Dental Accident
A dental accident is a sudden, unexpected event that causes injury to the mouth, teeth, or jaw, resulting from an external force rather than from decay, chewing, or normal use. Examples include being struck in the face, falling and hitting your mouth, or suffering an impact during sports. Dental accident coverage helps pay for the repair or replacement of natural teeth damaged in such incidents.
How It Works
A dental accident is treated as an accidental injury to natural teeth caused by a direct blow to the mouth, such as a fall, a hit to the mouth, or an impact while playing sports, rather than damage from an object placed in the mouth while eating. Because it is defined as an unexpected and unforeseen injury to natural teeth or their surrounding structures resulting from an event that occurs by chance, it excludes injuries linked to normal acts such as cleaning, brushing, and chewing. This benefit is an extended health benefit and sits separately from regular dental coverage, which handles routine care like exams, X-rays, denture repairs, orthodontics, and preventive treatment. Under plans such as Blue Cross, the accident coverage falls under Health Benefits and covers a dentist's fees only when a direct blow to the mouth damages natural teeth. Many Canadian plans, including typical student plans, reimburse the repair or replacement of healthy natural teeth according to the Provincial Dental Fee Guide for General Practitioners in the province where the service was performed, sometimes paying a coinsurance percentage of the cost, with treatment required to be completed within the 12 months following the accident. When more than one plan provides dental accident benefits, the payments are coordinated so the combined payment for a particular item cannot exceed the full eligible expense, in line with CLHIA coordination of benefits guidelines.
Example:
Imagine you slip on ice during a Canadian winter and break a front tooth. Your dental accident benefit, which sits under your extended health benefits rather than your regular dental plan, may help pay to repair or replace the natural tooth, as long as you report the injury promptly and complete treatment within the timeframe your plan requires.
What to Watch For:
Keep in mind that this benefit only applies to natural teeth damaged by an external blow, and injuries tied to normal acts such as cleaning, brushing, or chewing are not treated as accidents. While provincial health insurance may cover some emergency surgery services in a hospital, any dental expenses that follow an accident are entirely your own responsibility. Because the benefit follows the Provincial Dental Fee Guide and requires treatment to be completed within 12 months of the accident, report the injury promptly and start care within your plan's required timeframe. If you are covered under more than one plan, remember that the combined payment for any item is capped at the full eligible expense under coordination of benefits guidelines.
