Preventive / Basic Services
Preventive and basic services cover routine and common dental procedures that maintain and restore oral health. Preventive services include cleanings, X-rays, and exams, while basic services include fillings, extractions, and simple restorative work.
How It Works
Preventive and basic services form the foundation of most dental plans and are usually covered at higher reimbursement percentages, between 70 and 100 percent. Many dental plans provide immediate access to preventive care while imposing short waiting periods for basic treatments.
The exact list of covered procedures varies by plan. On a Canadian individual plan, preventive dental coverage can include examinations and diagnostics, tests, x-rays and lab exams, white fillings, cleaning, and topical application of fluoride, while basic (comprehensive) dental adds periodontics, endodontics such as root canals, scaling and root planing, minor oral surgery, minor denture repair, and uncomplicated extractions. On Sun Life's Personal Health Insurance Basic plan, preventive dental coverage includes examinations and diagnosis, tests, x-rays and lab exams, white fillings, scaling, minor extractions, space maintainers for children under 12, and pit and fissure sealant for children under 19.
Example:
Suppose you have a Canadian individual health and dental plan, such as Sun Life's Personal Health Insurance Basic plan. You go in for a routine exam, cleaning, and X-rays (preventive services) and the dentist also places a white filling (a basic service). Both are covered at your plan's basic-services reimbursement percentage, but the amounts paid for both categories count against the same combined annual dental maximum, so frequent basic work can use up the limit that would otherwise remain for preventive recalls later in the year.
What to Watch For:
Annual or combined maximums may limit how much a person can claim in total for preventive and basic services combined within a benefit period. Preventive and basic dental services can share a combined annual maximum, so claims for both categories draw down the same yearly limit rather than separate limits.
Reimbursement percentages and recall frequency also differ between insurers. On the Belairdirect Personal Health Plan, basic dental services are reimbursed at 80 percent with a recall limited to once every 9 months, while comprehensive basic services start at a lower percentage in early years and rise with continued enrolment (50 to 80 percent over three years). In a Trillium (Canada) basic plan, basic preventative dental services include examinations, cleaning, fillings, scaling, polishing and root canals, with no waiting period for basic preventative services.
