Your 海角社区 Dental Plan covers a wide range of dental services 鈥� everything from regular check-ups to root canals.
The Student and Staff Dental Clinic is open to all 海角社区 faculty members and employees. For more information and details on how to make an appointment, please visit this听web page or contact by telephone at 514-398-3155 or by email听clinic.dentistry [at] mcgill.ca听.
Optional participation
Participation in the dental plan is optional. If you refuse participation in the Dental Plan at enrolment, you will be re-offered the opportunity to join during the next enrolment window, which takes place in January, every three years, provided that you are actively at work and remain eligible.
For information about opting听into and out of the plan, please see听Changes to your coverage (life events).
Dental fee guide
It is important to note that all reimbursements under the plan are limited to the current fee guide for dental services provided by general practitioners published by the Quebec Dental Surgeons Association. If your dentist charges more for a given service or procedure than the amount recommended under the fee guide for general practitioners, the plan will limit the claim reimbursement amount.听
Annual maximum
Reimbursement under the dental plan for preventive, restorative, endo/perio听and major services is limited to a combined annual maximum of $2,000 per insured person.听The benefit year is calculated from January 1st to December 31st.
What's covered
The 海角社区 Dental Plan gives you and your family access to affordable dental coverage, covering a wide range of dental services and procedures听to keep you and your family smiling. Eligible expenses are outlined below.
All reimbursements under the plan are limited to the current听听for dental services provided by general practitioners published by the Quebec Dental Surgeons Association. If your dentist charges more for a given service or procedure than the amount recommended under the fee guide for general practitioners, you must pay the difference.
Preventive (100%)
The plan covers 100% of the cost of the following preventive, diagnostic, emergency and palliative services and procedures.
Twice a year, with intervals of five months:
- bitewing radiographs, including interpretation
- oral hygiene instruction
- prophylaxis (polishing of coronal portion of teeth)
- recall oral examinations
- topical fluoride applications (for patients less than 16 years of age)
Once every 2 calendar years:
- complete oral examinations
- complete set of radiographs or panoramic x-rays, including interpretation
As required:
- biopsy of soft and hard tissue
- cytological test
- laboratory tests and examinations
- emergency or specific oral examinations
- emergency or palliative services
- pit and fissure sealants (for patients less than 16 years of age)
- radiographs to diagnose a symptom or examine the progress of a particular course of treatment
- required consultation with another dentist
- intra oral periapical radiographs
Restorative (80%)
The plan covers 80% of the cost of the following restorative procedures:
- antibiotic drugs required for the purpose of dental treatment
- fillings, (amalgam, silicate, acrylic and composite) and retentive pins. Replacement fillings are covered only if:
- The existing filling is at least 12 months old and required due to significant breakdown of the existing filling or recurrent decay; or
- The existing filling is amalgam and there is medical evidence indicating that the patient is allergic to amalgam
- space maintainers
- preformed stainless steel crowns and repairs to preformed stainless steel crowns (except in conjunction with the placement of permanent crowns)
Endo/Perio (80%)
The plan covers 80% of the cost of the following endodontic and periodontic procedures:
- Endodontics (treatment of the root and pulp tissue)
- apectomy and retrofilling
- emergency treatments - Pulpotomy, pulpectomy and opening and draining of tooth
- hemisection, root amputation and root reimplantation
- root canal therapy and obturation.
- Periodontics (treatment of the gum and other supporting tissues of the teeth)
- periodontal scaling
- desensitization of tooth
- emergency services
- gingivoplasty
- guided tissue regeneration
- occlusal equilibration
- periodontal curettage (gingivectomy)
- root planning
- periodontal surgery
- tissue grafts
- periodontal appliances
- only one periodontal appliance (upper or lower) will be eligible when both are submitted within 60 days of one another
- periodontal appliances for children aged 16 and under are not covered
Major (70%)
The plan covers 70% of the cost of the following major procedures:
- crowns and repairs to crowns, other than preformed stainless steel crowns (see the Restorative section above)
- dentures and bridges
- the initial, complete or partial, fixed or removable prostheses (bridges or dentures), in the case of teeth extracted while the person is covered under the plan
- replacement of complete or partial, fixed or removable prostheses following the extraction of natural teeth, provided the person is covered under the plan at the time
- replacement of an existing prothesis that can no longer be used: Bridges every 7 years; Dentures every 5 years.
