| Benefit |
Dental |
Dental Plus |
|---|
| Co-insurance |
- Preventive and basic dental procedures: 80% of eligible expenses up to $1,500 maximum per insured person, per calendar year
If the insured person’s coverage starts in the second half of the calendar year, the maximum amount for that year is reduced by 50%.
|
- Preventive and basic dental procedures: 90% of eligible expenses up to $2,000 maximum per insured person, per calendar year
- Major dental procedures: 60% of eligible expenses up to $1,500 maximum per insured person, per calendar year
- Orthodontic procedures: 50% of eligible expenses up to $1,500 lifetime maximum per insured person. One-year waiting period.
If the insured person’s coverage starts in the second half of the calendar year, the maximum amount for that year is reduced by 50%.
|
| Preventive dental procedures |
Oral examinations
- 1 complete exam every 24 months
- 1 recall exam every 9 months
- Emergency or specific examinations
X-rays
- 1 complete series of x-rays or panorex every 24 months
- 1 set of bitewing x-rays every 9 months
- X-rays to diagnose a symptom or examine progress of a particular course of treatment
Other services
- Required consultations between two dentists
- Scaling and polishing and topical fluoride treatment once every 9 months
- Emergency or palliative services
- Diagnostic tests and laboratory examinations
- Removal of impacted teeth and related anaesthesia
- Oral hygiene instruction once per lifetime limit
- Dependent children aged 18 and under:
- Provision of space maintainers for missing primary teeth
- Pit and fissure sealants
|
Oral examinations
- 1 complete exam every 24 months
- 1 recall exam every 6 months, up to 2 exams each calendar year
- Emergency or specific examinations
X-rays
- 1 complete series of x-rays or panorex every 24 months
- 1 set of bitewing x-rays every 6 months, up to 2 sets each calendar year
- X-rays to diagnose a symptom or examine progress of a particular course of treatment
Other services
- Required consultations between two dentists
- Scaling and polishing and topical fluoride treatment once every 6 months, up to a maximum of 2 per calendar year
- Emergency or palliative services
- Diagnostic tests and laboratory examinations
- Removal of impacted teeth and related anaesthesia
- Oral hygiene instruction once every 6 months, up to a maximum of 2 sessions per calendar year
- Dependent children aged 18 and under:
- Provision of space maintainers for missing primary teeth
- Pit and fissure sealants
|
| Basic dental procedures |
- Fillings: silicate, acrylic, composite, or amalgam for teeth 1 - 6 only, amalgam for other teeth.
- Extraction of teeth: removal of teeth, except removal of impacted teeth.
- Restorative:
- Prefabricated metal restorations and repairs to prefabricated metal restorations, other than in conjunction with the placement of permanent crowns.
- Stainless steel crowns or bands (only for dependent children aged 18 years and under).
- Removable prosthodontics: repairs, adjustments, relines, rebasing of dentures once every 12 months.
- Endodontics: root canal therapy and root canal fillings, and treatment of disease of the pulp tissue.
- Periodontics:
- Treatment of disease of the gum and other supporting tissue.
- Scaling and root planing, combined maximum of 8 units of 15 minutes per calendar year.
- Oral surgery: surgery and related anaesthesia, other than the removal of impacted teeth
|
| Major dental procedures |
Not included |
Major restorations
- Inlays and onlays
- Crowns and repairs to crowns, other than prefabricated metal restorations
- Repair of bridges
Prosthodontics
- construction and insertion of bridges or standard dentures. Coverage is limited to teeth extracted while the Insured Person is covered under this policy. Charges for a replacement bridge or replacement standard denture are not considered an eligible expense during the 5 year period following the construction or insertion of a previous bridge or standard denture unless:
- it is needed to replace a bridge or standard denture which has caused temporomandibular joint disturbances and which cannot be economically modified to correct the condition.
- it is needed to replace a transitional denture which was inserted shortly following extraction of teeth and which cannot be economically modified to the final shape required
|
| Orthodontics |
Not included |
- 1 year waiting period. Only children age 18 and under are covered for these procedures:
- Orthodontic exams
- Interceptive, interventive or preventive orthodontic services, other than space maintainers
- Comprehensive orthodontic treatment, diagnostic procedures, treatments, and retention
|
| Extension of benefits |
If your coverage is terminated, any expenses incurred after the termination date are not covered, even if the treatment was pre-approved. The plans will cover expenses incurred within 31 days after the termination of your coverage if an insured person has started:
- Dental restoration in connection with crowns or bridges for which the tooth was prepared prior to the termination date
- Root canal therapy where the pulp chamber was opened prior to the termination of insurance, and your Dental or Dental Plus plan included coverage for these services prior to termination
You will still be covered for procedures to repair natural teeth damaged by an accidental blow if the accident occurred before termination of coverage and the procedure is performed within six months after the date of the accident.
|
| What is not covered |
Covered expenses shall not include any charges incurred directly for, as a result of, any one or more of the following:
- Procedures or supplies used in full mouth reconstructions (capping all of the teeth in the mouth), vertical dimension corrections (changing the way the teeth meet) including attrition (worn down teeth), alteration or restoration of occlusion (building up and restoring the bite), or for the purpose of prosthetic splinting (capping teeth and joining teeth together to provide additional support)
- Services or supplies payable or available (regardless of any waiting list) under any government-sponsored plan or program unless explicitly listed as covered under this benefit
- Services or supplies that are not usually provided to treat a dental problem
- Procedures performed primarily to improve appearance
- The replacement of dental appliances that are lost, misplaced or stolen
- Charges for appointments that you do not keep
- Charges for completing claim forms
- Services or supplies for which no charge would have been made in the absence of this coverage
- Supplies usually intended for sport or home use, for example, mouth guards
- Charges related to implants, including surgery charges
- Transplants and reposition of the jaw
- Experimental treatments
The plan will also not pay for dental work resulting from:
- The hostile action of any armed forces, insurrection or participation in a riot or civil commotion
- Participation in a criminal offence
- Teeth malformed at birth or during development
|