Is this covered?

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In Ontario, OHIP covers many major healthcare related costs, but there are some notable exceptions. One of the main among them? Dental care.

If you have private health insurance (either through your job or through a plan you’ve purchased yourself), then your coverage is more expansive and typically includes both eye and oral care.

But that doesn’t mean it covers everything. Here are some questions you should ask your insurance provider about your insurance coverage before your next appointment.

It’s also important to remember that your dental plan and treatment plan are not the same thing. A dental plan is what your benefits will cover when you go to pay the bill after your appointment. A treatment plan is something you and your dentist agree upon regarding the future of your oral health that might not necessarily be covered by your insurance.

 
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What Procedures and Services are Fully Covered?

Whether you’re going in for a routine cleaning or a root canal, you need to know whether your insurance company will foot the entire bill or if you’ll be required to pay for part of it.

 
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Is There a Deductible?

Some insurance companies require that you pay a specified amount of money out of pocket towards the total cost before they pay the rest of what’s owed. The deductible may only apply towards certain procedures but it’s good to know what to expect beforehand.

 

What is the Maximum amount of Money I can Claim on Dental Procedures each Year?

It’s important to know how much money your insurance company will allow you to claim back on a yearly basis. This way you can plan out your appointments and review your dentist’s treatment plan with the peace of mind that comes with knowing you’ll be covered.

 
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Can I Choose my own Dentist or am I Restricted to Dentists Endorsed by my Insurance Company?

Some insurance companies require you to choose one of the dentists they’ve selected or else they will deny coverage. This is definitely something you need to know before finding yourself stuck footing the cost for an expensive dental bill not covered by your benefits.

 

What is my Co-Payment Amount?

Much like a deductible, a co-payment is the part of the bill that you’re on the hook for and that the insurance company will not reimburse you for.