Dental Plan Benefits

Dental Coverage

Maximum Benefit

You and your eligible family members may be reimbursed up to $1,250 per person for dental treatment performed each calendar year. You cannot share maximums between family members.

Pre-Approval

If your treatment costs more than $500, Manitoba Blue Cross must pre-approve the treatment before it begins.

By getting pre-approval, you will know in advance how much the Plan covers. If some or all of the treatment is not covered, it will give the dentist an opportunity to consider alternative treatments that may be covered by the Plan.

Basic Dental Treatment

You will be reimbursed for 100% of the cost for the following basic procedures, subject to their maximum:

  • Oral examinations, teeth cleaning, fluoride treatments, and bite-wing x-rays twice per year but not more than once in any five-month period.
  • Full-mouth series of x-rays, provided that a period of at least two years has passed since the last series of x-rays was taken.
  • Extractions and alveolectomy (bone work) at the time of tooth extraction.
  • Amalgam, silicate, acrylic and composite restorations (fillings).
  • Dental surgery, excluding major treatment procedures.
  • Diagnostic x-ray and laboratory procedures required for dental surgery.
  • General anaesthesia required for dental surgery.
  • Endodontics (root canal treatment).
  • Periodontics (gum and tissue treatment).
  • Periodontal scaling when performed by a general practitioner, limited to four units (one unit = 15 minutes) per year, and 1.5 units of a combination of scaling and polishing twice each year, but not more than once in any five-month period.
  • The cost of medication and its administration when provided by injection in the dentist’s office.
  • Space maintainers for missing primary teeth, and habit-breaking appliances.
  • Consultations required by the attending dentist.
  • Relining and rebasing dentures once every three years.
  • Repairs to existing dentures.
  • Histopathological, cytological, microbiological, and odontology reports as required by the attending dentist.

Major Dental Treatment

You will be reimbursed for 50% of the cost for the following major procedures, subject to their maximum:

Extensive Restorations

  • Inlays and onlays (one per tooth every five years).
  • Jackets, crowns and bridges to rebuild or replace missing teeth (one procedure per tooth every five years).

Prosthetic

  • Partial or complete upper and lower dentures provided by a dentist or licensed denturist (one procedure every five years), including all adjustments. For example, a complete upper and lower procedure, either partial or full, or a complete upper and partial lower procedure (or vice versa).

Orthodontic Treatment

You will be reimbursed for 50% of the following orthodontic services, subject to their maximum:

  • Service for straightening teeth for dependant children under the age of 18, to a lifetime maximum of $1,250 per child (this is included in the $1,250 overall per year maximum).

The Plan does not pay in advance for orthodontic treatment.

Exclusions and Limitations

The Dental Plan will not pay for the following:

  • Gold, crowns, fixed bridges, veneers or other extensive treatment when another material or procedure is a reasonable substitute consistent with generally accepted dental practice. Where a reasonable substitute is possible, the covered expense will be that of the customary substitute.
  • Services purely cosmetic in nature, or for cosmetic reasons.
  • Congenital malformations (e.g., cleft palate prosthesis).
  • Fees arising out of extra services arranged privately between the patient and dentist.
  • Oral hygiene instructions and plaque control programs.
  • Charges for lost, stolen or broken appliances.
  • Separate charges for general anaesthesia, except in connection with office procedures as specified.
  • Bleaching of teeth.
  • Root canal on a permanent tooth more than once per lifetime per tooth.
  • Snoring or sleep apnea appliances.
  • Charges for treatment other than by a dentist, except for treatment performed in a dental office under the supervision and direction of a dentist by personnel duly licensed or certified to perform such treatment under applicable professional statutes and regulations.
  • Diagnostic photographs.
  • Precision attachments.
  • Hypnosis and dental psychotherapy.
  • Provision for facilities in connection with general anaesthesia.
  • Polishing restorations.
  • Any procedure in connection with forensic dental.
  • Complete clinical exams more often than once every three years.
  • Charges for broken/cancelled appointments.

See also General Exclusions section. 

Importance of the Fee Guide

Benefits paid by the Dental Plan are based on a specific dental fee guide established by your provincial dental association. While they are not required to do so, the majority of dentists charge according to the rates set out in the fee guide. There are certain procedures in the fee guide that are priced on an individual consideration (IC) basis; these will be reimbursed on a Reasonable and Customary basis, which refers to the amount usually charged for specific procedures or services in the area where the procedures or services are provided.

When you first visit your dentist, you can inquire about how rates are set before any work is carried out. If rates are higher than the fee guide rates, you will be responsible for the extra cost. In no event will the Plan pay more than the dentist’s actual charge.

© 2017 HEB Manitoba

 

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