50% coverage to an annual max reimbursement of $1,000.
Prior approval is required by submitting a pre-treatment plan including x-rays. Contact the claims department for more information.
Inlays (1 per 5 calendar year, per tooth)
- Tooth coloured or amalgam core, in conjunction with crown
- Prefabricated, metal (permanent teeth)
- Prefabricated, plastic (permanent teeth)
- Veneer application
- Metal inlay (three surfaces)
- Composite inlay
- Porcelain/Ceramic inlay
Onlays
- Metal onlay (per tooth)
- Composite onlay
- Porcelain/Ceramic onlay
- Retentive pins for inlays, onlays and crowns
- Posts, cast metal
- Posts, prefabricated
Crowns (1 per 5 calendar years, per tooth. Includes inlays, onlays and crowns combined)
- Plastics
- Plastic, transitional
- Porcelain/Ceramic
- Metal (full cast)
- Metal (3/4 cast) partial veneer
- Crown, made to existing denture
Prosthodontic Services:
- Complete denture
- Immediate complete denture
- Temporary complete denture
- Complete overdenture
- Immediate complete overdenture (inclusive)
- Temporary partial denture
- Immediate partial denture
- Partial overdenture (plastic)
- Partial free end
- Immediate partial free end
- Partial tooth borne
- Immediate partial tooth borne
- Partial opposing arch
- Partial overdenture (cast)
- Immediate partial overdenture (cast)
- Remake
- Pontics
- Bridges
Retainers – Crowns:
- Plastic/Acrylic
- Porcelain/Ceramic
- Metal cast
Retainers – Inlays and Onlays:
- Metal Inlay
- Metal onlay
- Metal onlay (acid etch bonded)
- Abutment preparation
- Retentive pins
- Transplantation of erupted tooth
- Alveoloplasty
- Removal of bone, exostosis
- Gingivoplasty
- Vestibuloplasty
- Surgical incision and drainage
- Fractures, Reductions, Alveolar
- Replantation, repositioning
- Repairs, lacerations
- Antral surgery
- Adjunctive Services – Drugs