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 $300.
Your plan covers up to a maximum of $750 per benefit year (Sept. 01 ~ Aug, 31), International students are covered by GuardMe which provides emergency coverage only.
Diagnostic & Preventative
Your plan covers 100% for diagnostic and preventative procedures including:
One examination and consultation during each benefit year, including any
necessary x-rays and diagnostic services at the time of the
• one cleaning and one unit of polishing; includes up to 4 units of scaling (above the gum line).
• Fluoride treatments will be limited to one per policy year.
• complete oral examinations
• recall oral examinations
• emergency or specific oral examinations
• full mouth series, minimum 16 films, including bitewings in any 36 consecutive months
• panorex (one in any 36 consecutive months)
• periapical (no more than 16 films in any 36 consecutive months)
• occlusal (no more that 4 films in 12 consecutive months)
• bitewing (no more than 4 films in 12 consecutive months)
• one cleaning and one unit of polishing, including up to 4 units of scaling (above the gum line).
• fluoride treatments will be limited to one per benefit year
Your plan covers 75% for services associated with minor restoration, including:
• amalgam, silicate and composite fillings;
• tooth-coloured fillings, limited to once every two years on the same tooth surfaces.
• space maintainers (for a Dependent Child only, up to and including 15 years of age).
• tooth-coloured fillings are covered provided no more than 24 consecutive months have elapsed since the last restoration
• multiple restorations on a common surface placed on the same service date will be considered a single restoration
• maximum benefit payable will not exceed the fee for a 5 surface restoration regarding the same tooth during one sitting
Your plan covers 75% for services associated with surgical extractions, including:
• extractions and residual root removal, limited to two wisdom teeth in any policy year
Your plan covers 10% for endodontic services including
where applicable, treatment plan, local anaesthesia, tooth isolation,
clinical procedures, sutures, appropriate radiographs and follow-up care
• pulpotomy (not in conjunction with root canal therapy if rendered within 30 days)
• root canal therapy
• periapal sevices
• root amputation
• intentional removal, apical filling and reimplantation
Periodontic and Other Oral Surgery
Your plan covers 10% for periodontic services including:
• non-surgical procedures
• definitive surgical procedures
• adjunctive surgical procedures
• occlusal equilibration
• periodontal appliances including impression and insertion (one appliance per arch in 24 consecutive months)
• periodontal appliance repair, maintenance and adjustment (no more that 4 units in any benefit year)
Major Restorative (crowns/bridges/dentures)
Your plan covers 10% of major restorative services including:
Most of the services listed below will be replaced only if the existing
appliance is at least 5 years old. If the appliance is temporary and
being replaced with a permanent appliance within 12 months of the
installation of the temporary appliance, or if the appliance was
necessary due to the extraction of one natural tooth.
• crowns, including treatment plan, occlusal records, local anaesthesia,
subgingival preparation of the tooth and supporting structures,
removal of decay and old restoration, tooth preparations, pulp
protection, impressions, temporary coverage, insertion, occlusal
adjustment and cementation, repairs and removal.
• removable prosthodontics will include, where applicable, treatment
plan, impressions, jaw relation records, try-in, insertion, occlusal
equilibration and 3 months post-insertion care on complete dentures,
transitional dentures, acrylic dentures and cast partial dentures.
• fixed prosthodontics will include, where applicable, treatment plan,
occlusal records, local anaesthesia, subgingival preparation of the
tooth and supporting structures, removal of decay and old restoration,
tooth preparation, pulp protection, impressions, temporary coverage,
splinting, intraoral indexing for soldering purposes, insertion,
occlusal adjustments and cementation on pontic, retainers, abutments and