NOTE: This information is only current as of Jul 21, 2017. Please visit asebp.ca for the most up-to-date information.

Dental

Our dental coverage encourages you and your dependants to proactively manage your oral health through basic preventative and restorative treatments (e.g. check-ups, X-rays and cleanings, etc.). Some plans also cover major restorative dental work (e.g. bridges and crowns, etc.) and orthodontic treatments (e.g. braces and appliances, etc.). You can find your plan number under Coverage on My ASEBP or on your ASEBP ID card on the My ASEBP Mobile App under Dental Care.  

Dental reimbursement rates are based on reasonable and customary costs as outlined in the ASEBP Dental Benefit List and dental fees in Alberta are not regulated. This means that even if you have 100 per cent coverage, you won’t necessarily have 100 per cent of your dentist’s bill covered. To avoid surprises, talk to your dental provider about whether their fees follow the ASEBP Dental Benefit List before your visit.

Note that the following is an interpretation of the official, legally binding ASEBP insurance policies and plan documents available through your employer or by contacting us.

What's covered?

Basic Preventative/Restorative Dental Treatments

Basic Preventative/Restorative Dental Treatments

For basic treatments over $800, a dental predetermination (treatment plan) is recommended.

Plan 1 Plan 2 Plan 3 Plan 4
100% of the Dental Benefit List fees for basic treatments up to $1,500 per person per calendar year 100% of the Dental Benefit List fees for basic and major treatments up to $2,500 per person per calendar year 100% of the Dental Benefit List fees for basic treatments per person per calendar year 50% of the Dental Benefit List fees for basic and major treatments up to $1,000 per person per calendar year with a $50 deductible per family per calendar year

Below is a list of some common basic preventative and restorative procedures and coverage limitations:

Dental Exam (recall/specific exams) 

One recall or specific examination is eligible for coverage every nine months from the date of last service. 

Complete Dental Exams 

Complete dental exams are eligible for coverage once every 30 months from the date of last service. 

Emergency Exams

Emergency exams are covered anytime, but only in conjunction with other emergency services, like X-rays, extractions, etc. or a written explanation on the claim form from your dental provider regarding the nature of the emergency.

Fillings 

Fillings are limited to five surfaces per tooth every 24 months from the date of the last service. For molar teeth, ASEBP will only reimburse up to the cost of silver fillings. 

Fluoride applications

Fluoride applications are eligible for coverage once every nine months from the date of last service. Note that only children up to and including age 15 are covered. 

Polishing

Polishing is eligible for coverage once every nine months from the date of last service. 

X-Rays (bitewing)

Bitewing X-rays are eligible for coverage once every nine months from the date of last service. 

Panoramic and Full-Mouth X-Rays

Panoramic and full-mouth X-rays are eligible for coverage once every 30 months from the date of last service. 

Root Planing/Scaling

Root planing/scaling is limited to 12 units of time (one unit of time is equal to 15 minutes) per person in a one-year rolling period

General Anesthetic 

General anaesthetic is eligible for coverage only in conjunction with eligible surgical procedures (e.g. surgical extractions) and excludes anesthetic facility (such as a recovery room), equipment and supply fees.

Extractions 

There are no specific limitations for tooth extractions.  

Root Canals (endodontics)

Root canals for the same tooth are only covered once every 24 months. Treatment of previously-completed root canals require a dental predetermination (treatment plan) to be completed prior to treatment. 

Specialist Referral Exam

Specialist referral exams are limited to once every 12 months per dental specialty from the date of last service. Referral to a specialist is made by your family dentist. Orthodontic referrals are covered under orthodontic services.

Major Restorative Dental Treatments

For major restorative treatments over $800, a dental predetermination (treatment plan) is recommended.

