Active employees
of locals 1145, 1770, 1775 and 3260
 

Visiting the dentist
What does the plan cover concerning:
  Preventive care?
  Maintenance work?
  Major restoration?
  Orthodontics?
Are eligible dental expenses reimbursed based on a fee guide?
Should I submit a treatment plan if I expect my dental work to cost more than $500?
How do I make a claim?
Basic care
such as a routine check-up,
fillings, other preventive care,
or maintenance work
Plan
pays
You pay
Major restoration/
dental problems
Plan
pays
Maximum reimbursement:
$1,000 per person each calendar year ($3,000/lifetime per person for orthodontic expenses incurred on or after July 1, 2006)
You pay

Preventive care

The plan covers the usual cost of eligible preventive care as follows, subject to general exclusions:

Anaesthesia
Plan
pays
You pay
Bite adjustment/equilibration
Cavity prevention
Examinations
Fillings
Finishing restorations
Interproximal discing
Minor oral surgery
Mouth guards
Recontouring of teeth
Space maintainers and related maintenance
Tests and other diagnostic services
X-rays

Anaesthesia From sedatives to total loss of consciousness During a surgical dental
procedure
Bite
adjustment/
equilibration
A procedure to correct the bite problem between the upper and lower teeth when they are in contact 8 units every calendar year
Cavity prevention    
Fluoride   Once every calendar year
Oral hygiene instruction and
re-instruction
One-on-one instruction by the dentist or oral hygienist on how to brush and floss  
Pit and fissure sealants Coating put on top of any pits or cracks in teeth to prevent cavities from forming Unlimited
Polishing/
cleaning of
teeth
  1 treatment every calendar year
Recall
package
Polishing, recall scaling, recall examinations, and perhaps fluoride Once every calendar year
Recall
scaling
  1 treatment every calendar year as part of the recall package
Examinations    
Analysis of primary and permanent
teeth
  Once each calendar year
Consultation To discuss a serious dental problem and to agree on a treatment plan Unlimited
Emergency examinations   Unlimited
Initial or
complete examination
  Once per dentist
Recall examinations   Once every calendar year
Fillings    
Amalgam
fillings
Silver fillings that are used to restore teeth  
Composite
fillings
White fillings that are used to restore teeth  
Pre-fabricated posts Pre-made posts used for additional support to the tooth after root canal treatment  
Retentive
pins
Pins used to make sure that a restoration or filling stays in place  
Sedative fillings
for caries,
trauma and
pain control
Caries result from tooth decay. Trauma means a blow to the mouth or teeth resulting in injury. Severe wear may be considered a traumatic injury. Pain control includes temporary fillings and local anaesthesia to reduce pain before a permanent filling is installed.  
Stainless steel, plastic and polycarbonate caps Caps that are installed to cover the whole teeth  
Veneer
applications
White facings placed on a tooth’s surface Veneers that are done for cosmetic purposes are not
covered.
Finishing restorations Polishing of a filling previously placed in the mouth Unlimited
Interproximal discing Removal of a thin slice of tooth enamel to make more room for the teeth that are slightly crowded Unlimited
Minor oral surgery    
Extractions Removal of a tooth, including an impacted tooth Unlimited
Residual root removal Removal of tooth roots left behind when a tooth is pulled out  
Mouth
guards
A soft, flexible, plastic protective appliance worn to protect upper and lower teeth during contact sports 1 each calendar year
Recontouring
of teeth
Procedure to correct the bite between opposing teeth by shaping or grinding the enamel surfaces For functional purposes only; unlimited
Space maintainers
and related maintenance
An appliance that a dentist uses to maintain a space where a tooth has been removed Unlimited maintenance
Tests and
other diagnostic services

   
Bacteriological analysis of the saliva To determine the susceptibility of cavities Unlimited
Biopsy of
oral tissue
  Unlimited
Cytological
tests
   
