Saint Mary's

Basic Benefits

Basic benefits include an 80% reimbursement level to a combined maximum with Major of $2500 per calendar year.

Dental benefits are based on the usual and customary charges up to the current Dental Society Fee Guide for general practitioners in effect in the prescriber's province of residence. The policy does not cover charges for speacialist fees for any dental procedures.

Predetermination of Benefits:

When the total cost of any proposed dental treatment is expected to exceed $500, ask your dentist to complete and submit the predetermination section of the claim form to Medavie Blue Cross before the start of the treatment. You will know, beforehand, the exact amount of reimbursement. If you change dentists in the course of treatment, you will be required to submit a new treatment plan.

Diagnostic Services:

• Clinical Oral examinations - one recall every calendar year
• X-ray examinations - Complete series to a maximum of 1 per calendar year
• Full mouth or panoramic films - one set of each every calendar year
• Occlusal, posterior bitewing, extra-oral or temporomandibular films-four of each type every calendar year
• Cephalometric films-five in every two calendar years
• Tests, laboratory examinations and treatment planning

Preventative Services:

• Prophylaxis 
• Fluoride treatments - once every calendar year
• Oral hygiene instruction - once every calendar year
• Pit and fissure sealants - once every calendar year
• Space maintainers and protective athletic appliances - once every calendar year

Restorative Services:

• Fillings
• Re-cementing inlays and crowns
• Cement restorations

Endodontic Services:

• Diagnostic and the treatment of the pulp (nerve) and tissue which affects the supporting tissue of the teeth, such as the gums and bones surrounding the teeth
• Root canal therapy
• Emergency procedures

Periodontic Services:

• Diagnostic and treatment of disease which supports the end of the root

Prosthodontic Services-Removable:

• Denture repairs and adjustments
• Denture rebasing and relining-once every two calendar years
• Tissue conditioning
• Temporomandibular joint intra-oral appliance and prosthesis

Prosthodontic Services-Fixed:

• Bridgework repairs-replacement of broken attachable facings, repair fractured pontics, removal and re-cementation of fixed bridge

Surgical Services:

• Extraction of teeth

Adjunctive General Services:

• Emergency treatment of pain
• Local anesthesia or conscious sedation
• Consultation with another Dentist

Major Surgical Procedures:

• Surgical exposure of tooth
• Surgical re-positioning of transplantation
• Cutting of bone to aid in removal of teeth or to permit insertion of a denture
• Surgical shaping of gum tissue in order to support teeth, and treatment of tumors and cysts.