Exclusions and limitations

The plan will not reimburse any portion of eligible expenses exceeding the suggested fee in the dental fee guide.

Reimbursement of lab fees will be limited to the reasonable and customary charge for such services in the area where the services are provided. However, in no event will the total reimbursement of lab fees exceed 67% of the suggested fee in the dental fee guide, for the particular dental treatment requiring the lab services.

Reimbursement of fees for composite restorations performed on posterior teeth is limited to the fees for amalgam restorations as specified by the insurer.

The plan will not cover any of the following:

• Any dental services or supplies, including x-rays, provided for full-mouth reconstruction, for vertical dimension correction, for the restoration of occlusion, for the correction of temporomandibular joint dysfunction or for permanent splinting of teeth.
• Any dental treatment rendered outside Canada except for treatment received for emergency purposes only (in this case, the plan will cover the treatment to the extent that payment would have been made under this plan if such treatment had been received in your province of residence).
• Any dental treatment that is not yet approved by the Canadian Dental Association or that is for experimental purposes.
• Any dental treatment which is for cosmetic purposes when the form and function of the teeth are satisfactory and no pathological condition exists.
• Charges for full-mouth X-rays for any insured dependent who is under age 10 when the charges are incurred.
• Charges for nutritional counselling.
• Charges levied by a dentist for broken appointments, completion of claim forms or advice by telephone.
• Dental services and supplies not included in the list of eligible expenses.
• Dental services, treatment or supplies that the individual received without charge or that a government health plan prohibits from being paid.
• Eligible expenses that result directly or indirectly from the following:
  • any cause for which payment is provided under any Workers' Compensation Act or similar legislation or under any other government plan;
  • committing, or attempting to commit a criminal offence;
  • intentionally self-inflicted injuries while sane or insane;
  • war, whether war be declared or not, or service in the armed forces of any country, or participation in a riot, insurrection or civil commotion.
• Expenses for anesthesia administered by acupuncture.
• Expenses for bacteriologic cultures/smears followed by a chlorzoïn treatment.
• Expenses for duplicate diagnostic casts (unmounted).
• Expenses for implants.
• Expenses incurred for athletic mouthguards.
• Expenses incurred for the replacement of an existing space maintainer.
• Services, treatment or supplies that the University provides to you.

Exclusions related to prostheses and crowns

The plan will not cover expenses to replace lost, mislaid or stolen dentures and appliances.

Exclusions related to orthodontic treatment

The plan will not cover any of the following:

• Expenses to replace lost, stolen or mislaid orthodontic appliances.
• Myofunctional therapy.
• Patient motivation (psychological evaluation and progress, per visit).
• Procedure requiring the insertion of an adjustable orthodontic appliance before the person is insured under this plan.