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.
Reimbursement is based on the fees listed in the Provincial Fee Guide for General Practitioners. If procedures are performed by a Dental Specialist, reimbursement is based on the fees listed in the Provincial Fee Guide for Dental Specialists.
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
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Dental Plus
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Plan maximum (lifetime reimbursement) |
If coverage starts July 1 or later, the maximum amount for that plan year will be reduced by 50 per cent. |
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:
X-rays:
Other services:
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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:
X-rays:
Other services:
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Basic and preventative dental procedures (continued) |
Other services:
Fillings:
Restorative:
Extraction of teeth:
Dentures:
Endodontics:
Periodontics:
Oral surgery:
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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:
The following orthodontic procedures are covered:
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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:
Prosthodontics:
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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:
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. |
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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:
The plan will also not pay for dental work resulting from:
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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.
This plan is underwritten by The Manufacturers Life Insurance Company (Manulife)
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