Diagnostic
casts and models of the upper and lower teeth
For diagnostic ability or for construction of impression trays and temporary bridges and partial dentures Unlimited
Diagnostic
cast interpretation
Diagnosis of dental condition by studying impressions or casts of a person’s mouth Unlimited
Diagnostic photographs Intra and extra oral photographs of the teeth, mouth and jaw that aid in the diagnostic determination of dental treatment Unlimited
Histological
tests
   
Laboratory reports and interpretation   Unlimited
Microbiological tests    
Pulp vitality
test
To determine if the pulp (the soft tissue inside a tooth) is healthy  
X-rays    
Bitewing films To detect decay in molar teeth Up to 4 per calendar year
Cephalometric
films
X-rays of the facial and skull profile for orthodontic purposes Up to 5 every 2 calendar years
Extraoral films X-rays taken outside of the oral cavity Up to 4 per calendar year
Facial and sialographic
films
Intra oral X-rays of the salivary glands that assist with the diagnosis of duct stones Unlimited
Full mouth or panoramic films   1 series per calendar year
Hand and
wrist
X-rays
 

 

Occlusal films X-rays of the chewing surface of the teeth to show the fit between the upper and lower teeth when they are in contact Up to 4 per calendar year
Panorex films One view of the entire mouth Once every calendar year
Radiopaque
dyes
Dyes that can be seen on an
X-ray and are used to determine decay in teeth, or gum pockets around abscessed teeth
Unlimited
Single films
TMJ films
(films relating
to temporo-mandibular joint dysfunction)
  Unlimited
Up to 4 per calendar year

Maintenance work

The plan covers the usual cost of eligible maintenance work as follows, subject to general exclusions:

Alveoloplasty
Plan
pays
You pay
Appliances and related adjustments
Gingivoplasty
Maintenance of existing dentures
Major oral surgery
Repairs to existing major restorative work
Treatment of gum disease
Treatment of roots

Alveoloplasty Remodelling, removing or reducing bone  
Appliances and related adjustments    
Myofacial pain syndrome appliances Worn to manage pain in the facial area caused by internal and external forces on the teeth due to muscle contractions from abnormal forces or stress Appliances once per arch every 2 calendar years; unlimited adjustments and repairs
Periodontal appliances Making the impression and inserting the appliances Appliances once per arch every 2 calendar years; unlimited adjustments and repairs
TMJ
appliances
Worn to manage temporomandibular joint pain and discomfort Cost of making the impression and inserting the appliance once per arch every 2 calendar years; unlimited adjustments and repairs
Gingivoplasty Remodelling gums Unlimited
Maintenance of existing dentures    
Adjustments (including remount and occlusal equilibration)   Unlimited, provided adjustments made more than 3 months after the new dentures were inserted
Custom-stained denture bases   Must be provided in a dentist’s office
Prophylaxis
and polishing
Procedure to clean and polish dentures; can be done in office or in a lab Unlimited
Rebasing Fitting dentures with a new base Once per arch every 2 calendar years
Rebuilding of worn acrylic teeth   Must be provided in a dentist’s office
Relining Adding material so that the dentures fit properly Once per arch every 2 calendar years
Remake Remaking a new partial denture using the patient’s existing framework Once per arch every 2 calendar years
Repairs Fixing broken or damaged dentures Unlimited
Resetting of teeth   Unlimited
Resilient
liner
  Unlimited
Tissue conditioning Applying a conditioner to the alveolar ridge that ensures a proper denture fit Unlimited
Major oral surgery May include local anaesthesia, appropriate X-rays, surgery and follow-up care Unlimited, provided the surgery is not for cosmetic purposes and not part of any implant or part of any orthognathic surgery, remodelling or repositioning of the lower jaw
Antral
surgery
Surgical removal of a tooth that has been forced up into a sinus cavity  
Fractures Treatment of fractures of the upper or lower alveolar bone, which holds the teeth in the sockets  
Frenectomy Surgery on the frenum (a thin tissue that connects the lips to the gums and the tongue to the floor of the mouth)  
Hemorrhage
control
Treatment to stop bleeding resulting from an extraction or trauma  
Post-surgical care Treatment given by the dentist after surgery until healing is complete  
Sialolithotomy Partial removal of the salivary duct  
Stomatoplasty Remodelling the floor of the mouth  
Surgical
enucleation
Surgical removal of teeth prior to eruption  
Surgical excision
Removal of cysts or a foreign body  
Surgical incision Incision made to an infected area usually to allow drainage  
Surgical
exposure
Surgical incision to expose teeth that will not erupt or come on time  
Surgical
repositioning
Surgical procedure to reposition teeth due to growth abnormalities or trauma, resulting in the correct alignment of the upper and lower jaws  
Transplantation of erupted or non-erupted teeth Placement of teeth to another area of the mouth because of the early removal of the pre-existing teeth due to decay or trauma  
Vestibuloplasty Ridge reconstruction  
Repairs
to existing
major
restorative
work
Repairs to existing crowns, inlays, onlays, and bridgework; porcelain staining of fabricated crown; and removal and/or recementation of crowns, inlays, onlays, and bridgework Unlimited
Treatment
of gum
disease
  May include local anaesthesia, surgical dressing, sutures and follow-up care for 1 month; post-treatment evaluation not covered
Desensitization Applying fluoride to reduce sensitivity  
Displacement dressing Placing a medicated pack on inflamed gums to move gums away from the calculus (deposits on teeth that irritate gums)  
Flap surgery The opening made for bone removal  
Gingival curettage Scraping out damaged tissue inside the gums  
Gingivectomy Removing damaged gum tissue  
Periodontal scaling and/or root planing (tartar removal) Scaling: removing calcium deposits on teeth; root planing: smoothing rough tooth surfaces and removing any calcium deposits  
Tissue graft The transfer of healthy gums to an area where the gums have receded  
Treatment
of roots
   
