Covered Dental Expenses

The percentage payable and the Calendar Year Maximum are specified in the “SUMMARY OF BENEFITS”.   Charges for reasonable and customary services and supplies specified below shall be considered covered expenses when incurred by you or a covered Dependent.  Eligible expenses include Basic and Preventive Treatment, Endodontics, Periodontics, Oral Surgery, Major Restorative and limited Prosthodontics.  An expense is eligible to the extent that coverage is not prohibited by provincial health insurance plans or because of other limitations described below or in the “SUMMARY OF BENEFITS”.

Diagnostic and Preventative Procedures:

1. oral hygiene instruction to the frequency specified in “SUMMARY OF BENEFITS”
2. oral examinations including scaling and cleaning of teeth to the frequency specified in “SUMMARY OF BENEFITS”
3. topical application of sodium or stannous fluoride to the frequency specified in “SUMMARY OF BENEFITS”
4. dental x-rays: single diagnostic x-rays; complete series or equivalent
5. consultations
6. full coverage restorations for primary teeth
7. passive space maintainers, those that do not move the teeth, and pit and fissure sealants for Dependent
8. Children under the age of 18 only
9. study casts to the frequency specified in “SUMMARY OF BENEFITS”

Minor Restorative Procedures:

1. extractions
2. amalgam, acrylic, silicate or composite fillings (amalgam only on molar teeth)
3. anaesthesia where reasonably and customarily required in connection with other covered procedures
4. occlusal equilibration to the frequency specified in “SUMMARY OF BENEFITS”
5. retentive pins
6. caries, trauma and pain control

Endodontic and Periodontic Procedures:

1. treatment of periodontal and other diseases of gums and tissues of the mouth,(special periodontal appliances)
2. emergency endodontic procedures and root canal therapy

Oral Surgery:

1. oral surgery including excision of impacted teeth

Dentures:

1. repairing, relining and rebasing of dentures to the frequency specified in the “SUMMARY OF BENEFITS"
2. denture adjustments
3. initial installation of partial or full removable dentures
4. replacement of existing partial or full removable denture(s) providing:
   i. the existing appliance is at least 5 years old and cannot be made serviceable; or,
   ii. the existing appliance is replaced as a result of the initial placement of an opposing denture.
   Replacement of lost or stolen dentures, the duplication of dentures and personalization or characterization of dentures is not covered.  A temporary appliance is considered to be permanent if not replaced within 12 months from the date the temporary appliance was inserted.