Dental Insurance
Dental insurance is a type of health coverage that helps pay for the cost of preventive, basic, and major dental services. It is designed to make oral care more affordable and to encourage regular checkups that prevent costly procedures later on. Dental insurance is offered through group employee benefits, individual plans, or conversion plans for people leaving workplace coverage.
How It Works
Routine dental care is not covered by Canada's universal health care, so without other coverage Canadians pay out of pocket for most routine services like cleanings, x-rays, and fillings, as well as major services like root canals, crowns, or orthodontics. There are three main ways most Canadians get dental coverage: through a government plan like the Canada Dental Care Plan, through a workplace benefits plan, or through a personal plan they buy for themselves and their family. Most Canadian dental plans work on a cost-sharing model where the insurer covers a percentage of the total bill and the patient pays the rest, though some plans cover the entire bill or the large majority of it. Common procedures covered include preventive care such as check-ups, cleanings, and X-rays, basic procedures such as fillings, extractions, and periodontal treatments, major procedures such as crowns, bridges, dentures, and root canals, and orthodontics in some plans.
Example:
A Canadian who buys a personal health and dental plan from an insurer like Sun Life may get reimbursed for a set percentage of preventive care such as cleanings and exams, with the plan covering part of the cost and the policyholder paying the rest. That coverage is subject to a waiting period and an annual maximum on what the plan will pay each year.
What to Watch For:
Under a Sun Life Personal Health Insurance plan, dental coverage can be accessed after a waiting period that begins on the effective date of coverage, and the Basic and Standard plans have a three-month waiting period. Some plans also apply deductibles and annual maximums that limit how much coverage you receive, and coverage differs from one plan to another. If you can submit a group health or dental claim to more than one plan, keep in mind that the combined payment from all group plans for a particular item cannot exceed 100 percent of the eligible expense.
