Dental Care

Dental care is an important part of overall health. The cost of dental services, whether it is routine preventive care or an unexpected problem, can have a serious impact on a household budget if no assistance is available. Your dental care coverage provides financial assistance for a number of services specified.

coverage provided by Manulife Financial

Overview of Dental Care Benefits

Plan Design

Deductible: $25 Individual, $50 Family (per calendar year)

Deductible Carry-Forward: Covered Expenses used to satisfy a Deductible in the last 3 months of a calendar year may also be used to satisfy the Deductible in the following calendar year.

Services Coverage Maximums
Level I – Basic Services 100% $2,000 per calendar year combined for Level I and Level II and Level III and Level IV
Level II – Supplementary Basic Services 100%
Level III – Dentures 50%
Level IV – Major Restorative Services 50%
Level V – Orthodontics 50% $2,000 per lifetime for Level V

Services are covered at rates as outlined in the current Fee Guide for General Practitioners for your Province of residence. For plan members residing in Alberta, the current Fee Guide is considered to be the 1997 Alberta Dental Association Fee Guide for General Practitioners, plus inflationary adjustments as determined by the carrier.

Should your Dentist charge fees in excess of the Fee Guide, the additional costs will not be covered.

Covered Expenses

Expenses for the services outlined below are covered if they:

  • are incurred for the necessary dental care of an insured person while insured under this benefit;
  • are incurred for services provided by a Dentist, a dental hygienist working within the scope of the dental hygienist’s license, or a denturist working within the scope of the denturist’s license;
  • are reasonable as determined by the insurer, taking all factors into account; and
  • do not exceed the fees recommended in the Dental Fee Guide, or Reasonable and Customary charges as determined by Manulife Financial, if the expenses are not listed in the Dental Fee Guide.

Predetermination

If the cost of any proposed dental treatment is expected to exceed $500, it is recommended that you submit a detailed treatment plan, available from your Dentist, before the treatment begins. You can then be advised of the amount you are entitled to receive under this benefit.

Alternate Treatment

Where any two or more courses of treatment covered under this benefit would produce professionally adequate results for a given condition, Manulife Financial will pay benefits as if the least expensive course of treatment were used. Manulife Financial will determine the adequacy of the various courses of treatment available, through a professional dental consultant.

Five Levels of Service

Level I - Basic Service

Coverage: 100% up to $2,000 per calendar year in combination with Levels II, III and IV

Expenses covered under Level I include:

  • complete oral exam, one per 2 calendar years;
  • full-mouth x-rays, one per 2 calendar years;
  • one unit of light scaling and one unit of polishing once every 6 months, when the service is performed outside Quebec, or prophylaxis (light scaling and polishing) once every 6 months, when the service is performed in Quebec;
  • recall exams, bitewing x-rays, and fluoride treatments, once every 6 months;
  • routine diagnostic and laboratory procedures;
  • initial oral hygiene instruction, plus one recall;
  • fillings, retentive pins, and pit and fissure sealants, replacement fillings are covered provided:
    • the existing filling is at least 12 months old and must be replaced either due to significant breakdown of the existing filling or recurrent decay, or
    • the existing filling is amalgam and there is medical evidence indicating that the patient is allergic to amalgam;
  • pre-fabricated full coverage restorations (metal and plastic);
  • space maintainers (excluding appliances placed for orthodontic purposes);
  • minor surgical procedures and post surgical care;
  • extractions (including impacted and residual roots);
  • consultations, anesthesia, and conscious sedation;
  • denture repairs, relines and rebases, only if the expense is incurred later than 3 months after the date of the initial placement of the denture;
  • injection of antibiotic Drugs when administered by a Dentist in conjunction with dental surgery.