Apexification Closing the root of a tooth with hard tissue  
Apicoectomy Surgical removal of a root end after root canal therapy  
Bleaching endodontically treated tooth The whitening of a tooth internally through the root canal opening of a tooth  
Endosseous intracoronal

Implants for root stabilization,
codes 34461, 34462 and 34471

 
Hemisection The removal of a portion of the
root(s) and the crown of a tooth but leaving the other root(s) in place
 
Intentional removal, apical filling and reimplantation The intentional removal of a healthy tooth and implanting it, e.g., a third molar is removed and used to replace a missing first molar  
Pulpectomy The removal of tissue from the pulp chamber  
Pulpotomy The removal of dental pulp from the crown portion of the tooth  
Retrofilling Filling done through the root end  
Root
amputation

Root(s) from a tooth removed because of infection

The crown and at least one root remain so that the tooth does not have to be removed.

 
Root canal therapy    

Major restoration

The plan covers the usual cost of eligible major restoration as follows, subject to general exclusions:

Bridges
Caps and tooth coverings
Dentures
Plan
pays
Maximum reimbursement:
$1,000 per person each calendar year
You pay

Bridges  

Crown lengthening (subgingival preparation) before tooth preparation is not covered.

Charges for replacing an existing bridge will only be paid if such replacement is for an equivalent bridge and meets one of the conditions shown below:

it has been more than 5 calendar years since the last bridge was inserted; or
it has been less than 5 calendar years since the last bridge was inserted and the existing bridge can no longer be worn.

