Dental

You may choose the level of coverage that best suits your and your family’s needs. You also have the option of just choosing coverage for yourself; or yourself and one dependent; or for you and all your dependents; or you may opt out of coverage altogether.

If you elect a lower level of coverage, you will have more Flex Credits to use elsewhere. If you elect Option 2 or 3, you may be required to pay for the cost of this coverage through payroll deduction.

Core coverage is the default coverage (member only) if you do not enrol during your initial enrolment period.

Option 2 and 3 have a two year lock in provision.

Eligible Expenses

To qualify for coverage, the expenses must be allowable under the plan and the dentist’s charges must be reasonable and customary. Expenses will be reimbursed according to the Dental Association Schedule of Fees in your province of residence which is in effect at the time of the service.

	Opt-Out (No Coverage)	Option 1	Option 2	Option 3
Deductible	No Coverage	$25 for member $50 for member + 1 $100 for member + 2 or more	$25 for member $50 for member +1 $75 for member + 2 or more	No deductible
Termination Age	No Coverage	Retirement	Retirement	Retirement
Dental Fee Guide	No Coverage	Current provincial fee guide for General Practitioners (except Alberta)	Current provincial fee guide for General Practitioners (except Alberta)	Current provincial fee guide for General Practitioners (except Alberta)
Recall Examination Frequency	No Coverage	Once every 9 months	Once every 9 months	Once every 6 months
Basic Services	No Coverage	80%	90%	100%
Supplementary Services	No Coverage	80%	90%	100%
Major Services	No Coverage	No Coverage	50%	60%
Periodontics and Endodontics	No Coverage	80%	90%	100%
Combined Annual Maximums	No Coverage	$1,000 per calendar year, per person for Basic and Supplementary Services, Periodontics and Endodontics	$1,500 per calendar year, per person for Basic and Supplementary Services, Periodontics and Endodontics $1,500 per calendar year, per person for Major Services	No maximum for Basic and Supplementary Services, Periodontics and Endodontics $2,500 per calendar year, per person for Major Services
Orthodontics	No Coverage	No Coverage	50% up to a lifetime maximum of $2,000 per person	60% up to a lifetime maximum of $3,000 per person

Basic Services include:

• Oral examinations
• Bite-wing or full mouth x-rays (subject to limitations)
• Scaling and polishing of teeth
• Topical application of an anti-cariogenic agent
• Extractions, including extraction of impacted teeth
• Removal of tumors, cysts, neoplasms, plus the incision and drainage of an abscess
• Amalgam, silicate, acrylic and composite fillings
• Space maintainers for missing primary teeth, and habit-breaking appliances
• Repair, relining and rebasing of existing denture
• Repair of an existing bridge
• Oral surgery and anesthesia where reasonably and customarily required

Supplementary Services include:

• Endodontic services (i.e., root canal 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 if the expense is incurred more than 12 months after the initial treatment.
• Periodontic services (i.e., treatment of diseases of the gums and other supporting tissue of the teeth including surgery, provisional splinting and occlusal equilibration).
  

Major Services include:

• Initial creation of bridge or denture
• Replacement of an existing bridge or denture, only under the following circumstances:
  • if necessitated by the extraction of additional teeth while insured under the policy; or
  • if the existing bridge or denture cannot be made serviceable and is at least 60 months old; or
  • if the existing bridge or denture is temporary and is replaced with a permanent bridge or denture within 12 months
• Onlays when the major portion of the clinical crown is decayed, heavily filled or the cusps are fractured and cannot be restored using Basic dental services
• Crowns, including gold or porcelain, where other less expensive material is not suitable. If crowns are required on molar teeth, reimbursement will be based on the cost of metal material only
• Inlays involving extensive restoration dentistry when three or more tooth surfaces are involved and the tooth cannot be restored using material under Basic services
• Injection of antibiotic drugs when prescribed by a dentist
• Other necessary oral surgical procedures not specifically listed under Basic services

Orthodontic Services include:

• All dental treatment required to correct malocclusion of the teeth (i.e., straightening of the teeth)
• Sealants for teeth in connection with orthodontic procedures

Treatment Plan

In order for you and your dentist to learn in advance how much the Dental Plan will cover and how much you will have to pay, it is recommended that you submit a Treatment Plan to Manulife when the total cost of the proposed dental work is expected to exceed $500. This Treatment Plan identifies coverage and limitations for specific services.

A Treatment Plan is a plan of dental treatment (including x-rays if required) showing the patient’s dental needs and the proposed treatment necessary in the professional judgment of the dentist.

The Treatment Plan is not intended to limit you in your choice of dentist, or to tell you or your dentist what treatment should be performed, or to tell the dentist what fee to charge, nor is it intended to guarantee reimbursement after coverage ceases.

Expenses Not Covered

The Dental Plan does not cover the following expenses:

• Replacement of a lost or stolen dental appliance
• Dental services or supplies that are primarily for cosmetic dentistry (i.e. full-mouth reconstruction, vertical dimension correction or correction to temporal mandibular joint dysfunction)
• Dental treatment received from a dental or medical department maintained by an employer, an association or a labour union
• Charges that are considered an insured service of the Provincial Health Insurance Plan
• Examinations required for use of a third party
• Dentist’s time spent traveling, broken appointments, transportation costs, room rental charges or advice given by the telephone or any other means of telecommunication
• Surgical procedures or treatments performed primarily for beautification or charges for hospital confinement for such surgical procedures or treatments, unless such surgery or treatment is for eligible accidental injuries and commenced within 90 days of the accident
• Occupational injury or disease covered by any Workers’ Compensation law
• Charges that would not normally have been incurred but for the presence of this coverage or for which you or your dependent is not legally obligated to pay
• Charges for services or supplies resulting from any intentionally self-inflicted injury or illness, while sane or insane
• Experimental medical procedures or treatment not approved by the Provincial Medical Association or the appropriate medical specialty society
• Charges which the insurer is not permitted, by any law or regulation, to cover
• Services or supplies not provided by a legally qualified dentist or denturist acting within the scope of his or her license