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OPIP - Dental and Dental Plus Plan Details

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Dental and Dental Plus - Plan Details

Dental benefits include coverage for preventative and diagnostic treatments to help plan members and their dependents pay for eligible dental procedures that are provided by a licensed dental professional.

Dental Plus is enhanced coverage that includes major services for procedures such as crowns and bridges and, after a one year waiting period, orthodontic coverage. This waiting period is in place to ensure ongoing affordability for all plan participants.​

Co-insurance​​​ for health and dental insurance refers to the portion that is paid by the insurance company. For example, a 90% co-insurance means the insurer pays 90% and you pay 10%.

The plan year for Dental and Dental Plus is January 1st to December 31st.

The table below is intended as a summary of the coverages available under the Dental and Dental Plus plans to help you compare the two options. Actual coverage descriptions are contained in the policy and all claims are subject to the terms, conditions, and limitations contained therein.
Dental Dental Plus
Plan Maximum
  • $1,500 per Insured person for each plan year for all covered services
Basic & Preventative Services
  • Combined maximum $2,000 per Insured person for each plan year
Major Dental Services
  • $1,500 per Insured person for each plan year
If coverage starts July 1st or later, the maximum amount for that plan year will be reduced by 50%.
Basic and Preventative Dental Procedures Dental benefits include the following procedures used to help prevent dental problems covered at 80% of the eligible expenses.

These are procedures that a dentist performs regularly to help maintain good dental health:

Oral Examinations
  • 1 complete examination every 24 months
  • 1 recall examination every 9 months
  • Emergency or specific examinations
X-rays
  • X-rays (to diagnose a symptom or examine progress of a particular course of treatment)
  • 1 set of bitewing x-rays every 9 months.
  • 1 complete series of x-rays or 1 panorex every 24 months.
Dental Plus benefits include the following procedures used to help prevent dental problems covered at 90% of the eligible expenses.

These are procedures that a dentist performs regularly to help maintain good dental health:

Oral Examinations
  • 1 complete examination every 24 months
  • 1 recall examination every 6 months up to maximum of 2 examinations per plan year
  • Emergency or specific examinations
X-rays
  • X-rays (to diagnose a symptom or examine progress of a particular course of treatment)
  • 1 set of bitewing x-rays every 6 months up to a maximum of 2 sets per plan year.
  • 1 complete series of x-rays or 1 panorex every 24 months.
Other Services
  • Scaling and polishing (cleaning of teeth) and topical fluoride treatment once every 9 months
  • Oral hygiene instruction once per lifetime
Other Services
  • Scaling and polishing (cleaning of teeth) and topical fluoride treatment once every 6 months up to a maximum of 2 sets per plan year
  • Oral hygiene instruction once every 6 months up to maximum of 2 sessions per plan year
Other services
  • Emergency or palliative services
  • Diagnostic tests and laboratory examinations
  • Removal of impacted teeth and related anesthesia
  • Provision of space maintainers for missing primary teeth (only for dependent children who have not attained their 19th birthday)
  • Pit and fissure sealants (only for dependent children who have not attained their 19th birthday)
Fillings
  • Silicate, acrylic composite, amalgam for teeth 1-6 only; amalgam for other teeth
Restorative
  • Stainless steel crowns or bands (only for dependent children who have not attained their 19th birthday)
  • Prefabricated metal restorations and repairs to prefabricated metal restorations other than in conjunction with the placement of permanent crowns
Extraction of Teeth
  • Removal of teeth
Dentures
  • Repairs, adjustments, relines, rebasing of dentures once every 12 months
Endodontics
  • Root canal therapy and root canal filling and treatment of disease of the pulp tissue
Periodontics
  • Treatment of disease of the gum and other supporting tissue
  • For scaling and root planing, you are covered up to a combined maximum of 8 units of 15 minutes per plan year
Oral Surgery
  • Surgery and related anesthesia
Orthodontics Not included Orthodontic coverage has a one year waiting period. Lifetime maximum of $1,500 per insured.

