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Overview

The dental plan offers you and your family the choice between two plan options:

Plan A Plan B
  • Preventative services
  • Maintenance services
  • Preventative services
  • Maintenance services
  • Major restorative services
  • Orthodontics (braces)

For a summary of your dental coverage, refer to the Benefits At-a-Glance section. There you will find information on reimbursement levels and applicable maximums.

Eligible dental expenses are those that a dentist, doctor, or denturist (provided the work is within the scope of the denturist’s license and they are registered with the Council of the Denturist Society of PEI) considers necessary.

Expenses are based on the Dental Association Suggested Schedule of Fees for General Practitioners or the Dental Specialist Fee Guide, if applicable, for the current year.

It is entirely up to you and your dentist to decide which treatment method to use - alternative or otherwise. However, reimbursement will be based on the least expensive treatment method that will provide a professionally adequate result.

We encourage you to get approval for unusual or large dental expenses beforehand to make sure the plan covers them.

For a list of dental plan exclusions, see the Exclusions section.

Plan A Plan B
  • 80% reimbursement for preventative and maintenance services
  • 80% reimbursement for preventative and maintenance services
  • 50% reimbursement for major restorative services, to a maximum of $1,000 per calendar year
  • 50% reimbursement for orthodontics (braces), to a lifetime maximum of $3,000

Submitting a Treatment Plan for Expensive Dental Treatment

If your dental treatment will cost more than $500, Canada Life recommends that you contact them before you incur the expense, to determine how much the plan will pay and how much you will pay. Here’s what you need to do:

  1. For pre-determination of benefits, send Canada Life a detailed description of the treatment plan and its cost. Your dentist can provide this information for you and send it on your behalf.
  2. You may also be asked to supply a fully completed written estimate, plus pre-operative X-rays, diagnostic casts, and laboratory reports.

Preventative Services
(Plans A and B)

The plan covers the usual cost of eligible preventive services as follows, subject to general exclusions:

Eligible Expense Description Special Notes

Anaesthesia

From sedatives to total loss of consciousness

During a surgical dental procedure

Bite adjustment/ equilibration

A procedure to correct the bite problem between the upper and lower teeth when they are in contact

8 units every calendar year

Cavity prevention

Fluoride

Once every calendar year

Oral hygiene instruction and re-instruction - One-on-one instruction by the dentist or oral hygienist on how to brush and floss

  

 

Pit and fissure sealants - Coating put on top of any pits or cracks in teeth to prevent cavities from forming

Unlimited

Polishing/cleaning of teeth

1 treatment every calendar year

Recall package - Polishing, recall scaling, recall examinations, and fluoride

Once every calendar year

Recall scaling

1 treatment every calendar year as part of the recall package

Examinations

Analysis of primary and permanent teeth

Once each calendar year

Consultation to discuss a serious dental problem and to agree on a treatment plan

Unlimited

Emergency examinations

Unlimited

Initial or complete examination

Once per dentist

Recall examinations

Once every calendar year

Fillings

Amalgam fillings - Silver fillings that are used to restore teeth

  

 

Composite fillings - White fillings that are used to restore teeth

  

 

Pre-fabricated posts - Pre-made posts used for additional support to the tooth after root canal treatment

  

 

Retentive pins - Pins used to make sure that a restoration or filling stays in place

  

 

Sedative fillings for caries, trauma and pain control - Caries result from tooth decay. Trauma means a blow to the mouth or teeth resulting in injury. Severe wear may be considered a traumatic injury. Pain control includes temporary fillings and local anaesthesia to reduce pain before a permanent filling is installed.

  

 

Stainless steel, plastic and polycarbonate caps - Caps that are installed to cover the whole teeth

  

 

Veneer applications - White facings placed on a tooth’s surface

Veneers that are done for cosmetic purposes are not covered.

