Dental Benefits - Postdoctoral Associates

Regular dental care is a vital part of good health. Western’s dental benefit provides comprehensive coverage to meet your needs.

Remember - In addition to the coverage noted below, you may use your Health Care Spending Account to cover the remaining cost of the services outlined.

What's Covered

The plan provides payment towards reasonable and customary charges for necessary dental services up to the current Dental Association Suggested Fee Guide for General Practitioners, or any dental specialist’s fee guide approved by the dental association in effect in the province where treatment is rendered. For most dental expenses, the plan reimburses you 85% of the cost.

Payment of Benefit

You will be reimbursed provided eligible expenses are:

  • For services or supplies ordered or provided by a Dentist or Denturist
  • For services or supplies which are generally accepted by the dental profession as essential, effective, appropriate and customarily used in the diagnosis, care or treatment of a specific dental condition or injury; and
  • For services or supplies specified below which are not performed or provided in connection with an ineligible service or supply
  • Not in excess of
  • Any maximum amount specified in the applicable fee guide; or
  • Reasonable and customary charges, as determined by the insurance provider, for expenses not included in the applicable fee guide

Pre-approval of large expenses

If the cost of a proposed dental treatment is expected to exceed $500, you are strongly advised to submit a detailed treatment plan to the insurance provider beforehand to find out how much will be covered by the plan.

The plan covers 85% of eligible Basic/Preventative Coverage such as:

  • Basic/Periodontics and Endodontic – Levels I and II
  • Reimbursements are based upon a 9 month recall period

The plan covers 80% of the following Major Dental:

  • Dentures (Level III) - 80% reimbursement
  • Bridges/Crowns (Level IV) - 80% reimbursement

Combined maximum (Basic/Preventative and Major Dental) of $1,200 per year, per covered person.

What's Not Covered

There are various items not covered including, but not limited to:

  • Any dental procedure which is not eligible
  • Services or supplies performed or provided in connection with an ineligible procedure
  • Dental care, services or supplies which are primarily for cosmetic purposes, as determined by the insurance provider
  • Services performed by a dental hygienist in an independent private practice
  • Services or supplies to which you or your eligible dependent are entitled to receive under any Government plan
  • Services or supplies which would be available without charge if this benefit was not in effect
  • Conditions arising from war (whether or not war is declared), participation in any civil commotion, insurrection or riot, or while serving in the armed forces
  • Temporomandibular joint-related problems
  • Laboratory fees which exceed Reasonable and Customary charges, as determined by the insurance provider.

Published on  and maintained in Cascade CMS.