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What is dental insurance?

Going to the dentist isn’t always fun and can get overlooked. But, oral health is important to your overall health, and the longer you avoid going to the dentist could spell trouble for your teeth and your wallet.

One way to keep consistent with your oral health is by having adequate dental insurance, a form of health insurance, to cover some or all of the costs associated with dental services. Paying for dental services out of pocket can be expensive. In fact, in 2018, 22.4% of Canadians (roughly 6.8 million people) avoided visiting a dental professional due to cost according to Statistics Canada.

OHIP and dental costs

Ontario Health Insurance Plan (OHIP) covers all Ontario residents, but only certain dental situations are fully covered. This could include oral surgery provided in a hospital and only in extreme situations, such as:

  • Correcting birth defects
  • Diseases of the jaw (tumors)
  • Correcting jaw and face damage due to an accident

Many people think that the above services are OHIP services, but they’re OHIP dental coverage, meaning dentists provide the service and bill OHIP.

But OHIP dental coverage does not cover regular dental services, such as check-ups, cleanings, x-rays and root canals/tooth removals.

Types of dental insurance coverage

Each dental insurance plan will be different in what services are offered, but there are generally four basic plans that insurance companies will have. Of course, these plans might vary slightly from insurer to insurer, so it’s best to find out what exactly each plan covers.

  • Basic: Most plans will include these basic services that will be available right away or after a short period. Services usually include routine cleaning, exams and x-rays. The frequency that the insurer will pay for treatments varies for each plan – some will cover a routine exam every six months, while others will cover an exam every nine months.
  • Comprehensive basic: This will cover the same as the basic plans, but also include periodontal treatment, root canals and denture cleaning and more.
  • Major: There will usually be a waiting period for a major plan. The waiting period means the services won’t be available until you’ve been a policyholder for at least a minimum amount of months, even up to three years. It can be worth the wait though, since these plans help cover extensive treatment that basic and comprehensive basic don’t cover, such as crowns, bridges and more.
  • Orthodontic: Just like major plans, orthodontic plans can also have a waiting period of up to three years. After your waiting period, orthodontic usually cover braces or some other type of alignment to straighten teeth and jaws.

Individual vs group dental insurance

Dental insurance is a straightforward product that is either called individual insurance or group insurance. Each insurance package varies in price and coverage of dental services offered.

Individual insurance is covered for single people, couples, or families, while group insurance is referring to employee benefits that are purchased by companies for their employees.

There are even some services that are add-ons to extend an insurance policy for both individual and group.

Dental care coverage by province

Depending on your eligibility, each province has their own government dental programs. Click on your province below to learn more.

  • Alberta offers multiple programs for low-income residents ranging from children to adults.
  • British Columbia offers basic dental coverage for adults on income or disability assistance and for youth under 19 years old in families on assistance.
  • Manitoba has a provincial health plan called Manitoba Health, Seniors and Active Living. Under the health plan, some dental procedures are covered when performed in a hospital.
  • New Brunswick offers a dental program to those who are over 19 years old who have special needs and qualify for assisted health care. Exams, x-rays, dentures and fillings are covered.
  • Newfoundland and Labrador has multiple dental health plans for kids, young adults and adults. Each program offers different services and eligibility varies.
  • Northwest Territories offers a school-based Oral Health Program to children attending school to teach about oral health education and provide oral examinations. The Extended Health Benefits for Seniors Program provides those 60 years of age and over, who are non-Aboriginal and Métis, residents access to a range of dental benefits not covered by insurance.
  • Nova Scotia Children’s Oral Health Program is for all children 14 years of age and under with a valid health card number. Once a year, children are able to have services such as one routine dental exam, one fluoride application and two x-rays.
  • Nunavut offers an Oral Health Program to children in grade 7 and under. Children enrolled in the program are eligible for free dental screenings.
  • Ontario offers a few different programs for low income and/or disabled youths and seniors on income assistance or disability assistance. There is also Cleft Lip and Palate/Craniofacial Dental Program for those who are eligible.
  • Prince Edward Island provides routine check-ups for all children in many of the schools. Adults in long-term care facilities are provided with long-term care dental treatment, such as annual screenings for oral disease, cleaning and scaling.
  • Quebec health insurance covers certain oral surgery. There are also services covered for children under age 10, including x-rays, fillings and tooth extractions.
  • Saskatchewan health coverage doesn’t cover routine dental services. However, it does cover surgery related to accidents and/or infection, extracting teeth and dental implants.
  • Yukon has Children’s Dental Program, which provides services to newborns to grade 8 or grade 12, depending on place of residence. Services include diagnosis, preventative and restorative services.