Finishing restorations

Polishing of a filling previously placed in the mouth

Unlimited

Interproximal discing

Removal of a thin slice of tooth enamel to make more room for the teeth that are slightly crowded

Unlimited

Minor oral surgery

Extractions

Removal of a tooth, including an impacted tooth

Unlimited

Residual root removal

Removal of tooth roots left behind when a tooth is pulled out

  

Mouth guards

A soft, flexible, plastic protective appliance worn to protect upper and lower teeth during contact sports

1 every calendar year

Recontouring of teeth

Procedure to correct the bite between opposing teeth by shaping or grinding the enamel surfaces

For functional purposes only

Unlimited

Space maintainers and related maintenance

An appliance that a dentist uses to maintain a space where a tooth has been removed

Unlimited

Tests and other diagnostic services

Bacteriological analysis of the saliva - To determine the susceptibility of cavities

Unlimited

Biopsy of  oral tissue

Unlimited

Cytological tests

  

 

Diagnostic casts and models of the upper and lower teeth - For diagnostic ability or for construction of impression trays and temporary bridges and partial dentures

Unlimited

Diagnostic cast interpretation - Diagnosis of dental condition by studying impressions or casts of a person’s mouth

Unlimited

Diagnostic photographs - Intra and extra oral photographs of the teeth, mouth and jaw that aid in the diagnostic determination of dental treatment

Unlimited

Histological tests

  

Laboratory reports and interpretation

Unlimited

Microbiological tests

  

Pulp vitality test - To determine if the pulp (the soft tissue inside a tooth) is healthy

  

X-rays

Bitewing films - To detect decay in molar teeth

Up to 4 per calendar year

Cephalometric films - X-rays of the facial and skull profile for orthodontic purposes

Up to 5 every 2 calendar years

Extra-oral films - X-rays taken outside of the oral cavity

Up to 4 per calendar year

Facial and sialographic films - Intra-oral X-rays of the salivary glands that assist with the diagnosis of duct stones

Unlimited

Full mouth or panoramic films

1 series per calendar year

Hand and wrist X-rays

  

 

Occlusal films - X-rays of the chewing surface of the teeth to show the fit between the upper and lower teeth when they are in contact

Up to 4 per calendar year

Panorex films - One view of the entire mouth

Once every calendar year

Radiopaque dyes - Dyes that can be seen on an X-ray and are used to determine decay in teeth, or gum pockets around abscessed teeth

Unlimited

Single films

TMJ films (films relating to temporomandibular joint dysfunction)

Unlimited

Up to 4 per calendar year

Maintenance Services
(Plans A and B)

The plan covers the usual cost of eligible maintenance services as follows, subject to general exclusions:

Eligible Expense Description Special Notes

Alveoloplasty

Remodelling, removing or reducing bone

  

Appliances and related adjustments

Myofacial pain syndrome appliances - Worn to manage pain in the facial area caused by internal and external forces on the teeth due to muscle contractions from abnormal forces or stress

Appliances once per arch every 2 calendar years, unlimited adjustments and repairs

Periodontal appliances - Making the impression and inserting the appliances

Appliances once per arch every 2 calendar years, unlimited adjustments and repairs

TMJ appliances - Worn to manage temporomandibular joint pain and discomfort

Cost of making the impression and inserting the appliance once per arch every 2 calendar years, unlimited adjustments and repairs

Gingivoplasty

Remodelling gums

Unlimited

Maintenance of existing dentures

Adjustments (including remount and occlusal equilibration)

Unlimited, provided adjustments made more than 3 months after the new dentures were inserted

Custom-stained denture bases

Must be provided in a dentist’s office

Prophylaxis and polishing - Procedure to clean and polish dentures, can be done in an office or in a lab

Unlimited

Rebasing - Fitting dentures with a new base

Once per arch every 2 calendar years

Rebuilding of worn acrylic teeth

Must be provided in a dentist’s office

Relining - Adding material so that the dentures fit properly

Once per arch every 2 calendar years

Remake - Remaking a new partial denture using the patient’s existing framework

Once per arch every 2 calendar years

Repairs - Fixing broken or damaged dentures

Unlimited

Resetting of teeth

Unlimited

Resilient liner

Unlimited

Tissue conditioning - Applying a conditioner to the alveolar ridge that ensures a proper denture fit

