More on Dental Plans: Part II

Dental plans, unlike car or home insurance, offer benefits which provide a limited allowance towards funding dental care costs. That said dental benefits are still useful and valuable. There are thousands of different Dental Plans in Canada, and each delivers different benefits. Dental treatments are divided into three main groups* by the dental plan providers:
  1. Basic Treatment: Usually include examination, x-rays, fillings, root canal, cleanings etc.
  2. Major Treatment: Such as crowns, bridges and dentures
  3. Orthodontics
*Some treatments, such as root canals or extractions, can be considered basic or major treatments, depending on your Dental Plan.

Dental Plan $ Limit

Most Dental Plans limit treatment reimbursement to a certain dollar value. This means that once you are reimbursed that sum, additional treatment cost is not covered. Most plans have four categories used to limit your benefits:
  1. Overall (Annual) Limit
Generally, Dental Plans use the calendar year to define this annual limit. Importantly, if you do not use your benefits by the end of the year, they cannot be used the following year.
  1. Percentage Eligible for Reimbursement
Dental plan providers also use percentage “coverage” as an additional limit, meaning that in addition to all other limitations, you will be reimbursed for only a certain portion of the cost based on the Provincial Dental Fee Guide. For basic treatments, the percentage for reimbursement is approximately 70-100% generally. The percentage is smaller for major dental work, ranging from 0 (no reimbursement at all) to 80%.
  1. Deductible
The Deductible is the cost of dental treatment you have to pay out of pocket before a dental plan provider will pay any expenses. As the concept is confusing, it is not used frequently.
  1. Frequency and Other Limitations
Some Dental Plans may have a limitation on the number of a specific treatment per year – for instance, eight cleanings per calendar year, or a limited amount of x-rays. Repeated treatments, such as replacing fillings, are usually limited in frequency (e.g. once every two years). Other common limitations are treatments that are not covered (for example dental implants) or partially covered, white (composite) fillings on back (molar) teeth.

Is there a way through this maze?

To learn about your benefits you need to directly contact your insurance company. You can also find information in brochures from you Provider Plan (insurance company) or through the online portal. Examples include Pacific Blue Cross service Centre, Sun Life Customer sign-in, Great-West Life GroupNet, or Manulife Plan Member Secure Site. We are also here to help if you contact us at least 4 days prior to your appointment. We also ask you to be patient – if your treatment plan includes less common procedures, it may take longer for us to estimate the benefits.

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