your plan covers 75% for services associated with dental health restoration, including:
• amalgam, tooth coloured filling restorations, and temporary sedative fillings
• inlay restorations - these are considered basic restorations and will be paid to the equivalent non-bonded amalgam
Oral Surgery
Your plan covers 75% for services associated with surgical extractions, including:
• extractions of teeth and/or residual roots
• general anaesthesia, deep sedation, and intravenous sedation in conjunction with eligible oral surgery only
Endodontic
Your plan covers 10% for endodontic services including:
• root canal therapy
• pulpotomy (removal of the pulp from the crown portion of the tooth)
• pulpectomy (removal of the pulp from the crown and root portion of the tooth)
• apexification (assistance of root tip closure)
• apical curettage, root resections and retrograde fillings (cleaning and removing diseased tissue of
the root tip)
• root amputation and hemisection
• bleaching of non-vital tooth/teeth
• emergency procedures including opening or draining of the gum/tooth
Periodontic
Your plan covers 10% for periodontic services (excluding periodontal scaling for 80% coverage) including:
• periodontal scaling and/or root planing 1 time unit per benefit year
• occlusal equilibration - selective grinding of tooth surfaces to adjust a bite 4 time units per benefit year
The fees for periodontal treatment are based on units of time (15 minutes per unit) and/or number of teeth in a surgical site in accordance with the General Practitioners Fee Guide.
• bruxism appliance once every 2 benefit years
Major Resortative
Your plan covers 10% for major restorative including:
• Standard onlays or crown restorations (paid to full metal on molar) to restore diseased or accidentally injured natural teeth, once every 5 years
• Standard bridges, including pontics, abutment retainers/crowns (paid to full metal on molar) on natural teeth, once every 5 years
• Standard dentures including complete, immediate, transitional, and partial dentures, once every 5 years
• Standard repair or recementing of crowns, onlays and bridge work on natural teeth
Standard denture services:
• denture repairs and/or tooth/teeth additions
• standard relining and rebasing of dentures, once every 3 benefit years, only after 6 months have elapsed from the installation of a denture
• denture adjustments and remount and equilibration procedures, only after 3 months have elapsed from the installation of a denture
• soft tissue conditioning linings for the gums to promote healing
• remake of a partial denture using existing framework, once every 5 years
Comprehensive oral surgery:
• surgical exposure, repositioning, transplantation or enucleation of teeth
• remodeling and recontouring - shaping or restructuring of bone or gum
• excision - removal of cysts and tumors
• incision - drainage and/or exploration of soft or hard tissue
• fractures including the treatment of the dislocation and/or fracture of the lower or upper jaw and repair of soft tissue lacerations
• maxilofacial deformities - frenectomy - surgery on the fold of the tissue connecting the lip to the gum or the tongue to the floor of the mouth