Level II - Supplementary Basic Services

Coverage: 100% up to $2,000 per calendar year in combination with Levels I, III and IV

Expenses covered under Level II include:

  • surgical procedures not included in Level I (excluding implant surgery);
  • periodontal services for treatment of diseases of the gums and other supporting tissue of the teeth, including:
    • scaling not covered under Level I, and root planing, up to a combined maximum of 8 units per calendar year;
    • provisional splinting; and
    • occlusal equilibration, up to a maximum of 8 units per calendar year;
  • endodontic services which include root canals and therapy, root amputation, apexifications and periapical services;
  • root canals and therapy are limited to one initial treatment plus one re-treatment per tooth per lifetime;

re-treatment is covered only if the expense is incurred more than 12 months after the initial treatment.

Level III - Dentures

Coverage: 50% up to $2,000 per calendar year in combination with Levels I, II and IV

Expenses covered under Level III include:

  • initial provision of full or partial removable dentures;
  • replacement of removable dentures, provided the dentures are required because:
    • a natural tooth is extracted and the existing appliance cannot be made serviceable;
    • the existing appliance is at least 60 months old and cannot be made serviceable; or

the existing appliance is temporary and is replaced with the permanent dentures within 12 months of its installation.

Level IV - Major Restorative Services

Coverage: 50% up to $2,000 per calendar year in combination with Levels I, II and III

Expenses covered under Level IV include:

  • crowns, onlays and veneers when the function of a tooth is impaired due to cuspal or incisal angle damage caused by trauma or decay;
  • inlays, covering at least 3 surfaces, provided the tooth cusp is missing;
  • initial provision of fixed bridgework;
  • replacement of bridgework, provided the new bridgework is required because:
    • a natural tooth is extracted and the existing appliance cannot be made serviceable;
    • the existing appliance is at least 60 months old and cannot be made serviceable; or

the existing appliance is temporary and is replaced with the permanent bridge within 12 months of its installation.

Level V - Orthodontics

Coverage: 50% up to $2,000 per lifetime

Orthodontic services are for Dependent Children only, provided treatment commences prior to reaching age 18.

Caveats

Work in Progess when Coverage Terminates

Covered Expenses related to dental treatment that was in progress at the time your dental benefits terminate (for reasons other than termination of the Group Policy or the Dental Care Benefit) are payable, provided the expense is incurred within 31 days after your benefit terminates.

Subtogation (Third Party Liability)

If your dental expenses result from an injury caused by another person and you have the legal right to recover damages, the carrier may request that you complete a subrogation reimbursement agreement when you submit a claim for such expenses. On settlement or judgment of your legal action, you will be required to reimburse the carrier those amounts you recover which, when added to the payments you received from the carrier, exceed 100% of your incurred expenses.

What the Plan Does Not Cover

No Dental Care benefits will be payable for expenses resulting from:

  • self-inflicted injuries;
  • war, insurrection, the hostile actions of any armed forces or participation in a riot or civil commotion;
  • the committing of or the attempt to commit an assault or criminal offence;
  • injuries sustained while operating a motor vehicle while under the influence of any intoxicant, including alcohol;
  • dental care which is cosmetic, unless required because of an accidental injury which occurred while the patient was insured under this benefit;
  • anti-snoring or sleep apnea devices;
  • broken dental appointments, third party examinations, travel to and from appointments, or completion of claim forms;
  • services which are payable by any government plan;
  • services or supplies provided by an employer’s medical or dental department;
  • services or supplies for which no charge would normally be made in the absence of insurance;
  • treatment rendered for a full mouth reconstruction, for a vertical dimension or for a correction of temporomandibular joint dysfunction;
  • replacement of removable dental appliances which have been lost, mislaid or stolen;
  • laboratory fees which exceed Reasonable and Customary charges;
  • services or supplies which are performed or provided by the insured person, an Immediate Family Member or a person who lives with the insured person;
  • implants, or any services rendered in conjunction with implants;
  • treatment which is not generally recognized by the dental profession as an effective, appropriate and essential form of treatment for the dental condition;
  • services or supplies which are not specified as a covered expense under this benefit.