Dental Plan

GOOD NEWS!

The maximum amount that you can be reimbursed each year has been increased. Effective January 1, 2005, the maximum amount that can be reimbursed has been increased from $1,300 to $1,500 per calendar year, per person covered. It is important to remember that if you join the Plan on or after July 1, 2005, the maximum amount that can be reimbursed for that year will be $750 and the full amount in the following years. This does not include orthodontic services, which continues to have a separate lifetime limit of $2,500 per covered person.

 COVERAGE LIMITATIONS

 Your dental plan covers eligible expenses for the reasonable and customary dental treatment that is necessary to prevent or correct dental disease or defect. The treatment must be consistent with accepted dental practices. The Plan pays a portion of the expenses for many dental procedures, but there are some that it does not cover. Sometimes there are a number of possible treatments for a specific situation and your treatment of choice may not be covered, but your plan may cover the costs of an alternative treatment. Check your options before getting major dental work done. Here are some examples of what is covered and what is not.

DENTAL PROCEDURES and LIMITATIONS

Crowns and replacement of crowns: Charges for major restorations, such as crowns, are considered an eligible expense only when the tooth structure is considerably damaged and a filling cannot restore the tooth adequately. Your plan will reimburse 50% of the eligible expenses subject to the normal deductible and maximum amounts. Your Plan also covers the replacement of a crown if the existing crown is at least five years old and cannot be repaired.

Implants: The costs for implants and work related to implants are not eligible expenses under the PDSP. However, your dental plan will generally cover the reasonable cost for the least expensive alternative course of treatment to an implant (i.e. standard removable dentures).

DID YOU KNOW?

• There is a lifetime limit of $2,500 per covered person for eligible orthodontic services.

• Reimbursements are based on the amounts specified in your provincial dental associations' fee guides from the previous year.

 • In 2005, the 2004 fee guides apply. [Fees for members in Alberta are based on the 1997 fee guide, increased by inflation.]

 • Eligible costs for major restorative, major prosthodontic and major orthodontic services are reimbursed at 50% and all other eligible services are reimbursed at 90%.

 • The annual deductible is a specific dollar amount that you must    satisfy each calendar year before you receive reimbursement by the Plan. If you have Category I (single) coverage, your annual deductible amount is $25. If you have Category II (two persons  or Category III (family) coverage, your annual deductible amount is $50. This amount will be subtracted from your first claim(s) during the year, and will be indicated on your Explanation of Benefits.

(The PDSP is administered by Sun Life Assurance Company of Canada, on behalf   of the Government of Canada.)

14 December, 2004