Dental Insurance - why insure?
Dental Insurance Plan Design
Diagnostic and Preventive
Members and their eligible dependents should regularly visit the dentist so that disease can be detected and treated as early as is reasonably possible.
With proper oral hygiene, it is reasonable for most people to see their dentist annually.
This level of service includes examinations, cleaning and X-rays.
Minor Restorative
If oral hygiene is not maintained, then scaling, fillings, extractions, periodontics (gum disease) and endodontics (root canal) may be required.
Major Restorative
Years of poor oral hygiene can result in the need for crowns, inlays, bridges and dentures.
Orthodontic
Braces are used to align irregular teeth. Most plans only cover dependents under the age of 19 for this benefit.
Adult orthodontia coverage in uncommon.
Benefit Schedule
Minor restorative, major restorative and orthodontic benefits often use
coinsurance to reduce cost and share the responsibility of dental health.
Major restorative claims are often reimbursed at 50% - 80% up to an annual maximum of $1,500 - $3,000.
Orthodontic claims are often reimbursed at 50% up to a lifetime maximum of $1,500 - $3,000.
The Dental Association Suggested Fee Guide for General Practitioners in effect
at the time of claim in the member's province of residence is normally used to
determine the maximum eligible charge for each procedure. It is possible to use the
Dental Association Suggested Fee Guide for Specialists. Some plan sponsors use
the prior year's Fee Guide or a specific year's Fee Guide to adjudicate claims.
Also see:
Disclaimer