Dentist

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Eligible Expenses


Eligible expenses are charges for the procedures listed below up to the amount in the Suggested Dental Fee Guide, as approved by the relevant Dental Association, for these procedures.

When determining what will be paid for the procedure, Sun Life will first find out if alternate procedures could have been done. These alternate procedures must be part of usual and accepted dental work and must obtain as adequate a result as the procedure the dentist performed. Sun Life will not pay more than the reasonable and customary cost of the least expensive alternate procedure.

If treatment is likely to cost more than $300, Sun Life recommends that you have your dentist submit a treatment plan and expected cost to Sun Life. In return, Sun Life will let you know how much of the cost the plan will pay.

Read what exclusions apply to this coverage.


Regular Dental Expenses

​Type of Expense ​Reimbursement
Anaesthesia in connection with oral surgery ​90%
​Bridges/dentures
  • exams, films and diagnostic casts
  • addition of tooth to a removable denture
  • partial and complete dentures
  • pontics (fixed bridges)
  • retainers
  • abutments (fixed bridges)
  • retentive pins in abutments
  • repairs of fixed appliances
  • other prosthodontic services
​50%
Consultations with another dentist ​90%
Crowns, inlays/onlays, and other restorative services
  • gold foil
  • gold inlays
  • retentive pins, posts and cores
  • porcelain inlays
  • crowns
  • other restorative services
​50%
​Denture repairs (minor)
  • repairs
  • adjustments
  • relining and rebasing (once every 3 years)
​90%
Emergency services not otherwise specified ​90%
Endodontics (root canals)
  • pulp capping
  • pulpotomy
  • root canal therapy
  • periapical services
  • other endodontic procedures
​90%
Examination and diagnosis
  • complete oral examination
  • recall oral examination (once every 9 months)
  • specific oral examination
  • emergency oral examination
  • treatment planning
​90%
​Fillings
  • amalgam
  • silicate
  • acrylic or composite
  • pin reinforcements for these restorations
​90%
House calls, hospital calls and special office visits ​90%
Oral surgery
  • uncomplicated removal of tooth
  • surgical removal and tooth repositioning
  • alveoplasty, gingivoplasty, stomatoplasty, osteoplasty, tuberoplasty
  • removal of excess mucosa
  • surgical excision or incision
  • removal of cyst
  • removal of impacted teeth
  • repair of soft tissue
  • frenectomy, dislocations
  • miscellaneous surgical services
​90%
​Orthodontics
  • orthodontic exam
  • films
  • orthodontic diagnostic casts
  • surgical services
  • observation and adjustments
  • repairs, alterations
  • removable appliances
  • fixed appliances
  • retention appliances
  • appliances to control harmful habits
​50%
Periodontics (treatment of gum disease)
  • non-surgical, surgical and post-surgical treatment
  • occlusal equilibration (not exceeding 8 time units every 12 months)
  • scaling and root planing
  • other periodontic services
​90%
​Preventive services
  • dental cleaning and polishing (once every 9 months)
  • topical application of fluoride (once every 9 months)
  • pit and fissure sealants (for children under age 15 only)
  • caries control
  • enameloplasty
  • space maintainers (not involving movement of teeth)
  • oral hygiene instructions (1 per benefit year)
​90%
Tests, lab work
  • biopsy of oral tissue
  • pulp-vitality tests
​90%
X-rays
  • periapical (one complete series every 36 months)
  • occlusal
  • bitewings (once every 9 months)
  • extra-oral
  • sialography, uses of dyes
  • panoramic (once every 3 years)
  • interpretation of radiographs from another source
  • tomography
​90%

Dental Surgery

You claim from the Dental Care Plan first, and any balance, from the Health Care Plan.

The Dental Care Plan covers up to 90%.

For any remaining balance, the Health Care Plan covers 80% of reasonable and customary charges for represented employees for the following oral surgical procedures: 

Avulsion of nerve - supra or infra-orbital
Cysts, lesions, abscesses
  • biopsy
    • soft tissue lesion
    • incision
    • excision
    • hard tissue lesion
  • excision of cysts
  • excision of benign lesion
  • excision of ranula
  • incision and drainage
    • intra oral - soft tissue
    • intra osseous (into bone)
  • periodontal abscess
    • incision and drainage
​​Frenectomy - labial or buccal (lip or cheek)
​​Fractures and dislocations
  • dislocation—temporomandibular joint (or jaw)
    • closed or open reduction
  • fractures—mandible
    • no reduction, closed reduction, or open reduction
  • fractures—maxillar or malar
    • no reduction, closed reduction, open reduction, or complicated open reduction
Gingival and alveolar procedures
  • alveoplasty
  • flap approach with curettage
  • flap approach with osteoplasty
  • flap approach with curettage and osteoplasty
  • gingival curettage
  • gingivectomy with or without curettage
  • gingivoplasty
​​Lingual (tongue)
​​Removal of teeth or roots
  • removal of impacted teeth
  • removal of root or foreign body from maxillar antrum
  • root resection—apiectomy or apicoectomy
    • anterior teeth
    • bicuspids
    • molars
​​Repair of antro-oral fistula
​​Sialolithotomy - simple
​​Sialolithotomy - complicated
​​Sulcus deepening, ridge reconstruction
​​Torus (bone biopsy)
Treatment of traumatic injuries
  • repair of soft tissue lacerations
  • debridement, repair, suturing

 

Dental Injury

Claims for dental injury are claimed through the Health Care Plan first, and any balance, from the Dental Care Plan.

The Health Care Plan covers 80% of reasonable and customary charges for represented employees for the services of a dentist/dental surgeon (as well as charges for braces and splints) required to treat a fractured jaw or accidental injuries to natural teeth caused by an external, violent injury or blow. Accidents associated with cleaning, chewing, and eating are not covered.

The Dental Care Plan covers up to 90% of any remaining balance for active represented employees.

Treatment must take place no more than 12 months after the accident (for children under the age of 17 treatment must take place before the child reaches age 18).

 

Published on February 01, 2016