Unlimited

Major oral surgery

Surgery - May include local anaesthesia, appropriate X-rays, surgery and follow-up care

Unlimited, provided the surgery is not for cosmetic purposes and not part of any implant or part of any orthognathic surgery, remodelling or repositioning of the lower jaw

Antral surgery - Surgical removal of a tooth that has been forced up into a sinus cavity

  

Fractures - Treatment of fractures of the upper or lower alveolar bone, which holds the teeth in the sockets

  

Frenectomy - Surgery on the frenum (a thin tissue that connects the lips to the gums and the tongue to the floor of the mouth)

  

Hemorrhage control - Treatment to stop bleeding resulting from an extraction or trauma

  

Post-surgical care - Treatment given by the dentist after surgery until healing is complete

  

Sialolithotomy - Partial removal of the salivary duct

  

Stomatoplasty - Remodelling the floor of the mouth

  

Surgical enucleation - Surgical removal of teeth prior to eruption

  

Surgical excision - Removal of cysts or a foreign body

  

Surgical incision - Incision made to an infected area usually to allow drainage

  

Surgical exposure - Surgical incision to expose teeth that will not erupt or come on time

  

Surgical repositioning - Surgical procedure to reposition teeth due to growth abnormalities or trauma, resulting in the correct alignment of the upper and lower jaws

  

Transplantation of erupted or non-erupted teeth - Placement of teeth to another area of the mouth because of the early removal of the pre-existing teeth due to decay or trauma

  

Vestibuloplasty - Ridge reconstruction

  

Repairs to existing major restorative work

Repairs to existing crowns, inlays, onlays, and bridgework, porcelain staining of fabricated crown, and removal and/or recementation of crowns, inlays, onlays, and bridgework

Unlimited

Treatment of gum disease

Desensitization - Applying fluoride to reduce sensitivity

May include local anaesthesia, surgical dressing, sutures and follow-up care for 1 month, post-treatment evaluation not covered

Displacement dressing - Placing a medicated pack on inflamed gums to move gums away from the calculus (deposits on teeth that irritate gums)

Flap surgery - The opening made for bone removal

Gingival curettage - Scraping out damaged tissue inside the gums

Gingivectomy - Removing damaged gum tissue

Periodontal scaling and/or root planing (tartar removal) - Scaling: removing calcium deposits on teeth, root planing: smoothing rough tooth surfaces and removing any calcium deposits

Tissue graft - The transfer of healthy gums to an area where the gums have receded

Treatment of roots

Apexification - Closing the root of a tooth with hard tissue

  

Apicoectomy - Surgical removal of a root end after root canal therapy

  

Bleaching endodontically treated tooth - The whitening of a tooth internally through the root canal opening of a tooth

  

Endosseous intracoronal - Implants for root stabilization, codes 34461, 34462 and 34471

  

Hemisection - The removal of a portion of the root(s) and the crown of a tooth but leaving the other root(s) in place

  

Intentional removal, apical filling and reimplantation - The intentional removal of a healthy tooth and implanting it (e.g., a third molar is removed and used to replace a missing first molar)

  

Pulpectomy - The removal of tissue from the pulp chamber

  

Pulpotomy - The removal of dental pulp from the crown portion of the tooth

  

Retrofilling - Filling done through the root end

  

Root amputation - Root(s) from a tooth removed because of infection

The crown and at least one root remain so that the tooth does not have to be removed.

  

Root canal therapy

  

Major Restorative Services
(Plan B Only)

If you chose Plan B with basic and major care, the plan covers the usual cost of eligible major restorative services as follows, subject to general exclusions, to a maximum reimbursement of $1,000 per calendar year:

Eligible Expense Description Special Notes

Bridges

Bridges

Crown lengthening (subgingival preparation) before tooth preparation is not covered.

Charges for replacing an existing bridge will only be paid if such replacement is for an equivalent bridge and meets one of the conditions shown below:

  • it has been more than 5 calendar years since the last bridge was inserted, or
  • it has been less than 5 calendar years since the last bridge was inserted and the existing bridge can no longer be worn.

