How do I receive an advanced review of expenses? This way you can find out how much the Dental Plan will cover and how much you will be responsible for paying. If you expect a dental treatment to cost $200 or more, SunLife will review the expense in advance. Laboratory charges are limited to 67% of the procedure fee in the ODA fee guide. If dental services are performed by a dental specialist, the maximum reimbursement will be 120% of the general practitioners fee guide. If your dentist chooses to charge more than the ODA fee guide, the portion of the cost above the recommended fee will not be reimbursed under the Dental Plan. The current Ontario Dental Association (ODA) General Practitioner Fee Guide is used to determine the maximum that the Plan will pay for each dental service. If the dentist charges more than the fee that would have been paid if the expense was occurred in Ontario, then employees are responsible for paying the excess. The procedures and associated costs must also be considered reasonable and customary in the area in which the service was performed. The plan will reimburse your expenses up to the amount that would have been paid if the work had been done in Ontario. The benefit year runs from January 1 to December 31 each year.
Please note that each eligible expense is allocated to the benefit year in which it is incurred. The plan covers eligible expenses up to an unlimited overall lifetime maximum, but some eligible expenses are subject to maximums or limitations. Is there an upper limit to my reimbursement under the Dental Plan? They will help you determine if the expense is covered and if it is subject to any restrictions. If your dentist recommends a treatment or service that is not mentioned, call Sun Life at 1-80. See Excluded expenses for a list of ineligible expenses. If an expense is not eligible under the Dental Plan, you are responsible for its cost. For example, if you have a claim for an eligible major restorative treatment, the plan will reimburse you 65% of the total cost up to the Ontario General Practitioner Dental Fee Guide maximum. When the plan does not cover an expense at 100%, employees are responsible to pay for the portion not covered.
Eligible expenses are reimbursed at the percentage shown, up to the limits stated based on reasonable and customary amounts suggested in the current Ontario General Practitioner Dental Fee Guide. Your Dental Plan coverage is described below. What coverage does the Dental Plan provide?
This page outlines your extended dental care covered expenses, limitations and exclusions.
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