Frequently asked questions about dental insurance

Have more questions about dental insurance? Here are some answers to dental basics.

Is there free dental care in Ontario?

The short answer is yes, there is free dental care in Ontario, but only if you meet certain eligibility requirements.

Healthy Smiles Ontario is one government program that offers free dental services to children and youth 17 years old and younger who come from low income households.

The program provides regular visits to a dental provider while covering costs for services such as check-ups, cleanings, fillings, x-rays and emergency services. Braces and teeth whitening aren’t covered.

There is also free dental care for seniors 65 years of age and older from low income households called the Ontario Seniors Dental Care Program. The program provides free routine visits while covering costs for services such as check-ups, repairing broken teeth, x-rays, removing teeth, treating pain and gum conditions.

Is there free dental care in Canada?

Another tricky question to answer, but the short answer is yes, because each province has some form of dental care that’s free to those who are eligible. The longer answer is no, there isn’t a free dental care program across the country, but each province has their own government dental programs that offer free services, often to youth and seniors from low income households and/or on disability.

Dental care isn’t included in the Canada Health Act, and most residents who aren’t eligible for free dental care, or don’t get benefits through their employer, end up paying for services through private insurance or out of their own pocket.

What is the best dental insurance?

This depends on what is best suited for your needs and budget. If your teeth and oral health are in good standing, a basic plan would suit you over a more comprehensive plan.

If you have kids, you might benefit from an orthodontic plan, since many kids end up getting braces at a young age.

Some plans might also have dental add-ons that you can pay extra for as your budget and needs change.

How is my dental insurance premium calculated?

A premium is the amount of money an individual or business pays for their insurance policy. Along with the package you pick, different factors come into play when calculating the premium, including your age, dental records, and illness history.

Other factors like the location you live in and how many dependents are in your family also affect the premium.

How do I claim dental benefits and how long does it take for dental insurance to pay a claim?

To claim dental benefits, a form must be completed and submitted to your claim provider. If you have insurance through your employer, you can ask Human Resources for assistance or customer service at your plan provider.

When submitting a claim to dental insurance providers, you have to follow a specific process set out by the dental insurance provider you've chosen. Paperwork must be filled out detailing the type of treatment, clinic, costs and other details. After you've filled out the paperwork, it will go through the approval process with your dental care insurer. The length of time for approval ranges with each firm.

How does group benefit dental insurance work?

Group benefits, also known as employee benefits, are part of the compensation package for employees that help cover some or all medical and dental costs.

Each group benefit package is different in what is covered. Some benefit packages cover up to a certain allotted monetary amount, while others cover up to a certain percentage. For example, one employer might cover up to 80% of basic dental procedures, while another employer might reimburse up to $500 for any dental work.

If some employee benefit packages don’t cover everything you need, your employer might have options for specific add-ons to your coverage or let you personalize your benefits. In some cases, add-ons and personalization aren’t available, you can consider getting private insurance to help bridge the gap of your employee benefits.

Part-time or contract employees generally won’t be eligible for benefits, so you would need to get private insurance or pay for any work out of your own pocket.

Do self-employed or freelancers get dental insurance?

If you’re a freelancer or self-employed, you might be thinking that group benefits aren’t even an option for you.

If this is the case, your decision on getting insurance will have to be partly based on knowing your oral health, which can be tricky.

Some people have a history of bad oral health and will need a lot of dental work done in a year, so having insurance could help reduce overall costs.

Another thing to consider is if you’re only paying for yourself and only need routine checkups, you could save more by paying out of pocket than with insurance. On the other side of that, if you have a spouse and/or kids, getting insurance could save you money rather than paying out of pocket for the whole family.

Before deciding on getting insurance or not, make sure you know what’s covered, because not every plan has what you need. Some plans also come with yearly spending limitations or limiting procedures, such as only covering certain emergencies.

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