Coverage is a combined maximum of $750 per benefit year
Ask your dentist to submit a pre-authorization to Canada Life prior to any dental treatment plan exceeding $500.
These are the different treatments and coverages included:
| Dental Benefits |
Coverage |
| Diagnostic & Preventative |
80% |
- 1 recall examination per benefit year.
- Initial or complete examination, once per dentist in a lifetime.
- Complete series of x-rays
Maximum 16 films including bitewings in any period of 36 months. Not eligible for dependants under 12 and periapical.
- Bitewings
Maximum 4 films per benefit year.
- Panoramic
1 in any period of 36 months.
- Scaling
2 units per benefit year.
- Polishing
1 unit per benefit year.
- Oral hygiene instruction
1 treatment per lifetime.
- Fluoride
Under 19 years of age, 2 treatments per benefit year.
- Pit and fissure sealants
Under 19 years of age, 1 per molar in any period of 36 months.
- Space maintainers and maintenance
Under 15 years of age, 1 per space per benefit year.
- Anaesthesia
Eligible when done in conjunction with a covered dental procedure.
|
| Minor Restorative |
70% |
- Space maintainers and maintenance
Under 15 years of age.
- Amalgam and tooth coloured fillings
1 per tooth in any period of 24 months.
- Stainless steel and plastic full coverage restorations
Under 15 years of age, 1 per tooth in any period of 36 months.
- Denture adjustments and repairs.
- Relining, rebasing and tissue conditioning
One treatment in any period of 36 months.
- Re-cementation of existing restorations.
|
| Extractions |
50% |
- Extractions
Maximum 2 wisdom teeth per benefit year.
|
| Endodontic, Periodontic and Other Oral Surgery |
15% |
- Root canal therapy
- Occlusal equilibration
Maximum 4 units per benefit year.
- periodontal appliances
Maximum 1 appliance per arch in any period of 24 months.
- periodontal appliance repairs, maintenance and adjustments
Maximum 4 adjustments per benefit year.
- other oral surgical services
- additional scaling and/or root planing
Maximum of 2 units per benefit year.
|
| Major Restorative |
15% |
Replacement of an existing crown or bridge is an eligible expense if the replacement is required to replace an existing crown or bridge, which was installed 5 years before the replacement.
|
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.
Limitations and Exclusions to Dental Benefits
An exclusion is a condition or instance that is not covered by the Dental Plan. It's important to review and understand exclusions to the plan before using your benefits.
No benefit is payable for:
- Any cause for which the insured may apply for and receive protection, exemption or compensation under any Workers' Compensation Act;
- Self-inflicted injuries while sane or insane;
- Services or supplies received outside of Canada;
- Committing or attempting to commit a criminal offence or provoking an assault;
- Any group or policyholder sponsored dental care or treatment;
- Any dental care, treatment or supplies primarily for cosmetic purposes;
- Failing to keep scheduled appointments;
- File transfers, the completion of claim forms or other documentation;
- Any dental treatment for the correction of temporomandibular joint dysfunction;
- Expenses for treatment of root canal therapy, inlays, onlays, crowns, veneers, and bridges started prior to becoming an insured member/dependant under this plan;
- Replacement of mislaid, lost or stolen appliances;
- Expenses for crowns placed on a tooth not functionally impaired by incisal angle or cuspal damage;
- Any charges incurred for other than metal only crowns or pontics, posterior to the second bicuspid tooth;
- Expenses for full mouth reconstructions for vertical dimension correction or to repair or restore teeth damaged or worn due to attrition or vertical wear or to restore occlusion;
- Any services or supplies for implantology, including tooth implantation and surgical insertion of fabricated implants;
- Any dental procedure which is not listed in the descriptions of dental benefits indicated herein;
- Charges that are in excess of the fees stated in the Dental Association General Dentist Fee Guide applicable to this benefit;
- Where coverage for services is provided under any government plan;
- War, insurrection or hostilities of any kind, whether or not the insured was a participant in such actions;
- Participation in any riot or civil commotion;
- Where services would be provided without charge in the absence of this policy; or
- Any other exclusions identified in the policy contract.