Dental

• recall examination, once every 6 months initial or complete exams, once every 36 months
• specific or emergency exams
• complete series of x-rays (not eligible for dependants under 12) and periapical, up to 16 films
• including bitewings, 1 in any period of 36 months
• bitewings, not more than 4 films every 12 months
• panoramic, 1 in any period of 36 months
• polishing, 1 unit every 12 months
• scaling, 4 units per benefit year
• fluoride, every 12 months
• oral hygiene instruction, once every 12 months
• pit and fissure sealants
• anaesthesia, eligible when done in conjunction with a covered dental procedure

Minor Restorative
Coverage level of 50% (plus 20% student discount at Select Dentists) for services associated with dental health restoration, including:

• amalgam and tooth coloured fillings
• stainless steel and plastic full coverage restorations
• denture adjustments and repairs
• denture relining, rebasing and tissue conditioning
• recementation of fixed prosthesis 
• space maintainers and maintenance, under 15 years of age

 
Oral Surgery
Coverage level of 50% (plus 20% student discount at Select Dentists) for services associated with surgical extractions and root canals, including:

• simple extractions,
• impacted extractions,
• anaesthesia, when done in conjunction with Oral Surgery
• endodontics
• periodontics to 4 units per benefit year

 
Major Restorative
Discount of 20% at Select Dentists for services associated with major restoration including: crowns, bridges and dentures.


Payment of dental benefits is based on the General Practitioners Dental Association suggested fee guide (or the Insurance Reimbursement Rate set by CLHIA when a fee guide is not available) in the province where the services are rendered. Eligible expenses are the reasonable and customary charges for the items listed below, provided they are medically necessary for the treatment of disease or injury, prescribed by a physician or dentist and dispensed by a registered pharmacist or physician. Charges are considered reasonable and customary if they do not exceed the general level of charges made by other providers in the same geographical area.
 
Alternate Benefit
When there are 2 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. This Alternate Benefit Clause is in no way an attempt to change a treatment plan. The choice of treatment is a matter of agreement solely between the Insured and the dentist.
 
Select Dental Savings
To enhance your existing coverage, select dentists have agreed to help students by providing savings on certain plan eligible services. You must present your Care Card at each visit. For further information on participating dental offices, please visit the Student Benefits Plan Office or the website at www.gallivan.ca and view the Select Dental Savings tab on the left side menu bar.
 
Important! If you need to cancel your dental appointment, 24 hours notice is expected. If you do not give 24 hours notice, the dental office may charge a fee which is not covered under the plan.
 
Dental Specialist
Coverage is provided for the specialty services of an oral surgeon, endodontist, or periodontist when such specialty services are identified as eligible (based on plan design). For services provided by a dental specialist, payment is based upon the General Practitioners Dental Association suggested fee guide (or the Insurance Reimbursement Rate set by CLHIA when a fee guide is not available) in the province where the services are rendered.
 
Pre-determination/Pre-authorization
It is recommended to submit a pre-determination/pre-authorization to the insurance company prior to treatment of specialist services and any treatment plan. This determines how much of the claim the insurance company will pay, and the dollar amount that the student will be responsible for.
 
The insurance company will provide a written response to the student and dentist/specialist outlining eligible benefits. Pre-determinations are valid for a period of 90 days from date of issue.