Dental Care

We all need dental care. But how much we need can vary dramatically depending on our teeth and dental history. With that in mind, the DGC Benefits Plan offers a range of preventative, routine and restorative procedures designed to keep you and your family smiling.

Coverage Levels

The DGC Benefits Plan provides three distinct levels of coverage. See the Coverage Level Overview for a summary of each coverage level and Life Member coverage.

Each year, during the re-enrolment period, you’ll be assigned an automatic coverage level for the upcoming plan year based on your producer contributions. If your automatic coverage level doesn’t meet your benefit needs, you may be able to upgrade your coverage. If you upgrade your coverage, keep in mind that your new coverage level will apply to all of your DGC Benefits.

Dental expenses will be reimbursed (based on your coverage level and reimbursement rates), provided they are:

For reasonable and customary treatment;
Within the amounts specified in the current general practitioner’s fee schedule (as approved in your province of residence); and
For services performed or prescribed by a dentist or denturist (or dental hygienist with an independent practice).

Charges above those shown in the current general practitioner’s fee schedule will not be covered.

If a reimbursement amount is not shown in the applicable fee schedule, the insurer will determine a reasonable amount.

Remember, you can use your Healthcare Spending Account (HSA) to offset the cost of those services and procedures not covered (or not fully covered) under your coverage level.

Maximums And Deductibles

Benefit maximums and deductibles run on a calendar year, with the exception of orthodontics, which has a lifetime maximum.

Remember, you can use your HSA to offset the cost of those services and procedures not covered (or not fully covered) under your coverage level.

Eligible Expenses

The following services and supplies are covered (based on your coverage level and reimbursement rates):

BASIC DENTAL COVERAGE

DETAILS

DIAGNOSTIC SERVICES, INCLUDING:

	LEVEL I	LEVEL II, III & ENHANCED LIFE MEMBER
Complete oral examination	—	1x every 3 years
Emergency, oral pathology, periodontal, surgical, prosthodontic and endodontic examinations	—	As required
Limited oral examinations	1x/calendar year	2x/calendar year, but 1x in years when you have a complete oral exam
Limited periodontal examinations	1x/calendar year	2x/calendar year
Complete series of x-rays	—	1x every 3 years
Intra-oral x-rays — up to 15 images	—	1x every 3 years
Panoramic x-ray	—	1x every 3 years, except provided in same year as complete series
Sialography	—
Extra-oral x-rays (other than panoramic and sialography)	—
Radiopaque dyes used to pinpoint lesions	—
Interpretation of x-rays	—
Microbiological, histological, cytological, and pulp vitality tests	—
Laboratory reports	—

PREVENTATIVE AND ROUTINE SERVICES INCLUDING:

	LEVEL I	LEVEL II, III AND ENHANCED LIFE MEMBER
Preventative scaling (one time unit = 15 mins)	1 unit/calendar year	Scaling units included in “periodontal”
Polishing	1x/calendar year	2x/calendar year
Fluoride treatments	1x/calendar year	2x/calendar year
Bitewing x-rays	1x/calendar year	—
Oral hygiene instruction	1x/lifetime	1x/lifetime
Pit and fissure sealants on bicuspids and permanent molars	—	1x every 5 years
Space maintainers	—	For missing central or lateral teeth
Appliances for the control of harmful habits	—
Finishing restorations	—
Interproximal disking	—
Recontouring of teeth	—

Minor restorative services, including:

Amalgams and tooth-coloured fillings (replacement fillings are covered only if the existing filling is at least two years old or was not covered under this plan);
Cavities, trauma and pain control;
Pins and posts for fillings; and
Pre-fabricated crowns for primary teeth.

Denture maintenance, including:

Relining dentures that are at least six months old, once every three years;
Rebasing dentures that are at least two years old, once every three years; and
Resilient liner (at least three months after denture insertion), once every three years.

Oral surgery, including:

Palatal obturators;
Removal of teeth;
Remodeling and recontouring oral tissue (minor alveoloplasty, gingivoplasty and stomatoplasty);
Surgical exposure of teeth;
Surgical excision of tumors, cysts, and granulomas;
Surgical incisions;
Treatment of fractures; and
Treatment of maxillofacial deformities.

Adjunctive services, including:

Pain relief (emergency basis only);
Therapeutic injections; and
Anesthesia required in relation to covered services.

Periodontal services, including:

Scaling and root planing, up to eight “time units” (combined) per calendar year. One time unit equals 15 minutes;
Periodontal surgery;
Occlusal adjustment and equilibrium, up to four “time units” (combined) per calendar year; and
Periodontal appliances, including adjustments, relines and repairs.

Endodontics, including:

Treatment of the pulp chamber;
Root canal therapy for permanent teeth, limited to one course of treatment per tooth (repeat treatment is covered only if the original therapy fails after the first 18 months);
Apexification; and
Periapical services.

