Major Restorative
Major restorative coverage includes complex dental procedures designed to restore the function and appearance of teeth. Examples include crowns, bridges, onlays, dentures, and sometimes implants. These treatments are more extensive and expensive than basic restorative services such as fillings.
How It Works
Major restorative care, sometimes called major dental, covers more extensive and complex work that goes beyond basic services like checkups, cleanings, and fillings, and it is meant to restore teeth that are too damaged for basic restorative services. Plans typically group crowns, bridges, and dentures here, and some also classify root canals, implants, inlays, and onlays as major dental. Whether procedures such as root canals and wisdom teeth removal count as major depends on the plan, and some plans instead include those as routine dental care. Because most government health insurance in Canada does not cover major dental, many Canadians get it through workplace benefits or an individual plan. Reimbursement for major work is usually at a lower percentage than basic care, often 50 percent coinsurance with the plan member paying the remaining 50 percent, and the major category frequently shares one overall annual maximum claim amount with basic and routine services rather than having its own separate limit.
Example:
Picture a Canadian whose individual health and dental plan includes major restorative coverage at 50 percent coinsurance and who needs a crown. Once any deductible is met, the plan reimburses about half of the eligible cost and the member pays the rest, subject to the plan's annual maximum. Because crowns fall under major dental, the member first submits a pre-determination, or treatment estimate, to confirm coverage, and may need to satisfy a waiting period before claiming.
What to Watch For:
Many plans apply a waiting period before dental benefits can be used, although it can sometimes be waived if you are coming straight off another plan. Before major dental work begins, confirm the waiting period and whether pre-determination, or pre-approval, is required, since submitting a treatment estimate early helps avoid unexpected costs.
