Dental
What is covered?
- 100% of the dental fee guides, up to $6,000 every calendar year (January 1 to December 31)
What is not covered?
Some ineligible services include:
- Cosmetic dental services
- Replacements for lost, missing, or stolen prosthetic devices
- Charges for missing a dental appointment
- Plaque control programs
- Experimental procedures
Eligible practitioners
- Licensed dentist
- Denture therapist
- Dental hygienist
Eligible services
- Routine oral exams and cleaning every nine months
- Bitewing x-rays every 12 months
- Full mouth x-rays every 36 months
- Dental x-rays related to a specific condition requiring treatment
- Emergency treatment of pain
- General anesthesia
- Extractions, oral surgery, root canal therapy, fillings, crowns, onlays, bridgework
- Treatment of gum disease
- Partial or full removable dentures (including repairs and replacements)
- Fluoride (for those under age 20)
- Porcelain veneers (for those under age 19)
- Pit and fissure sealants for permanent molars (for children up to age 14)
Your coverage maximum resets on January 1 each year.
If you reach the dental plan maximum partway through the year, the full coverage amount will again be available to you on January 1.
For Example:
Sam visits his dental hygienist for regular cleanings. Last year, he needed a crown and submitted the following claims:
Sam reached the annual maximum after his crown in April. He then had three choices:
- Continue with his routine oral exams and pay out of pocket for the remainder of the year (until December 31); OR
- Continue with his routine oral exams and use Health Care Spending Account (HCSA) to help cover his cost—in full or in part; OR
- Wait until his coverage maximum refreshes on January 1 and begin dental visits again.
Have a major dental treatment coming up?
Dental treatments beyond routine exams and x-rays can be expensive—like bridges, crowns, dentures, and wisdom tooth extractions. Ask your dental service provider for a pre-determination of coverage to get an estimate of the dental services being recommended so you can see before receiving treatment what will be covered by your plan, and how much you will have to pay. Some providers can submit this information electronically and in real time. A pre-determination is not required, but it can save you a lot of money.
Choose your dental provider with care, and ask about the dental fee guide.
Every province has a dental fee guide—the maximum recommended costs for dental treatments and services.
However…
Each dental provider sets their costs and may charge more, or less, than those listed in their province’s dental fee guide.
And…
Your plan will cover expenses up to the maximum amount outlined in your province’s current dental fee guide.
That means…
If your dental provider charges more than the dental fee guidelines, you will have to pay the remaining amount out of pocket.
Tip!
Dental fee guides are not always available online. Before scheduling an appointment, ask your dental provider about their fees, and how they compare to the current dental fee guide in your province.
For Example:
Bill just moved to a new neighbourhood and is looking for a new dentist. The dentist that is nearby charges $180 for a 1-hour dental cleaning. The cost for this service in Bill’s provincial dental fee guide is $150, which is the maximum amount your plan will pay.
Since Bill would be $30 out of pocket, he has three choices:
- Pay the remaining $30 out of pocket; OR
- Look for another dentist that charges less; OR
- Use his Health Care Spending Account (HCSA) to help cover his cost—in full or in part.
Orthodontic coverage for dependent children under age 21
What is covered?
- 100% up to a lifetime maximum of $3,600 for each dependent child
Eligible Services
- Orthodontic appliances, such as biteplates, braces, and retainers
- Oral exams related to orthodontic procedures and treatments
Ask your orthodontist for a pre-determination of coverage to get an estimate of the services being recommended so you can see before your child receives treatment what will be covered by your plan, and how much you may have to pay.
Your orthodontic coverage maximum is a lifetime maximum and does not reset at the beginning of the calendar year.
Once you reach the lifetime maximum, additional orthodontic expenses will not be paid.
For Example:
Marco is the legal guardian of his 11-year-old granddaughter, Julia. Two years ago, Julia had an orthodontic oral exam. Last year, Julia got braces.
Marco can also use his Health Care Spending Account (HCSA) to help cover the cost—in full or in part—once the $3,600 lifetime maximum has been reached.
