Dental Coverage

Please note: During the month of September until mid-October, there will be a blackout period. Coverage starts on September 1, so you are covered by the plan but must manually submit any claim forms during this period. This is because we are still waiting on the student lists from the University, as well as having to wait until the opt-out period is closed. Claim forms are available online or in MUSC 201.

You have $600 that you can claim for the entire policy year (September 1 - August 31) Click here to download the full Health & Dental brochure  .

Basic & Preventative Services

80% (100% on the dental network) of one examination and consultation, including any necessary x-rays and diagnostic services at time of exam, during each policy year.
 
Eligible exams:
  • Complete oral examinations
  • Recall oral examinations
  • Emergency or specific oral examinations
  • Consultation

Eligible X-Rays:

  • Full mouth series, minimum 16 films including bitewings in any 36 consecutive months
  • Panorex (one in any 36 consecutive months)
  • Periapical (no more than 16 films in 12 consecutive months)
  • Bitewing (no more than 4 films in 12 consecutive months)
  • Occlusal (no more than 4 films in 12 consecutive months)
80% (100% on the dental network) of one cleaning and one unit of polishing, includes up to 4 units of scaling (above the gum line)
 
Flouride treatments will be limited to one per policy year.
 
Minor Restorative Services
 
50% (75% on the dental network) of the cost of amalgam, silicate, composite, or tooth-coloured fillings and space maintainers.
 
Please note the following information:
  • Space maintainers only applicable to dependents under 15 years of age
  •  Tooth-coloured fillings are covered provided no more than 24 consecutive months have elapsed since last restoration
  • Multiple restorations on a common surface placed on the same service date will be considered a single restoration
  • Maximum benefit payable will not exceed the fee for a 5 surface restoration regarding the same tooth during one sitting
Extractions & Oral Surgery
 
50% (75% on the dental network) coverage of extractions and residual root removal, limited to two wisdom teeth in any policy year, other oral surgery is covered at 10% as noted below.
 
Services covered at 10% (25% on the dental network)
 
Endodontics - will include, where applicable, treatment plan, local anaesthesia, tooth isolation, clinical procedures, sutures, appropriate radiographs (x-rays) and follow up care:
  • Pulpotomy (not in conjunction with restoration or root canal therapy if rendered within 30 days)
  • Root canal therapy
  • Apexification
  • Periapical services
  • Root amputation
  • Hemisection
  • Intentional removal, apical filling and re-implantation

Periodontics:

  • Non-surgical procedures
  • Definitive surgical procedures
  • Adjunctive surgical procedures
  • Occlusal equilibration
  • Periodontal appliances including impression and insertion (no more than one appliance per arch in any period of 24 consecutive months)
  • Periodontal appliance repair, maintenance, and adjustment (no more than 4 units in any policy year)

Major Restorative (crowns/bridges/dentures) - most of the services listed below will be replaced only if the existing appliance is at least 5 years old, if the appliance is temporary and being replaced with a permanent appliance within 12 months of the installation of the temporary appliance or if the appliance was necessary due to the extraction of one natural tooth.

  • Crowns (only if more than 5 years have elapsed since the last placement) will include, where applicable, treatment plan, occlusal records, local anaesthesia, subgingival prepation of the tooth and supporting structures, removal of decay and old restoration, tooth preparations, pulp protection, impressions, temporary coverage, insertion, occlusal adjustments, and cementation
  • Removable prosthodontics will include, where applicable, treatment plan, impressions, jaw relation records, try-in, insertion, occlusal equilibration and 3 m onths post-insertion care on complete dentures, transitional dentures, acrylic dentures, and cast partial dentures
  • Fixed prosthodontics will include, where applicable, treatment plan, occlusal records, local anaesthesia, subgingival prepation of the tooth and supporting structures, removal of decay and old restoration, tooth preparation, pulp protection, impressions, temporary coverage, splinting, intraoral indexing for soldering purposes, insertion, occlusal adjustments, and cementation on pontic, retainers, and abutments.

Exclusions

  • Services not included in the list of defined eligible services (e.g. temporary fillings)
  • Completion of claim forms, advice by phone, or charges for missed or cancelled appointments
  • Cosmetic surgery or treatment when classified as such by the Company
  • Any dental treatment not yet approved by the Canadian Dental Association or which is clearly experimental in nature
This is a summary of the benefits available under the Group Insurance Plan.
Further details may be obtained from the Plan Provider
 

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Contact Details

Victoria Scott
asc@msu.mcmaster.ca
905-525-9140 ext. 23251

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