Plan 1 Plan 2 Plan 3 Plan 4
Not covered 50% of the Dental Benefit List fees up to $2,500 for basic and major treatments per person per calendar year 60% of the Dental Benefit List fees up to $2,500 for major treatments per person per calendar year 50% of the Dental Benefit List fees up to $1,000 for basic and major treatments per person per calendar year with a $50 deductible per family per calendar year

Below is a list of some common major restorative procedures and coverage limitations:

Bridges

Bridge replacements must be seven years old from the date of last placement. 

Crowns

Crown replacements must be five years old from the date of last placement. Re-cementation of a crown is limited to twice per tooth per lifetime.  

Dental Implants

Surgical procedures, such as a dental implant, are limited to a maximum of $1,650 per tooth payable at 60 per cent ($990) for Plan 3 or 50 per cent ($825) for plans 2 and 4. Replacements must be 12 years old from the date of the last placement.  

Dentures - Full and Partial

Denture replacements must be five years old from the date of the last placement. 

Inlays and Onlays

Inlay and onlay replacements must be five years old from the date of the last placement. 

Veneers 

Veneer replacements must be five years old from the date of the last placement. Re-cementation of a veneer is limited to twice per tooth per lifetime. Veneers for cosmetic purposes are not covered. 

Orthodontics

With the exception of diagnostic tests, ASEBP requires a dental predetermination (treatment plan) to be in place before reimbursing orthodontic services. 

Plan 1 Plan 2 Plan 3 Plan 4
Not covered Not covered 100% of the Dental Benefit List fees for examinations and diagnostics and 60% of the Dental Benefit List fees for all other treatments (e.g. appliances, banding, etc.) up to $3,000 per person per lifetime Not covered

 

Resources

Asset 40

What's not covered?

The following are a number of products and services not covered under the plan. Note that this list is not exhaustive. 

  • Appliances which have been lost, stolen or broken because of an incident that did not involve accidental bodily injury
  • Charges for broken or missed appointments
  • Correction of temporomandibular joint (TMJ) dysfunction
  • Cosmetic treatment, such as teeth bleaching or diastema (gap) closure, unless necessitated by an accidental injury
  • Dietary planning, plaque control or oral hygiene instructions
  • Full mouth reconstructions and vertical dimension correction
  • Mouth guards worn for safety protection for sports, work or other related activities
  • Services or supplies that were not provided by a dentist or other dental professional
  • Treatment that is experimental, educational or for the purpose of research
  • Treatment where expenses are not considered necessary for the prevention of a dental disease or correction of a dental defect
  • Treatment provided free of charge
  • Services provided by a family member if the family member has been given a discount. If you or your dependant is required to pay a portion of the cost of the services, you must pay for that portion or have your entire claim deemed ineligible (for example, if a dentist bills $300, we pay $180 (60 per cent) and you pay the remaining $120 (40 per cent). If the dentist does not require you or your dependant to pay your portion, we will not pay either)
  • Expenses covered through a government program, whether or not you or your dependants choose to participate in the program
  • Where charging for services or supplies is prohibited under legislation
  • Expenses incurred while on active duty in any military or peacekeeping force
  • All expenses incurred as a result of conduct that would constitute an indictable offence within Canada.

Additional Information

Dental Accidents

Your plan doesn’t include additional coverage for dental accidents; however, you may be eligible for additional coverage through Accidental Dental depending on the circumstances of the accident and the type of injury. To be eligible for Accidental Dental, you must have Extended Health Care coverage (you can confirm the benefits you have under Coverage on My ASEBP or on your ASEBP ID card on the My ASEBP Mobile App).

Coverage Outside Alberta and Canada

If you are travelling outside Alberta or Canada, you can submit routine and emergency dental expenses to ASEBP to be reimbursed. Expenses will be paid according to plan provisions defined by your Dental Care coverage. 

Note that your Dental Care plan does not include additional coverage for dental emergencies while travelling outside Canada; however, if you have Extended Health Care coverage, you will be eligible for additional coverage through the dental portion of your Travel Emergency benefit. In the event of a dental emergency while travelling outside Canada, please submit your claim through your Travel Emergency benefit first. You can confirm the benefits you have under Coverage on My ASEBP or on your ASEBP ID card on the My ASEBP Mobile App.

