TMSU - mystudentplan - Dental Benefits

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Student Health and Wellness! mystudentplan provides health, prescriptions, dental, mental health care plus additional benefits for eligible students.

Dental Benefits

The student dental plan can ease the costs of regular check ups, cleanings and a variety of dental procedures to make a plan for your oral health.

Coverage is a combination maximum of $750 per benefit year

Ask your dentist to submit a pre-authorization to Green Shield Canada prior to any dental treatment plan exceeding $500.

These are different treatments and coverages included:

Dental Benefits	Coverage
Basic Diagnostic and Preventive Services	80%	Complete oral examinations once every 3 benefit years Emergency and specific oral examinations Full series X-rays and panoramic X-rays once every 3 benefit years Bitewing X-rays once per benefit year Recall examinations once per benefit year Cleaning of teeth (up to 1 unit of polishing plus up to 1 unit of scaling) once per recall period Topical application of fluoride twice per benefit year for covered persons 19 years of age andunder Oral hygiene instruction once per lifetime Denture cleaning once per recall period Pit and fissure sealants on molars only Space maintainers Protective mouth guards once per benefit year
Comprehensive oral surgery	10%	Surgical exposure, repositioning, transplantation or enucleation of teeth. Remodeling and recontouring - shaping or restructuring of bone or gum. Excision - removal of cysts and tumors. Incision - drainage and/or exploration of soft or hard tissue. Fractures including the treatment of the dislocation and/or fracture of the lower or upper jaw and repair of soft tissue lacerations. Maxilofacial deformities - frenectomy - surgery on the fold of the tissue connecting the lip to the gum or the tongue to the floor of the mouth.
other basic services	75%	Basic Restorative Services: Amalgam, tooth coloured filling restorations, and temporary sedative fillings. Inlay restorations - these are considered basic restorations and will be paid to the equivalent nonbonded amalgam. Basic oral surgery: Extractions of teeth and/or residual roots. General anaesthesia, deep sedation, and intravenous sedation in conjunction with eligible oral surgery only. Standard denture services: Denture repairs and/or tooth/teeth additions. Standard relining and rebasing of dentures, once every 3 benefit years, only after 6 months have elapsed from the installation of a denture. Denture adjustments and remount and equilibration procedures, only after 3 months have elapsed from the installation of a denture. Soft tissue conditioning linings for the gums to promote healing. Remake of a partial denture using existing framework, once every 5 benefit years.
Comprehensive Basic Services	10%	Endodontic treatment including: Root canal therapy. Pulpotomy (removal of the pulp from the crown portion of the tooth). Pulpectomy (removal of the pulp from the crown and root portion of the tooth). Apexification (assistance of root tip closure). Apical curettage, root resections and retrograde fillings (cleaning and removing diseased tissue of the root tip). Root amputation and hemisection. Bleaching of non-vital tooth/teeth. Emergency procedures including opening or draining of the gum/tooth. Periodontal treatment of diseased bone and gums including: Occlusal equilibration - selective grinding of tooth surfaces to adjust a bite 4 time units per benefit year. Bruxism appliance once every 2 benefit years. The fees for periodontal treatment are based on units of time (15 minutes per unit) and/or number of teeth in a surgical site in accordance with the General Practitioners Fee Guide.
Periodontal scaling and/or root planing	80%	periodontal scaling and/or root planing 1-time unit per benefit year.
Major Services	10%	Standard onlays or crown restorations to restore diseased or accidentally injured natural teeth, once every 5 benefit years. Standard bridges, including pontics, abutment retainers/crowns on natural teeth, once every 5 benefit years. Standard dentures including complete, immediate, transitional, and partial dentures, once every 5 benefit years. Standard repair or recementing of crowns, onlays and bridge work on natural teeth.
Orthodontic Services	10%	Reimbursement for in-person orthodontic treatment to straighten teeth and/or correct the bite. This plan does not provide coverage for any virtual/tele-orthodontics. Receipts for payment must be received by Green Shield Canada no later than 12 months from the date the service is incurred while treatment is in progress, not at the end of the treatment.

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 Health Plan. it's important to review and understand exclusions to the plan before using your benefits.

