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The Dental Insurance plan is a non-taxable benefit designed to help cover the cost of necessary dental care expenses.
This benefit plan is mandatory for employees within CUPE Locals 229, 254 and 1302, the Faculty Association and individuals covered under the agreement between the University and the Staff Association unless there is proof of coverage under another plan.
Coverage is reimbursed in accordance with the Ontario Dental Association Fee Guide for General Practitioners for the prior year at 100% for basic procedures and 75% for major procedures. The maximum reimbursement is $3,000 per person per calendar year. First year coverage for late applicants enrollment is limited to $500 per individual.
- oral examinations (one per 6 months)
- dental x-rays (bitewings 2 per year, full mouth one per 24 months)
- cleaning and polishing (two per year)
- fluoride treatment and oral hygiene instructions (one per 6 months)
- space maintainers for insured dependents under 13
- pit and fissure sealants
- regular (non-bonded) amalgam, silicate, acrylic or composite fillings (“bonded amalgam” fillings will only be reimbursed up to the non-bonded rate)
- retentive pins and amalgam restorations
- stainless steel, plastic and polycarbonate restorations for insured dependents under 13
- minor surgical extractions and miscellaneous surgical procedures
- anaesthesia and sedative dressings
- endodontic services (root canal therapy)
- periodontal services (treatment of gum disease)
- denture adjustments, repairs, relining and rebasing
Crowns and Onlays
Crowns and Onlays are covered when a tooth has extensive structural loss that cannot be adequately restored using other procedures. The following crowns and related items are covered:
- metal, plastic, porcelain and ceramic crowns. Coverage for crowns on molars is limited to the cost of metal crowns. Coverage for complicated crowns is limited to the cost of standard crowns
- coverage for tooth-coloured onlays on molars is limited to the cost of metal onlays
- posts, cores and pins related to covered crowns
- copings related to covered crowns
- repairs to covered tooth-coloured materials
- removal and recementation of crowns and onlays
Replacement crowns and onlays are covered when the existing restoration is at least five years old and cannot be made serviceable.
If a crown or onlay is provided when a tooth could have been adequately restored using other procedures, alternative benefits will be provided based on coverage for fillings.
The following appliances are covered when required to replace one or more teeth extracted while the person was insured for major coverage on or after July 1, 2000:
- standard complete dentures
- standard cast or acrylic partial dentures
- complete overdentures or bridgework when standard complete or partial dentures are not viable treatment options. Coverage for tooth-coloured retainers and pontics on molars is limited to the cost of metal retainers and pontics.
Replacement appliances are also covered when:
- the existing appliance is a covered temporary appliance
- the existing appliance is at least five years old and cannot be made serviceable. If the existing appliance is less than five years old, a replacement will still be covered if the existing appliance becomes unserviceable while the person is insured for major coverage as a result of:
- the placement of an initial opposing appliance, or
- the extraction of additional teeth. If additional teeth are extracted but the existing appliance can be made serviceable, coverage is limited to the replacement of the additional teeth
If overdentures or initial bridgework is provided when standard complete or partial dentures would have been a viable treatment option, alternative benefits will be provided based on coverage for:
- in the case of overdentures, standard complete dentures
- in the case of initial bridgework:
- a standard cast partial denture; and
restoration of abutment teeth when required for purposes other than bridgework
Alternative benefits will be provided for the following appliances based on coverage for standard dentures or bridgework.
- equilibrated and gnathological dentures
- dentures with stress breaker, precision and semi-precision attachments
- dentures with swing lock connectors
- partial overdentures
- dentures and bridgework related to implants
The following denture-related surgical services for remodelling and recontouring oral tissues are covered:
- remodeling, excision, removal, reduction or augmentation of the alveolar bone
- remodeling of the floor of the mouth
- reconstruction of the alveolar ridge
- extensions of mucous folds
related surgical grafts
Related stents, although not listed with denture related surgery in the Canadian Dental Association Uniform System of Coding and List of Services, are also covered under this provision.
The following services are covered after the three month post-insertion care period has elapsed:
- denture remakes, once every three years
- denture adjustments, once a year
- denture repairs and additions, tissue conditioning and resetting of denture teeth
- repairs to covered bridgework
- removal and recementation of bridgework
Where there are two or more courses of treatment available to adequately correct a dental condition, reimbursement may be based on the cost of the least expensive treatment which provides adequate care to you (or your insured dependent).
This Alternate Benefit Clause is in no way an attempt to change a treatment plan. The choice of treatment is a matter of agreement solely between you and your dentist.
Note: If the dental expenses in connection with your (or your insured dependent's) treatment exceed $200, a proposed treatment plan completed by the attending dentist must be filed with and approved by Great-West Life prior to the date on which the treatment is to start.
No amount of benefit will be payable under this provision for any charge that resulted either directly or indirectly from, or was in any manner or degree associated with, or occasioned by, one or more of:
- any cause for which you may apply and receive indemnity or compensation under any Workers' Compensation Act
- intentionally self-inflicted injury
- war, insurrection or hostilities of any kind, whether or not you were a participant in such actions
- participating in any riot or civil commotion
- committing or attempting to commit a criminal offence or provoking an assault
- any dental care or treatment for which you are not legally obliged to pay
- any dental care or treatment which is principally for cosmetic purposes (veneers, staining porcelain, recontouring existing crowns, etc)
- any appointments not kept or for the completion of claims forms
- any dental treatment that has as its purpose the correction of temporomandibular joint dysfunction
- any endodontic therapy commencing prior to the date on which you became insured under this provision
- replacement of mislaid, lost or stolen appliances
- any crowns placed on teeth that are not functionally impaired by incisal or cuspal damage
- any crowns, bridges or dentures for which tooth preparations were made prior to the date on which you (or your insured dependent) became insured under the major dental plan that became effective July 1, 2000
- inlays, except as provided under alternative benefits
Leave of Absence
Special provision can be made for benefits to be continued for you and your insured dependents during a temporary leave of absence of less than two years. Arrangements for premium payments must be made with Human Resources before departure.
Insurance ceases immediately upon termination of employment except where a disability exists at termination. Benefits may continue in respect of that disability in certain cases.
No payment will be made by Great-West Life for any part of the charge, which exceeds the amount shown for the treatment in the current Ontario Dental Association Suggested Fee Guide for General Practitioners in your province or territory of residence.