An Overview of Dental Plans

You may have a dental plan through your employer, union or provincial government. This fact sheet may help you understand your plan if you're paying for dental care on your own.

First, remember that a dental plan and a treatment plan are two different things:

A dental plan is a means to help you to pay for your dental treatment. Employers provide health and dental benefits for a variety of reasons, including the promotion of good health.
A treatment plan is the personal plan you and your dentist develop together to meet your oral health needs. It serves as your road map to good oral health and should not be limited by what a dental plan will cover.
If you have a dental plan:
It's up to you as a full partner in your oral health care to know how your plan works. Read the booklet or other materials available from your provider.

Checklist

Some things you need to know about your plan:

What is covered each year?
Is there a deductible?
Is there a total dollar limit on my coverage?
Can I choose a procedure other than the one my plan covers?
Will I still be covered if I change jobs?
To what extent am I covered for cleanings and x-rays?
To what extent am I covered for dental treatments such as fillings and root canals?
What about other treatments such as bridges and crowns, dentures and oral surgery?
Can I choose my own dentist? (Some plans may restrict you to a list of approved dentists.)
Your co-payment is the part of the bill you won't be reimbursed for. You need to understand what your plan covers and the extent of the coverage.

How Your Dentist Can Help

Your dentist can assist in claiming your benefits.
Your dentist can help you estimate how much will be covered before you move ahead. They can submit a pre-treatment plan to your dental plan administrator for a pre-determination of benefits. This is not a guarantee, but it does reduce the chances of your claim for reimbursement being limited or declined.

Remember that your dentist in Chilliwack at Valley Smiles Dental Clinic we are treating you, not your dental plan.

 

Co-Payment

What is co-payment?
Co-payment—also called co-insurance—is the portion of the bill that is your own responsibility. It's the most common way for dental plans to limit their costs, thereby providing various plans with an assortment of benefits and price points for the purchaser to choose.

Some plans are also taking other approaches to limit plan spending: setting annual deductibles, capping the dollar amount or limiting the number of visits covered within a year.

How much do I have to pay?

That depends on your plan.
An 80/20 co-payment is common for basic procedures such as x-rays, cleaning, fillings and root canals. This means that the dental plan covers 80% of the bill. A 50/50 co-payment is common for major procedures such as crowns and bridges.

But there are many variations; be sure to check your specific plan.

Can my dentist waive my co-payment?
 

No. The waiving of a co-payment is insurance fraud and is against the law. Your dentist could be heavily fined or even lose their license.

When you and your dentist sign the claim form that goes to the insurance company, you are stating which services were provided and how much, in total, was charged. The insurance company pays its share based upon the assumption that you will do the same.

 

More Affordable Dental Care: The Canada Dental Benefit:

Tooth decay is the most common, but preventable, childhood chronic disease both in Canada and around the world. Oral diseases frequently begin in the preschool years which is why it is so important to establish good oral hygiene behaviours in those early years.

In March 2022, the federal government announced plans to enhance access to dental care for Canadian families with annual household incomes of less than $90,000.

Phase one of the government’s plans to enhance access to dental care begins with children under 12-years-old was announced in September, 2022, and takes the form of the Canada Dental Benefit (CDB)

Parents or guardians of eligible children must apply to receive the CDB through the Canada Revenue Agency (CRA). Applicants must attest that:

their child does not have access to private dental care coverage;
they will have out-of-pocket dental care expenses for which they will use the Benefit; and
they understand they will need to provide documentation to verify out of pocket expenses occurred (e.g. show receipts), if required.
Note that in order to apply for the CDB, parents or guardians must be up-to-date on their income tax filings, and must currently be in receipt of the Canada Child Benefit (CCB) for the child on whose behalf they are applying.

Please visit the CRA website for the latest details on how and when to apply. You can also learn how to apply for the Canada Dental Benefit  from the Government of Canada.