Which employees are eligible for coverage under the CISVA, Dentalcare Plan?
The eligibility requirements are as follows as defined in our Group Policy Contract:
1. You must be an Insurable Employee
2. You must be Actively at Work
3. You must be in the appropriate Benefit Class
Please refer to the Definitions and General Terms section of your benefit booklet for further clarification. Further details on the Benefit Class structure can be found on the CISVA website: CISVA Benefit Plan Overview / Basic Elements of Our Plan
Basic information about the dental plan
Dental Care coverage pays for eligible expenses that you incur for dental procedures provided by a licensed dentist, denturist, dental hygienist and anaesthetist while you are covered by this group plan.
For each dental procedure, we will only cover reasonable expenses. We will not cover more than the fee stated in the current Dental Association Fee Guide for general practitioners in the employee’s province of residence on the date that the treatment is received.
Payments will be based on the current guide at the time the treatment is received. If services are provided by a board qualified specialist in endodontics, prosthodontics, oral surgery, periodontics, paedodontics or orthodontics whose dental practice is limited to that speciality, then the fee guide used will be the specialist’s fee guide as set by the applicable governing authority.
The dental benefit year is from January 1 to December 31.
How much of our dental costs are paid by our plan?
There is no deductible for covered dental costs.
|Plan A: Basic treatment
||100% coverage of dental fee guide
No annual limit
|Plan B: Major treatment
||50% coverage of dental fee guide
$1000 per person, per calendar year maximum
|Plan C: Orthodontia
||50% coverage of dental fee guide
$3,000 lifetime maximum per insured person
(Coverage is available for both adults & children)
Pre-authorizations are recommended for anything over $500.00
Pre-authorization is required for dental claims estimated to cost $500 or more. If you or a dependent requires dental treatment that the dentist estimates will cost $500 or more, a Pre-Treatment description (including x-rays) and fee estimate must be obtained from the dentist and submitted to Great-West Life directly for approval before treatment is commenced. If the treatment program is approved you will be notified and reimbursement will be based on the applicable fee guide.
It is strongly recommended to obtain a preauthorization with regards to extensive dental procedures performed. This is to prevent unexpected costs.
What general expenses are covered in our Dentalcare plan?
Please refer to the Booklets section of the CISVA website. The available booklets are reflective of the appropriate Benefit Class that pertains to you. Dental benefits are detailed according to your class status. Please ensure that you are referring to the correct benefit booklet.
Dentists can charge anything they want!
The Fee Guide forms the basis of what insurance companies will pay for dental treatments. The Fee Guide is only a guide for what dentists may charge for any particular treatment. Dentists may set their own fees. Specialists usually charge higher fees than those in the Fee Guide.
For more detailed information on the Fee Guide, please contact the BC Dental Association (www.bcdental.org).
What is coordination of benefits?
If you or your dependents are covered under more than one benefit plan (for example, your spouse’s plan), you can claim up to 100% of an eligible expense (as per the dental fee guide) by coordinating your benefits under both plans. Here’s how:
- The plan that covers you as a plan member pays first. Then, the plan that covers you as a dependent pays any remaining eligible balance. Your spouse’s claims should go to his or her plan first, then any remaining balance should be sent to your plan.
- Dependent children are covered first by the plan of the parent whose birthday falls earlier in the calendar year. In other words, if your birthday falls in January and your spouse’s birthday is in March, you should submit your children’s claims to your plan first.
Your first benefit plan will send you an explanation of how much of your claim has been covered. You will need to send that explanation, along with copies of your expense receipts, to the second benefit plan in order to claim any remaining balance that’s eligible.