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Dental and Dental Plus

Dental benefits provide coverage for preventative and diagnostic treatments to help pay for eligible dental procedures that are provided by a licensed dental professional.

Enhanced dental coverage is available under OMA’s Dental Plus plan, including major services for procedures such as crowns and bridges and, after a one-year waiting period, orthodontic coverage for children under the age of 19.

Co-insurance for dental insurance refers to the portion that is paid by the insurance company. For example, a 50 per cent co-insurance means the insurer pays 50 per cent and you pay 50 per cent.

The plan year for Dental and Dental Plus is Jan. 1 to Dec. 31. Your plan will automatically renew each year. You have 180 days after the end of the benefit year (Dec. 31) to submit your claim expenses that were incurred during that benefit year.

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Dental

Dental Plus

Plan maximum (lifetime reimbursement)

  • $1,500 per insured person for each plan year for all covered services

If coverage starts July 1 or later, the maximum amount for that plan year will be reduced by 50 per cent.

  • Basic and 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 1 or later, the maximum amount for that plan year will be reduced by 50 per cent.

Basic and preventative dental procedures

Dental benefits include the following procedures used to help prevent dental problems covered at 80 per cent of the eligible expenses.

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

Oral examinations:

  • One complete examination every 24 months

  • One recall examination every nine months

  • Emergency or specific examinations

X-rays:

  • X-rays (to diagnose a symptom or examine progress of a particular course of treatment)

  • One set of bitewing X-rays every nine months

  • One complete series of X-rays or one panorex every 24 months

Other services:

  • Scaling and polishing (cleaning of teeth) and topical fluoride treatment once every nine months

  • Oral hygiene instruction once per lifetime

Dental Plus benefits include the following procedures used to help prevent dental problems covered at 90 per cent of the eligible expenses.

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

Oral examinations:

  • One complete examination every 24 months

  • One recall examination every six months up to maximum of two 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)

  • One set of bitewing X-rays every six months up to a maximum of two sets per plan year

  • One complete series of X-rays or one panorex every 24 months

Other services:

  • Scaling and polishing (cleaning of teeth) and topical fluoride treatment once every six months up to a maximum of two sets per plan year

  • Oral hygiene instruction once every six months up to maximum of two sessions per plan year

Basic and preventative dental procedures (continued)

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 one to six 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 eight 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 per cent 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 per cent co-insurance of the eligible expenses for the following 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 five-year period following the construction or insertion of a previous bridge or standard denture unless:

    • It is needed to replace a bridge or standard denture that has caused temporomandibular joint disturbances and that cannot be economically modified to correct the condition

    • It is needed to replace a transitional denture that was inserted shortly following extraction of teeth and that 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:

  • Dental restoration in connection with crowns or bridges for which the tooth was prepared prior to the termination date

  • 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 six 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

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 expenses 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

​For details on changing between Dental and Dental Plus, see your benefits booklet or contact one of our OMA Insurance service representatives, who will be happy to help you.​


OMA Dental and Dental Plus is underwritten by Sun Life Assurance Company of Canada. Sun Life Assurance Company of Canada is the insurer of this product and is a member of the Sun Life group of companies. For inquiries, please call Sun Life’s Client Care Centre at 1-800-758-1641, Monday to Friday, 8 a.m. to 8 p.m. ET. or visit www.sunlife.ca.

For complete details regarding coverage, please see the terms and conditions of Policy 17884. If there is any conflict between this document and the wording of the policies (or the certificate), the wording of the policies will govern. A copy of the policy may be requested.

Exclusions and limitations may apply.