Canada Life must approve this.

Pontics - Artificial teeth that replace missing teeth

Covered only if it has been more than 5 calendar years since the last pontic was installed in that space

Posts in retainers/abutments - Posts and cores used for additional support to the retainer/abutment

Covered only if it has been more than 5 calendar years since the last installation to that tooth

Retainers/abutments - The tooth beside the missing tooth that will be used to support the bridge

Preparation of the tooth is covered only if it has been more than 5 calendar years since the last preparations were made to that tooth.

Caps and tooth coverings

Build-up/fillings - Restoring a tooth prior to capping for better adaptation of the cap

  

Crowns - A cap that covers the whole tooth

  

Inlay/onlay restorations - Metal, composite, or porcelain casts placed on the surface of the tooth

  

Posts and cores - Laboratory-processed posts and cores used for additional support to the tooth after root canal therapy

  

Retentive pins in inlays, onlays and crowns - Pins used to make sure that the inlays, onlays or crowns stay in place

  

Veneer applications (laboratory processed) - White facings put on a tooth’s surface

Veneer applications that are done for cosmetic purposes are not covered

Dentures

Acrylic dentures - Dentures with an acrylic denture base

Covered only if it has been more than 5 calendar years since the last acrylic dentures were inserted

Complete dentures - Dentures that replace either all of the top teeth or all of the bottom teeth

Charges for replacing an existing denture will only be paid if such replacement is for an equivalent denture and meets one of the conditions shown below:

  • it has been more than 5 calendar years since the last complete dentures were inserted, or
  • it has been less than 5 calendar years since the last complete dentures were inserted and the existing dentures can no longer be worn.

Canada Life must approve this.

Gnathological dentures - Placed to realign the upper and lower jaws following surgical procedures for jaw correction

Covered only if it has been more than 5 calendar years since the last dentures were inserted

Overdentures - Placed over a few remaining teeth that have had root canal treatment, and adapted to assist with the stabilization of the denture

  

Partial dentures - Partial dentures replacing one or more top or bottom teeth

The partial dentures may be acrylic (plastic), metal or chrome base that can have acrylic, wire or chrome clasps (which hold on to the teeth).

Covered only if it has been more than 5 calendar years since the last partial dentures were inserted or additional teeth have been extracted

Transitional dentures - Temporary dentures used for healing purposes due to the extraction of one or more teeth

Covered for one complete upper denture and one complete lower denture in 5 calendar years

Orthodontics
(Plan B Only)

If you chose the basic/major care option, the plan covers the usual cost of eligible orthodontic procedures to correct crooked or misaligned teeth (e.g. braces), to a lifetime maximum of $3,000. This includes all dental treatment needed to correct the problem, such as:

  • examinations,
  • X-rays, models,
  • photographs, reports,
  • surgical exposure of teeth,
  • appliances, and
  • adjustments.

The cost of dental treatment that is not an orthodontic service but is needed because of the orthodontic treatment is covered as if it were an orthodontic service.

Exclusions

  • Any dental charges not included in the Dental Association Suggested Schedule of Fees for General Practitioners or the Dental Specialist Fee Guide
  • Dental services or supplies that you are eligible to claim under any workers’ compensation legislation
  • Any endodontic treatment that was started before the effective date of coverage
  • Any treatment related to orthognathic surgery
  • Charges for appointments that are not kept
  • Charges for completing claim forms
  • Cosmetic procedures
  • Crown lengthening (subgingival preparation) before tooth preparation
  • Experimental treatment or testing
  • Procedures or supplies used in vertical dimension corrections (changing the height of teeth) or to correct attrition problems (worn-down teeth)
  • Replacement of dental appliances, including dentures, that are lost, misplaced, or stolen
  • Treatment to correct temporomandibular joint dysfunction, except for temporomandibular joint dysfunction appliances

In addition to the above, the plan does not cover the following major dental coverage:

  • Crowns, bridges, or dentures for which tooth preparations were started before the effective date of coverage
  • Implanting fabricated teeth or any major surgery resulting from implanting fabricated teeth