MAJOR RESTORATIVE (LEVELS II, III AND ENHANCED LIFE MEMBER)

DETAILS

Crowns and onlays when a tooth has extensive structural loss that cannot be adequately restored using other procedures (the cost for crowns on molars is limited to the cost of metal crowns; the cost of tooth-coloured onlays on molars is limited to the cost of metal onlays). If a crown or onlay is provided when a tooth could have been restored using other procedures, alternative coverage will be provided.
Replacement crowns and onlays when the existing restoration is at least five years old and cannot be repaired.
Standard complete or partial dentures to replace teeth extracted while insured under this plan.
Implantology.
Complete overdentures or bridgework to replace teeth extracted while insured under this plan when standard complete or partial dentures are not a viable treatment option. Coverage for tooth-coloured retainers and pontics on molars is limited to the cost of metal retainers and pontics.
Replacement of any denture or bridge that is:
- Temporary;
- At least 5 years old and unserviceable; or
- Less than five years old, but unserviceable due to the placement of an 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.
Appliance maintenance, including:
- Denture remakes, once every three years;
- Denture adjustments, once a year;
- Denture repairs and additions;
- Tissue conditioning;
- Resetting of denture teeth;
- Removal, repairs and recementing of bridgework; and
- Denture-related surgery for remodeling and recontouring oral tissue.

ORTHODONTICS (LEVEL III ONLY)

DETAILS

Diagnostic services, including:
- Orthodontic examinations;
- Cephalometric x-rays;
- Diagnostic photographs; and
- Orthodontic diagnostic casts.
Fixed and removable orthodontic appliances, including related charges for observations, adjustments, repairs, alterations, removal, and retention.

ACCIDENTAL DENTAL

TREATMENT PLAN

Find out how much reimbursement you can expect — before your treatment begins.

For anything other than routine dental care, it is highly recommended that you ask your dentist to provide Canada Life with a treatment plan before the treatment begins. A treatment plan is simply a description of the proposed procedure and its related cost. Canada Life will review the plan and report what portion of the cost (if any) is covered.

What’s Not Covered

Regardless of your coverage level, the DGC Benefits Plan will not pay any benefit or accept liability for any dental claims relating to expenses such as (but not limited to) the following:

Duplicate x-rays;
Custom fluoride appliances;
Audio-visual oral hygiene instruction and nutritional counselling;
Root canal therapy for primary teeth;
Isolation of teeth;
Enlargement of pulp chambers;
Endosseous intra coronal implants;
Desensitization;
Topical application of antimicrobial agents;
Subgingival periodontal irrigation;
Charges for post-surgical treatment;
Periodontal re-evaluations;
Cleft palate obturators;
Hypnosis;
Alveoloplasty or gingivoplasty performed in conjunction with extractions;
Acupuncture;
Veneers;
Recontouring of existing crowns;
Staining porcelain;
Inlays (except when provided as an alternative benefit);
Crowns or onlays if the tooth could have been restored using other procedures;
Overdentures or initial bridge if a standard complete or partial denture would have been a viable treatment option;
Expenses covered under another policy (i.e., under another group plan);
Expenses a private insurer is not permitted to cover by law;
Services and supplies you are entitled to, by law, at no charge;
Charges that are made only because you have insurance coverage;
Services or supplies that are considered unreasonable;
Treatment performed for cosmetic purposes only;
Treatment for temporomandibular joint (TMJ); and
Expenses arising from war, insurrection, or voluntary participation in a riot.

When Coverage Ends

Your coverage will continue as long as you earn sufficient producer contributions, use money from your dollar bank, or pay out of your pocket to buy coverage (provided you are a member in Active Good Standing).

Your spouse’s coverage ends when your coverage ends, or if you move to Level I coverage, which does not include family coverage.

Coverage for a dependent child ends when your coverage ends, you move to Level I, or the child no longer qualifies as a dependant… whichever comes first.

Survivor Benefits

If you die while a member in Active Good Standing, your surviving dependant(s) will continue to receive coverage, as noted in the table below.

COVERAGE LEVEL AT THE MEMBER’S DEATH	SURVIVOR’S COVERAGE LEVEL
Level I	Level II – Single or Family
Level II	Level II – Single or Family
Level III	Level III – Single or Family
Life Member – Single or Family	Enhanced Life Member – Single or Family
Enhanced Life Member – Single or Family	Enhanced Life Member – Single or Family

Your surviving dependants’ coverage will continue for a period of time based on your years of membership in the DGC, as noted in the table below.

YEARS OF MEMBERSHIP IN THE DGC	PERIOD OF CONTINUING COVERAGE
Less than 25 years	2 years
25+ years	3 years