Dental Plus benefits include the following procedures used to treat misaligned or crooked teeth. Only children under age 19 are covered for these procedures at 50% of the eligible expenses:
  • Coverage includes orthodontic examinations, orthodontic diagnostic services and treatment plans involving fixed or removable appliances, such as braces
The following orthodontic procedures are covered:
  • Interceptive, interventive or preventative orthodontic services other than space maintainers
  • Comprehensive orthodontic treatment using a removable or fixed appliance or combination of both. This includes diagnostic procedures, formal treatment and retention
Major Dental Procedures Not included Dental Plus benefits include the following procedures used to treat major dental problems covered at 60% co-insurance of the eligible expenses for these procedures:

Major Restorations
  • Inlays and onlays
  • Crowns and repairs to crowns and other prefabricated metal restorations
  • Repair of bridges
Prosthodontics
  • Construction and insertion of bridges or standard dentures
  • Coverage is limited to teeth extracted while insured person is covered under the plan.
  • Charges for a replacement bridge or replacement standard denture are not considered an eligible expense during the 5 year period following the construction or insertion of a previous bridge or standard denture unless:
    1. It is needed to replace a bridge or standard denture which has caused temporomandibular joint disturbances and which cannot be economically modified to correct the condition
    2. It is needed to replace a transitional denture which was inserted shortly following extraction of teeth and which cannot be economically modified to the final shape required
Extension of Benefits If your coverage is terminated, any expenses incurred after the termination date are not covered, even if the treatment was pre-approved. The plans will cover expenses incurred within 31 days after the termination of your coverage if an insured person has started;
  1. Dental restoration in connection with crowns or bridges for which the tooth was prepared prior to the termination date, or
  2. Root canal therapy where the pulp chamber was opened prior to the termination of insurance, and your Dental or Dental Plus plan included coverage for these services prior to termination.
You will still be covered for procedures to repair natural teeth damaged by an accidental blow if the accident occurred before termination of coverage and the procedure is performed within 6 months after the date of the accident.
Survivor Benefit If you die with no insured Dependent Spouse but with insured Dependent Child(ren), such coverage for the Dependent Child(ren) will be continued without payment of premium but will terminate on the earliest of the following circumstances:
  • termination of this plan;
  • 12 months from the date of your death.
Note: If you die and have an insured Dependent Spouse, your spouse will have 60 days to become insured as an Independent Person and he/she will be able to continue coverage on insured Dependent Child(ren)
What is not covered Covered expense shall not include any charges incurred directly for, as a result of, any one or more of the following:
  • Procedures or supplies used in full mouth reconstructions (capping all of the teeth in the mouth), vertical dimension corrections (changing the way the teeth meet) including attrition (worn down teeth), alteration or restoration of occlusion (building up and restoring the bite), or for the purpose of prosthetic splinting (capping teeth and joining teeth together to provide additional support)
  • Services or supplies payable or available (regardless of any waiting list) under any government-sponsored plan or program unless explicitly listed as covered under this benefit
  • Services or supplies that are not usually provided to treat a dental problem
  • Procedures performed primarily to improve appearance
  • The replacement of dental appliances that are lost, misplaced or stolen
  • Charges for appointments that you do not keep
  • Charges for completing claim forms
  • Services or supplies for which no charge would have been made in the absence of this coverage
  • Supplies usually intended for sport or home use, for example, mouth guards
  • Charges related to implants, including surgery charges
  • Transplants and reposition of the jaw
  • Experimental treatments
The plan will also not pay for dental work resulting from:
  • The hostile action of any armed forces, insurrection or participation in a riot or civil commotion
  • Participation in a criminal offence
  • Teeth malformed at birth or during development

​Download​ the my Sun Life Mobile app

Please register online at mysunlife.ca first before you use the app.

Screenshot of my Sun Life Mobile app
With the app you can:
  • Submit and track medical, dental and vision claims and see the money in your account – usually within 48 hours. You can also view your drug claim history over the past 12 months.​
  • Use your smartphone as your drug card.
  • Download, access and use the my Sun Life mobile app all for free! However, your wireless carrier’s data charges may apply if you are not connected to a Wi-Fi network. 
  • Download it today for iPhone, Blackberry and Android devices


Get it on Google Play Download on the App Store Get it from BlackBerry World

To learn more about the my Sun Life mobile app visit sunlife.ca/mobile.

If you don’t have the my Sun Life Mobile app you can still file a claim by completing an Dental and Health Spending Account Claim Form (for Dental claims only).