My Benefits

Dental 

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 $500.

Your plan covers up to a maximum of $750 per benefit year.

Camosun College Dental Clinic
Included with your dental plan is the option to visit the Camosun College Dental Clinic which provides diagnostic and preventive services to students. Should you choose to visit the Dental Clinic, your diagnostic & preventive benefits will be covered at 100% including one annual exam, x-rays, polishing, scaling and fluoride once per benefit year. Please contact CCSS Member Services for further information and booking appointments with the Dental Clinic.

Note: you are encouraged but not required to use the Camosun dental clinic.

Diagnostic & Preventative
Your plan covers 80% of diagnostic and preventative procedures including:
• recall examination, 1 per benefit year
• initial or complete examination, once per dentist in a lifetime
• complete series of x-rays, up to 16 films including bitewings, 1 in any 36 month period, not eligible for dependent children under 12
• bitewings, 1 per benefit year
• panoramic, 1 in any 36 month period
• polishing, 1 unit per benefit year
• scaling, 2 units per benefit year
• fluoride, for dependent children under the age 19, 1 treatment in a benefit year
• oral hygiene instruction, one treatment per lifetime
• pit & fissure sealant, for dependent children under the age 19, once per molar in any 36 month period

Restorative
Your plan covers 70% for services associated with dental health restoration, including:
• amalgam (silver) fillings and composite resin (tooth coloured)
• stainless steel and plastic full coverage restoration, for dependent children under the age of 15, 1 per tooth in any 36 month period
• recementation of fixed prosthetics
• denture adjustments and repairs
• denture relining, rebasing and tissue conditioning, once every 36 months
• space maintainers & maintenance for dependent children under the age 15, one per space, per benefit year

Extractions
Your plan covers 50% for services associated extractions, including:
• extractions, not more than 2 wisdom teeth per benefit year
• anaesthesia, eligible when done in conjunction with oral surgical procedures

Endodontic
Your plan covers 50% for endodontic services including:
• root canal therapy

Periodontic
Your plan covers 50% for periodontic services including:
• additional scaling and/or root planing, maximum of 2 units per benefit year
• occlusal equilibration, not more than 4 units per benefit year
• periodontal appliances, not more than 1 appliance per arch in any 24 month period
• periodontal appliance repairs, maintenance and adjustments, 4 adjustments per benefit year
• oral surgical procedures
• anaesthesia, eligible when done in conjunction with oral surgical procedures

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