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:
• examination, 1 per benefit year
• 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, under 19 years of age, 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
• anaesthesia, eligible when done in conjunction with a covered dental procedure
Minor Restorative
Your plan covers 70% 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
Oral Surgery
Your plan covers 70% for services associated oral surgery, including:
• extractions, limited to 2 wisdom teeth per benefit year
Endodontic
Your plan covers 15% for endodontic services including:
• root canal therapy
Periodontic
Your plan covers 15% for periodontic services including:
• 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
• other oral surgical services
Major Restorative
Your plan covers 15% of major restorative services including:
• inlays, onlays
• crowns
• veneers, other than for cosmetic purposes
• bridges
• dentures
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.