Dental Coverage and Levels of Benefit

There is no deductible required.

Effective March 24, 1998 there are no annual maximums applicable to the Teachers’ Dental Plan.

Reimbursement will be made to the teacher for a percentage of eligible dental charges incurred up to the Maximum Plan Reimbursement level for each dental procedure code listed.

Percentage reimbursements vary by type of service:

Level I – Preventive Services – 100% of eligible dental charges to the Maximum Plan Reimbursement level.

Preventive services are those items designed to maintain good regular dental health and to give the dentist an opportunity to see if further work is required.

  • Oral examinations (maximum of twice per year)
  • Polishing (maximum of once per year)
  • Scaling (maximum two units per year at 100% and 3-8 units at 85%)
  • Fluoride treatments (maximum of once per year)
  • Bite-wing x-rays (maximum of twice per year)
  • Full mouth x-rays (maximum of once per 24 months)
  • Uncounted study models

Level II – Basic and Routine Services – 85% of eligible dental charges to the Maximum Plan Reimbursement level.

This level is designed to cover most of the standard services required.

  • Amalgam, composite or acrylic fillings
  • Retentive pins
  • Extractions
  • Dental surgery including x-rays and laboratory services
  • Endodontics including root canal therapy
  • Periodontics both surgical and non-surgical dealing with the soft tissue surrounding the teeth
  • Emergency treatment for dental pain
  • Repairs to existing dentures
  • Relines and rebases of existing dentures
  • Recementing of existing inlay or crown
  • Stainless steel crowns

Level III – Major Restorative Services – 60% of eligible dental charges to the Maximum Plan Reimbursement level.

Major restorative services are those items related to the removal and replacement of natural teeth.

  • Initial installation of crowns, complete or partial dentures or fixed bridges to replace natural teeth
  • Replacement of crowns, dentures or bridges where the existing appliance is at least five years old and cannot be made serviceable
  • Installation of additional teeth to existing dentures to replace additional teeth extracted
  • Repairs to and recementing of an existing fixed bridge

Procedures involving the use of gold will be covered if no other substitute is deemed suitable. Where gold is considered to be elective, only the cost of a customary substitute will be considered for reimbursement.

Dental Implants are not an eligible service under the Teachers’ Dental Plan.

Level IV – Orthodontic Services – 50% of eligible dental charges to the Maximum Plan Reimbursement level.

  • Orthodontic services are covered for dependent children and adults to a lifetime maximum of $2,000 per individual.
  • If you choose to pay for the orthodontic fees as a lump sum prior to service being provided, and have a payment receipt, you can submit a claim for the lifetime orthodontic maximum.
  • Where a teacher is married to a teacher and both are eligible for dental coverage, the family is eligible for a lifetime maximum of $4,000 per dependent.