- inlays and onlays
- rebasing or relining of an existing partial or complete denture
- repair of bridges and dentures
- oral surgery
- alveolectomy, alveoloplasty, osteoplasty and tuberoplasty
- frenectomy
- minor surgical procedures and post-surgical care;
- repair of soft tissue laceration
- surgical excision (cysts and tumours)
- surgical removal of erupted and impacted tooth
- treatment of salivary glands
- uncomplicated removal of erupted tooth
Lab Fees
The lab fee听is the amount the commercial laboratory charges to the dentist to provide the service. Lab fees are typically 50%-60% of the total cost of the procedure. This amount is听reimbursed according to the same coinsurance as the procedure itself, and is subject to the overall annual combined maximum under the dental plan of $2,000.
Orthodontia (50%)
The plan covers 50% of the cost of comprehensive orthodontic treatment, using removable or fixed appliance (or a combination of the two), for dependent听children under 21 years of age to a lifetime maximum of $3,000 per person.
Coverage includes:
- diagnostic procedures
- corrective orthodontics treatment
- retention
- orthopaedic and/or myofunctional appliances
- control of oral habits
- interceptive, interventive or preventive orthodontic services other than space maintainers (see "Restorative")
Note:听Coverage is for dependent children under age 21 only. Your orthodontist may set an overall fee at the beginning of a course of treatment expected to extend beyond a year. In this case, the insurer may spread this fee over the entire treatment period and reimburse your expenses periodically over that period.
What isn't covered
The plan does not pay any benefit or accept liability for claims for the following听non-exhaustive list of items and听services.听If you are in doubt as to whether an item or service is covered by the plan, see听Coverage by area/service听below or听contact Manulife Financial at 1-800-268-6195.
Services not covered
- dental care covered in whole or in part under the provisions of any hospital, medical or dental plan in your province of residence, except for those expenses in excess of those provided under such provisions
- dental care arising directly or indirectly from:
- war, insurrection or the hostile action of the armed forces of any country
- participation in a riot, civil commotion, or commission of a criminal offence
- any cause for which indemnity or compensation is provided under any workers' compensation law or similar legislation
- implants, or any services rendered in conjunction with implants. However, where an implant is the choice of treatment and a denture or bridge would produce professionally adequate results for the condition, the cost of the implant expense and any related services, will be paid at a cost equal to the least expensive cost of a denture or bridge;
- missed appointments or the completion of claims forms
- replacement of lost, misplaced or stolen dentures
- services or supplies
- services normally intended for sport or home use (such as, but not limited to, mouthguards)
- services rendered for full mouth reconstructions, vertical dimensions corrections, and temporomandibular joint dysfunction or splinting
- services that are not clinically required, are given for cosmetic purposes, or exceed ordinary services given in accordance with current therapeutic practice
- periodontal appliances for children aged 16 and under will generally be ineligible for coverage. Bruxism in children is usually not treated because children's mouths are still constantly growing and changing
- desensitization听when performed at a hygiene appointment
Treatment plans
If the total treatment is expected to cost more than $400, you should ask your dentist to submit a treatment plan to the insurer before treatment begins. A treatment plan is simply a description of the required procedure proposed by the dentist,听including any related radiographs or study models, if required, and the cost of the treatment.
The insurance company will review the plan and report back to you on what portion of the cost (if any) is covered under the 海角社区 plan. This will keep you from having to pay for an expensive treatment that you thought was covered under the plan, but isn't.
Alternate treatment plan
If more than one type of treatment exists for your dental condition, you will be reimbursed for the lesser fee (provided that the treatment given is clinically acceptable and appropriate).
When coverage ends
Your coverage under the plan will end when you leave the University (before retirement), fail to qualify for coverage under the terms of the plan or opt out of the plan.
Coverage for your eligible spouse and children will end when yours does. In addition, coverage will end for your family members when they are no longer eligible under the terms of the plan (for example, when a son or daughter marries or assumes full-time employment).
If you (or a covered spouse or child) are undergoing a course of treatment that requires multiple appointments when you leave the University, you can claim expenses related to that procedure provided the expenses are incurred within 31 days of your departure.
Please refer to听Changes to your coverage (life events)听for more details.
If you become disabled
Your coverage under the Dental Plan will continue while you are eligible for benefits under the听Long Term Disability Plan, provided you continue to pay your share of plan costs.
If you die
If you were听under age 65听and you had family health and/or dental coverage, your spouse and eligible dependent children can continue this coverage under the plan for up to three (3) months. The University will pay both shares of the benefit cost.
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