No benefit is payable for:

Services or supplies received as a result of disease, illness or injury due to:
- Intentionally self-inflicted injury while sane or insane;
- An act of war, declared or undeclared;
- Participation in a riot or civil commotion; or
- Committing a criminal offence;
Services or supplies provided while serving in the armed forces of any country;
Failure to keep a scheduled appointment with a legally qualified dental practitioner;
The completion of any claim forms and/or insurance reports;
Any dental service that is not contained in the procedure codes developed and maintained by the Canadian Dental Association, adopted by the provincial or territorial dental association of the province or territory in which the service is provided (or your province of residence if any dental service is provided outside Canada) and in effect at the time the service is provided;
Implants and related services;
Restorations necessary for wear, acid erosion, vertical dimension and/or restoring occlusion;
Appliances related to treatment of myofacial pain syndrome including all diagnostic models, gnathological determinants, maintenance, adjustments, repairs and relines;
Posterior cantilever pontics/teeth and extra pontics/teeth to fill in diastemas/spaces;
Service and charges for sleep dentistry;
Diagnostic and/or intraoral repositioning appliances including maintenance, adjustments, repairs and relines related to treatment of temporomandibular joint dysfunction;
Any specific treatment or drug which:
- Does not meet accepted standards of medical, dental or ophthalmic practice, including charges for services or supplies which are experimental in nature, or is not considered to be effective (either medically or from a cost perspective, based on Health Canada's approved indication for use);
- Is an adjunctive drug prescribed in connection with any treatment or drug that is not an eligible service;
- Will be administered in a hospital;
- Is not dispensed by the pharmacist in accordance with the payment method shown under the Health Benefit Plan Prescription Drugs benefit; or
- Is not being used and/or administered in accordance with Health Canada's approved indication for use, even though such drug or procedure may customarily be used in the treatment of other illnesses or injuries; or
Services or supplies that:
- Are not recommended, provided by or approved by the attending legally qualified (in the opinion of Green Shield Canada) medical practitioner or dental practitioner as permitted by law;
- Are legally prohibited by the government from coverage;
- You are not obligated to pay for or for which no charge would be made in the absence of benefit coverage; or for which payment is made on your behalf by a not-for-profit prepayment association, insurance carrier, third party administrator, like agency or a party other than Green Shield Canada, your plan sponsor or you;
- Are provided by a health practitioner whose license by the relevant provincial regulatory and/or professional association has been suspended or revoked;
- Are not provided by a designated provider of service in response to a prescription issued by a legally qualified health practitioner;
- Are used solely for recreational or sporting activities and which are not medically necessary for regular activities;
- Are primarily for cosmetic or aesthetic purposes, or are to correct congenital malformations;
- Are provided by an immediate family member related to you by birth, adoption, or by marriage and/or a practitioner who normally resides in your home. An immediate family member includes a parent, spouse, child or sibling;
- Are provided by your plan sponsor and/or a practitioner employed by your plan sponsor, other than as part of an employee assistance plan;
- Are a replacement of lost, missing or stolen items, or items that are damaged due to negligence (replacements are eligible when required due to natural wear, growth or relevant change in your medical condition but only when the equipment/prostheses cannot be adjusted or repaired at a lesser cost and the item is still medically required);
- Are video instructional kits, informational manuals or pamphlets;
- Are delivery and transportation charges;
- Are a duplicate prosthetic device or appliance;
- Are from any governmental agency which are obtained without cost by compliance with laws or regulations enacted by a federal, provincial, municipal or other governmental body;
- Would normally be paid through any provincial health insurance plan, Workplace Safety and Insurance Board or tribunal, or any other government agency, or which would have been payable under such a plan had proper application for coverage been made, or had proper and timely claims submission been made;
- Relates to treatment of injuries arising from a motor vehicle accident; Note: Payment of benefits for claims relating to automobile accidents for which coverage is available under a motor vehicle liability policy providing no-fault benefits will be considered only if:
  - The service or supplies being claimed is not eligible; or
  - The financial commitment is complete (a letter from your automobile insurance carrier will be required); or
- Are cognitive or administrative services or other fees charged by a provider of service for services other than those directly relating to the delivery of the service or supply.

Fall Deadline
Submit your online Family Add-On, Opt-Out, or Opt-In applications by October 4^th, 2024

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Benefits Plan Office

Email: tmsu@mystudentplan.ca
Phone: 416-979-5000 Extension 552358
Address: 55 Gould Street, Student Centre (SCC) lobby.
Toronto, Ontario M5B 1E9, CA

General Inquiries Line

Monday to Friday
from 8:00am to 7:00pm EST
Phone: 1-877-746-5566

Dental Benefits

Coverage is a combination maximum of $750 per benefit year

Limitations and Exclusions to Dental Benefits

Benefits Plan Office

General Inquiries Line

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