Great-West Life must approve this.
Pontics Artificial teeth that replace missing teeth Covered only if it has been more than 5 calendar years since the last pontic was installed in that space
Posts in
retainers/
abutments
Posts and cores used for additional support to the retainer/abutment Covered only if it has been more than 5 calendar years since the last installation to that tooth
Retainers/
abutments
The tooth beside the missing tooth that will be used to support the bridge Preparation of the tooth is covered only if it has been more than 5 calendar years since the last preparations were made to that tooth.
Caps
and tooth
coverings
   
Build-up/
fillings
Restoring a tooth prior to capping for better adaptation of the cap  
Crowns A cap that covers the whole tooth  
Inlay/onlay restorations Metal, composite, or porcelain casts placed on the surface of the tooth  
Posts
and cores
Laboratory-processed posts and cores used for additional support to the tooth after root canal therapy  
Retentive pins in inlays, onlays and crowns Pins used to make sure that the inlays, onlays or crowns stay in place  
Veneer applications (laboratory processed) White facings put on a tooth’s surface Veneer applications that are done for cosmetic purposes are not covered.
Dentures    
Acrylic
dentures
Dentures with an acrylic denture base Covered only if it has been more than 5 calendar years since the last acrylic dentures were inserted
Complete dentures Dentures that replace either all of the top teeth or all of the bottom teeth
Charges for replacing an existing denture will only be paid if such replacement is for an equivalent denture and meets one of the conditions shown below:
it has been more than 5 calendar years since the last complete dentures were inserted; or
it has been less than 5 calendar years since the last complete dentures were inserted and the existing dentures can no longer be worn.

Great-West Life must approve this.
Gnathological dentures Placed to realign the upper and lower jaws following surgical procedures for jaw correction Covered only if it has been more than 5 calendar years since the last dentures were inserted
Overdentures Placed over a few remaining teeth that have had root canal treatment, and adapted to assist with the stabilization of the denture  
Partial
dentures

Partial dentures replacing one or more top or bottom teeth

The partial dentures may be acrylic (plastic), metal or chrome base that can have acrylic, wire or chrome clasps (which hold on to the teeth).

Covered only if it has been more than 5 calendar years since the last partial dentures were inserted or additional teeth have been extracted
Transitional
dentures
Temporary dentures used for healing purposes due to the extraction of one or more teeth Covered for one complete upper denture and one complete lower denture in 5 calendar years

Orthodontics

The plan covers the usual cost of eligible orthodontic procedures to correct crooked or misaligned teeth. This includes all dental treatment needed to correct the problem, such as examinations, X-rays, models, photographs, reports, surgical exposure of teeth, appliances and adjustments. Coverage applies only to expenses incurred on or after July 1, 2006, as follows:

   
   
   
PSGIP
pays
Maximum lifetime reimbursement:
$3,000 per person
You pay

The cost of dental treatment that is not an orthodontic service but is needed because of the orthodontic treatment is covered as if it were an orthodontic service.

 

Are eligible dental expenses reimbursed based on a fee guide?

Yes. Expenses are based on the Dental Association Suggested Schedule of Fees for General Practitioners or, as of December 1, 2005, the Dental Specialist Fee Guide, if applicable.

Should I submit a treatment plan if I expect my dental work to cost more than $500?

Yes. If your dental treatment will cost more than $500, Great-West Life recommends that you contact them before you incur the expense, to determine how much the plan will pay and how much you will pay. Here’s what you need to do:

1. For pre-determination of benefits, send Great-West Life a detailed description of the treatment plan and its cost.
2. You may also be asked to supply a fully completed written estimate plus pre-operative X-rays, diagnostic casts, and laboratory reports.

How do I make a claim?

1. Ask your dentist if he or she can bill Great-West Life directly.
2. If your dentist bills Great-West Life directly:
  Pay only your portion of the cost. You have no claim form to submit.
  If your dentist does NOT bill Great-West Life directly:
  Pay the total cost up-front and ask for a receipt.
  Complete a claim form.
  Send the claim form and your receipt to Great-West Life within 12 months after incurring the expense.
3. For orthodontic treatments, obtain a treatment plan from your dentist and submit it to Great-West Life. The plan will pay 50% of the eligible expense up to the maximum, as follows: 30% of the cost at the beginning of the treatment, excluding the diagnostic fee, and the rest on a monthly or quarterly basis depending on how the dentist bills for the services or how you submit receipts. No advance payments will be made.

General exclusions apply.

December 2014