The Dental Benefit is underwritten by Manulife Financial.

The Dental Expense Benefit has been designed to help you meet the cost of today's dental services and to facilitate a sound program of dental hygiene for you, your spouse and dependent children.

Co-Insurance

Alternative Services

Eligible Expenses

Basic Services

Restorative Services

Major Services Benefit Level 04

Predetermination

Orthodontic Services Benefit Level 04

Deceased Member’s Dependents

Exclusions and Limitations

Alternative Services

Co-Insurance

The co-insurance percentage refers to the percentage of eligible expenses payable by Manulife as outlined in the Schedule of Benefits. You will be required to pay the amount of the remaining eligible expenses that exceed the co-insurance percentage

Predetermination Expense Estimates

If expenses for a proposed course of treatment will exceed $400, it is recommended that you have your dentist complete a Predetermination (Dental Claim Estimate) form which should be sent to Manulife

Based on this information, Manulife will estimate the extent of its liability and what amounts, if any, will be reimbursed.

If you do not send a predetermination form, all of your expenses may not be reimbursed: Manulife requires necessary proof of the recommended procedures (such as x-rays and/or a detailed description).

Alternative Services

If alternative services may be performed for the treatment of a dental condition, the maximum amount payable will be the amount shown in the Fee Guide for the least expensive service or supply required to produce a professionally adequate result. For example, white fillings on the back three teeth (molars) will be paid up to the cost of amalgam coverage.

Eligible Expenses

Eligible expenses include charges for services, supplies and treatment provided they are:

• reasonable and customary,
• recommended as necessary by a physician or dentist and are performed by a qualified:
  - dentist,
  - dental hygienist under the supervision of a dentist, or
  - licensed denturist,
• not in excess of the Provincial Fee Guide,
• subject to the maximums in the Schedule of Benefits, and
• specified as follows:

Basic Services Include:

• services are limited to twice every Plan Year but not more than once every 6 months for:
• oral examinations
• cleaning
• topical application of fluoride, and
• bitewing x-rays
• full mouth series x-rays (limited to once every two years)
• laboratory and diagnostic procedures
• consultation, if required by the attending dentist
• fillings
• extractions and other minor surgical procedures
• anaesthesia
• diagnostic casts (unmounted)
• scaling is limited to 12 units per person per Plan Year, including periodontic services.

Restorative Services Include:

• surgical procedures not included in Basic Services
• endodontic services (root canal work)
• periodontic services (treatment of gum disease), scaling is limited to 12 units per person per Plan Year including Basic Services scaling units.
• space maintainers
• relining, rebasing and repair of existing dentures

Major Services BENEFIT LEVEL 04 include:

• crowns
• inlays and onlays
• initial provision of an appliance (denture or fixed or removable bridge) if found necessary as a result of the extraction of a natural tooth while the individual was insured under this Benefit
• replacement of an existing appliance, provided:
• the existing appliance is at least 5 years old and cannot be made serviceable; or,
• it was only temporary and within 12 months of its installation it is replaced by a permanent bridge or denture; or,
• the new appliance is made necessary due to the extraction of a natural tooth while the individual is insured and the existing appliance cannot be made serviceable
• recementing of crowns, inlays, or a fixed bridge

Predetermination

If expenses for a proposed course of treatment will exceed $400, it is recommended that you have your dentist complete a Predetermination (Dental Claim Estimate) form which should be sent to Manulife with the necessary proof of required treatment.

Orthodontic Services BENEFIT LEVEL 04

Dependent children up to and including 18 years of age are eligible for the following coverage:

• charges for treatment necessary for the correction of malocclusion of the teeth performed by a licensed practising orthodontist, and
• habit-breaking and orthodontic appliances.

Deceased Member’s Dependents

If you die while your dependents are covered for the Dental Benefit, your dependents will continue to be covered until the earliest of:

• 2 years after the date of your death,
• the termination of the Group Policy,
• the remarriage of the spouse (children will continue to be insured up to a total maximum period of 2 years),
• the date the dependent child ceases to qualify as a dependent.

Exclusions and Limitations

Eligible expenses do not include and no payment will be made for:

• broken appointments, advice by telephone, transportation costs, examinations or use by a third party, and completion of claim forms,
• protective appliances such as athletic guards,
• treatment initiated, supplies ordered or services rendered before the individual was insured under this Benefit,
• services, supplies or treatment payable by the individual's Provincial Medicare Plan, (or would have been payable had proper application been made),
• amounts payable under any other benefit of this Group Policy,

• services, supplies or treatment for which there would have been no charge, had the individual not had any Insurance coverage,
• services, supplies or treatment received from a medical or dental department maintained by an employer, association, union or any other similar type group,
• replacement of removable appliances which are lost, mislaid, stolen or broken,
• laboratory fees to the extent that such fees exceed 65% of the dentist's fee for the related procedures allowable by the Provincial Fee Guide,
• any claims resulting from:

- self-inflicted injuries or illnesses,

- insurrection, war or civil commotion,

- committing or attempting to commit a criminal offence,

- cosmetic surgery or treatment unless necessitated by an accident, and
  commenced within 90 days of the accident,

• medical, surgical or dental treatment in any way related to the correction of temporomandibular joint dysfunction.
• oral hygiene instruction or nutritional counseling
• implants

Alternative Services

If alternative services may be performed for the treatment of a dental condition, the maximum amount payable will be the amount shown in the Fee Guide for the least expensive service or supply required to produce a professionally adequate result. For example, white fillings on the back three teeth (molars) will be paid up to the cost of amalgam coverage.