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MAJOR RESTORATIVE TREATMENTS (90%)

Extensive Restorations

  • Inlays/onlays/crowns (once per tooth every five calendar years) but not for cosmetic reasons or if a filling or denture would suffice.
  • Complete permanent and temporary dentures (once every five consecutive calendar years)
  • Partial permanent and temporary dentures (once every five consecutive calendar years) including repair and replacement

Note: The Plan does not cover replacement of a denture unless it is at least 5 years old and cannot be made serviceable, nor the replacement of dentures that may have been lost, mislaid or stolen

Prosthodontic Services

  • Permanent and temporary bridgework (once every five consecutive calendar years)
  • Restorations over implants (i.e. crowns, bridgework and dentures) (once per tooth every five consecutive calendar years) and repairs

Removable denture adjustments Minor adjustments

  • Repairs and additions
  • Rebasing and relining (one per two consecutive calendar years) Other basic prosthetic services, tissue conditioning
  • Includes adjustments to initial or replacement partial or complete denture and fixed bridge restoration after the 3-month post-insertion period (care in the 3-month post-insertion period is included in the initial expense)

The initial request for dentures or bridgework must be as a result of the extraction of one or more natural teeth while covered under the Plan.

THE MAXIMUM ANNUAL BENEFIT FOR ROUTINE AND MAJOR TREATMENTS COMBINED IS $3,000 PER INDIVIDUAL

THERE IS ALSO A CONCURRENT LIFETIME MAXIMUM BENEFIT OF $3,000 PER INDIVIDUAL FOR MAJOR DENTAL TREATMENTS (excluding repairs, rebases and relining of dentures). Both limits apply and no benefit is payable if either limit is reached.

When an alternative treatment exists, the Plan will pay for the least expensive treatment that is consistent with good health management or accepted dental practice. For example, the Plan would pay towards the cost of a metal crown rather than a porcelain crown on a molar.


DENTAL IMPLANTS

Dental implants are not normally a covered expense under the Plan. However, you may be able to use the benefit otherwise available to replace an existing tooth under an alternative eligible treatment (fixed bridgework or partial denture) towards the cost of a dental implant but only for that specific tooth and up to the maximum that would have been paid for the least expensive professionally adequate alternative treatment. No other coverage will be available for any other dental procedure on that tooth, or the two adjacent teeth, for at least five years. If the Plan pays for a partial denture, any teeth the partial denture would have replaced are also subject to the five year rule.

Effective July 1, 2017 – The Dental Plan will be expanded to include Dental Implants directly as opposed to the alternate coverage options noted above. Current reimbursement percentages, annual and life time maximums will continue to apply along with a 10-year limit on an implant for each tooth.