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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.

Your plan covers up to a maximum of $500 per benefit year

Diagnostic & Preventative
Your plan covers 100% for diagnostic and preventative procedures including:
One examination and consultation during each benefit year, including any necessary x-rays and diagnostic services at the time of the examination.

Eligible Exams
• complete oral examinations
• recall oral examinations
• emergency or specific oral examinations
• consultation

Eligible X-rays
• full mouth series, minimum 16 films, including bitewings in any 36 consecutive months
• panorex (one in any 36 consecutive months)
• periapical (no more than 16 films in any 36 consecutive months)
• occlusal (no more that 4 films in 12 consecutive months)
• bitewing (no more than 4 films in 12 consecutive months)
• one cleaning and one unit of polishing, including up to 4 units of scaling (above the gum line).
• fluoride treatments will be limited to one per benefit year
• oral hygiene instruction, 1 treatment per lifetime

Minor Restorative
Your plan covers 75% for services associated with minor restoration, including:

(a) amalgam, silicate and composite fillings;
(b) tooth-coloured fillings, limited to once every two years on the same tooth surfaces.
(c) space maintainers (for a Dependent Child only, up to and including 14 years of age).

Multiple restorations on a common surface placed on the same service date will be considered
a single restoration. The maximum benefit payable will not exceed the fee for a five surface
restoration regarding the same tooth during one sitting.

Extractions and Oral Surgery
Your plan covers 75% for services associated with surgical extractions and root removal, including:
• extractions of teeth and residual root removal, limited to two wisdom teeth in any policy year;
• surgical excision, surgical enucleation and surgical movement of teeth;
• surgical incision and drainage, surgical incision for removal of foreign bodies and antral surgery;
• gingivoplasty, stomatoplasty, vestibuloplasty and all alveoloplastys;
• general anaesthesia;
• remodelling of floor of the mouth, reconstruction of alveolar ridge;
• extensions of mucous folds, bone grafts to the jaw and prosthetic augmentations to the jaw;
• replantation and repositioning of teeth;
• treatment of fractures, repairs of lacerations;
• frenectomy, hemorrhage control, treatment of salivary glands;
• treatment of maxillofacial deformities.

Endodontic
Your plan covers 10% for endodontic services including where applicable, treatment plan, local anaesthesia, tooth isolation, clinical procedures, sutures, appropriate radiographs and follow-up care for:
• pulpotomy (not in conjunction with root canal therapy if rendered within 30 days)
• root canal therapy
• apexification
• periapal sevices
• root amputation
• hemisection
• intentional removal, apical filling and reimplantation

Periodontic & Other Oral Surgery
Your plan covers 10% for periodontic services including:
• non-surgical procedures
• definitive surgical procedures
• adjunctive surgical procedures
• occlusal equilibration
• periodontal appliances including impression and insertion (one appliance per arch in 24 consecutive months)
• periodontal appliance repair, maintenance and adjustment (no more that 4 units in any benefit year)

Major Restorative (crowns/bridges/dentures)
Your plan covers 10% of major restorative services including:
Most of the services listed below will be replaced only if the existing appliance is at least 5 years old. If the appliance is temporary and being replaced with a permanent appliance within 12 months of the installation of the temporary appliance, or if the appliance was necessary due to the extraction of one natural tooth.

• crowns, including treatment plan, occlusal records, local anaesthesia, subgingival preparation of the tooth and supporting structures, removal of decay and old restoration, tooth preparations, pulp protection, impressions, temporary coverage, insertion, occlusal adjustment and cementation, repairs and removal.
• removable prosthodontics will include, where applicable, treatment plan, impressions, jaw relation records, try-in, insertion, occlusal equilibration and 3 months post-insertion care on complete dentures, transitional dentures, acrylic dentures and cast partial dentures.
• fixed prosthodontics will include, where applicable, treatment plan, occlusal records, local anaesthesia, subgingival preparation of the tooth and supporting structures, removal of decay and old restoration, tooth preparation, pulp protection, impressions, temporary coverage, splinting, intraoral indexing for soldering purposes, insertion, occlusal adjustments and cementation on pontic, retainers, abutments and repairs.

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