CAEAS-ECAB
Dental coverage
Under your plan, coverage is based on the current dental fee guide in the province of treatment. The guide is a reference of suggested fees for dental services that is updated annually by the provincial Dental Associations. Knowing what your dental provider charges will help you determine your coverage and avoid extra costs to you for service fees that are above the reasonable and customary limits in the dental fee guide.
Getting a predetermination
Dental work can be expensive, and we don’t want members to be unpleasantly surprised! That’s why it’s important to get a predetermination for any significant dental work – like bridges, crowns, or dentures – before starting treatment.
A predetermination is basically an estimate of the work needed and the costs involved. It’s a useful tool to help you make more informed dental care decisions, since you can see the expected costs, how much you’ll be out of pocket, and if some of those out-of-pocket costs exist because your dentist charges more than the fee guide. It will also help smooth the claims process and minimize any delays in payment.
To get a dental predetermination:
- Have your dental practitioner complete a dental claim form (either electronic or hard copy) and make sure it’s clearly marked as a predetermination request;
- Include any supporting documentation (e.g., x-rays and/or models); and
- Submit the predetermination request to Canada Life for review.
Once you hear back from Canada Life, you and your dental practitioner can determine next steps.
Remember, you may be able to coordinate benefits to maximize your reimbursements and/or use your HCSA to help pay for any out-of-pocket dental expenses.
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