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 90% of 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 (not eligible for dependents under 12) and periapical, up to 16 films including bitewings in any period of 36 months
• bitewings, not more than 4 films per benefit year
• panoramic, 1 in any period of 36 months
• polishing, 1 unit per benefit year
• scaling, 2 units per benefit year
• fluoride, 2 treatments per benefit year
• oral hygiene instruction, 1 treatment per lifetime
• pit and fissure sealants, under 19 years of age, 1 per molar in any period of 36 months
• space maintainers and maintenance, under 15 years of age, 1 per space per benefit year
• anaesthesia, eligible when done in conjunction with a covered dental procedure
Your plan covers 90% for services associated with dental health restoration, including:
• 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
Your plan covers 60% for services associated oral surgery, including:
• extractions, limited to 2 wisdom teeth per benefit year
Your plan covers 60% for endodontic services including:
• root canal therapy
Your plan covers 60% for periodontic services including:
• additional scaling and/or root planing, not more than 5 units per benefit year
• occlusal equilibration, not more than 4 units per benefit year
• periodontal appliances, not more than 1 appliance per arch in any period of 24 months
• periodontal appliance repairs, maintenance and adjustments, not more than 4 adjustments per benefit year
Your plan covers 50% of major restorative services including:
• inlays, onlays
• veneers, other than for cosmetic purposes
Replacement of an existing inlay, onlay, crown, veneer, and bridge is an eligible expense if the replacement is required to replace an existing inlay, onlay, crown, veneer, and bridge which was installed 5 years before the replacement.