Dental Benefit List

Dental fees are the amount your dentist charges for the services they provide and, typically, these fees increase on a yearly basis. Further, fees in Alberta are both unregulated and the highest in Canada. As a result, we, like most Alberta benefit providers, have our own dental benefit list which outlines the maximum amount we will reimburse for treatments based on what’s considered reasonable and customary. Dental providers have easy access to our dental benefit list so, to avoid surprises, be sure to confirm that your dental provider charges according to the ASEBP Dental Benefit List before your visit.

Dental Predetermination

You should discuss any proposed basic or major restorative treatments with your dentist to understand both the cost of the treatment and to determine if a proposed treatment plan (dental predetermination) is needed. To avoid surprise out-of-pocket expenses, we recommend having your dentist submit a dental predetermination in advance of any proposed treatment, especially if the cost is $800 or more.
On occasion, ASEBP may request pre-treatment X-rays or other information from your dentist to support a treatment plan. Where two or more courses of treatment are submitted, reimbursement will be based on the least expensive of the proposed treatments. 

Here’s some important things for you to know:

  • Receiving a predetermination is not a pre-approval for the reimbursement of your expenses. It is a confirmation that the prescribed treatment you are considering is included as part of your ASEBP coverage. 
  • Predeterminations only take into account the costs that have been accumulated against your maximum at the time of the authorization—they do not include any costs that have not yet been billed to ASEBP or coordination of benefit rules, etc.
  • To be reimbursed for the amounts confirmed, you or your dependants must start the treatment within 90 days of your dentist submitting the predetermination to ASEBP. If your treatment began prior to you receiving ASEBP coverage, please submit a predetermination with the start date of your current treatment plan. Note that treatments incurred prior to your effective date of coverage will be not be eligible for reimbursement.
  • Depending on the cost of your proposed treatment plan (whether it’s above or below $800) as well as how your dental provider submits the predetermination (e.g. mail or electronically), you may or may not receive your own copy of the predetermination. If you do not receive a copy and would like to review the predetermination and how much your ASEBP Dental Care benefits will cover, please speak with your dental provider as they will receive confirmation of payment breakdowns for all submitted predeterminations.

Orthodontic Predetermination

With the exception of diagnostic tests, ASEBP requires a proposed treatment plan (called a predetermination) before reimbursing for orthodontic services. The predetermination must be completed by your dental provider to determine what procedures are allowable and the amount covered under your plan.

For an orthodontic predetermination to be complete, your orthodontist must include the following information:

  • A description of the condition requiring treatment, including the classification and malloclusion (misalignment)
  • The proposed payment plan including:
    • length of time per course of treatment,
    • total cost of treatment,
    • amount of down payment (if applicable),
    • type of instalments, and
    • amount payable for each instalment.

Here are some important things for you to know:

  • Receiving a predetermination is not a pre-approval for the reimbursement of your expenses. It is a confirmation that the prescribed treatment you are considering is included as part of your ASEBP coverage. 
  • Predeterminations only take into account the costs that have been accumulated against your maximum at the time of the authorization—they do not include any costs that have not yet been billed to ASEBP or coordination of benefit rules, etc.
  • To be reimbursed for the amounts confirmed, treatment must begin within 90 days of your dentist submitting the predetermination to ASEBP. If your orthodontic treatment began prior to you being enrolled in ASEBP dental coverage, a predetermination for any remaining work will need to be submitted and approved by ASEBP before any portion of the work will be paid.

 

Rolling Period

Your plan maximum for root planing/scaling is 12 units based on a rolling one-year period by service date (the date you received the treatment, service or product being claimed—not the date it was paid for)—not calendar year. (E.g. if you claim eight units of time on March 31, 2017, and four units of time on September 1, 2017, you’ll be eligible for eight more units on March 31, 2018, and four more units on September 1, 2018.)