Dental Plan Coverage
The majority of Canadians are provided with health and dental plans through their employer as part of their employee benefit package. Many dental benefit plans provide coverage for preventive care, as well as for the treatment of a host of dental health conditions and problems.
The actual coverage you receive will depend on how much you and your employer or union have agreed to pay toward the costs of your dental care, and the specific benefits that they have agreed to provide.
Remember, your dental plan is not a treatment plan. You should not allow your dental plan to dictate the care you receive. Only you and your dentist can decide the treatment plan that best meets your specific needs and circumstances.
What types of services will my dental plan cover?
Dental plans provide employees with prepaid coverage for a variety of dental procedures. A good dental plan should provide you and your family with assistance in paying for your family’s care, including an appropriate preventive care program, as well as assistance in covering the costs associated with more extensive restorative and corrective procedures.
Ask your employer for an up-to-date explanation of your plan, written in plain language, and read through it carefully.
To help you determine which services are covered, your dentist can submit a treatment plan – outlining the treatment that you have mutually agreed upon – to the plan carrier for a pre-determination of benefits.
Some things to watch for
Dental benefit plans are contracts, and are usually written in legal terms that are difficult to understand. In most cases, the plan carrier or your employer will be able to provide a written explanation of your plan in plain language.
This is a good start, but remember that this explanation is not the actual contract. If you’re not certain about some points, ask your employer or the plan carrier for clarification.
Your actual coverage will depend on how much your employer or union has agreed to pay toward the costs of your dental care, and the specific benefits that your employer or union has agreed to provide.
You may also be required to pay an annual deductible or to make co-payments, depending on the type of treatment you require and the provisions of your dental plan. Remember, the purpose of the dental plan is to assist you in paying for dental treatment; most plans do not cover the entire cost of all treatment required.
Here are some questions to ask:
|1.||Who controls treatment decisions?
Do I decide in consultation with my dentist or does my plan direct the treatment I’ll receive?
|2.||Can I receive care from a specialist?
Can my dentist and I choose the specialist?
|3.||Who is covered? Myself? My whole family?|
|4.||Will my plan provide benefits if I’m covered by another plan?|
|5.||Can I freely choose my own dentist, or am I required to choose my dentist from a list provided by my employer?|
|6.||How many visits to the dentist are covered each year?
Can I see my dentist when I need to and schedule appointments that are convenient to me?
|7.||Does my plan have a deductible?|
|8.||Is there a total dollar limit on my coverage?|
|9.||Can I keep my coverage if I change jobs?|
|10.||Am I covered during a strike or layoff?|
|11.||To what extent am I covered for basic preventive care?
(e.g. examinations, sealants, cleanings, X-rays, fluoride applications)
|12.||To what extent am I covered for basic dental treatments?
(e.g. fillings, periodontal treatments, root canals)
|13.||What about other treatments?
(e.g. bridges or crowns, dentures, oral surgery, cosmetic treatments)