Your McGill Dental Plan covers a wide range of dental services — everything from regular check-ups to root canals.
Participation in the dental plan is optional. If you refuse participation in the Dental Plan at enrolment, you will be re-offered the opportunity to join every 3 years; unless you provide proof of loss of coverage elsewhere.
Reimbursement under the dental plan for preventive, restorative, endo/perio, and major services is limited to a combined annual maximum of $2,000 per insured person. The benefit year is calculated from January 1st to December 31st.
The McGill Dental Plan gives you and your family access to affordable dental coverage. The plan covers a wide range of dental services and procedures intended to keep you and your family smiling. Eligible expenses are outlined below.
The plan covers 100% of the cost of routine cleanings and examinations, and 80% of other basic dental work such as fillings. If you or covered family members require endodontic or periodontic treatments, orthodontia or other major dental treatment, the coverage is generally lower, at 50%-70%. To avoid surprises, please make sure to submit a treatment plan from your dentist before starting any major work.
The plan covers 100% of the cost of the following preventive, diagnostic, emergency and palliative services and procedures:
Twice a year, with intervals of five months
- bitewing radiographs, including interpretation
- oral hygiene instruction
- prophylaxis (polishing of coronal portion of teeth)
- recall oral examinations
- topical fluoride applications (for patients less than 16 years of age).
Once every 2 calendar years
- complete oral examinations
- complete set of radiographs or panoramic x-rays, including interpretation
- biopsy of soft and hard tissue
- cytological test
- laboratory tests and examinations
- emergency or specific oral examinations
- emergency or palliative services
- pit and fissure sealants (for patients less than 16 years of age)
- radiographs to diagnose a symptom or examine the progress of a particular course of treatment
- required consultation with another dentist.
- intra oral periapical radiographs.
The plan covers 80% of the cost of the following restorative procedures:
- antibiotic drugs required for the purpose of dental treatment
- fillings - acrylic or composite resin restorations (limited to anterior teeth and 1st and 2nd bicuspids), and amalgam restorations.
- space maintainers
- preformed stainless steel crowns and repairs to preformed stainless steel crowns (except in conjunction with the placement of permanent crowns).
The plan covers 80% of the cost of the following endodontic and periodontic procedures:
- Endodontics (treatment of the root and pulp tissue)
- apectomy and retrofilling
- emergency treatments - Pulpotomy, pulpectomy and opening and draining of tooth
- hemisection, root amputation and root reimplantation
- root canal therapy and obturation.
- Periodontics (treatment of the gum and other supporting tissues of the teeth)
- periodontal scaling
- desensitization of tooth
- emergency services
- guided tissue regeneration
- occlusal equilibration
- periodontal curettage (gingivectomy)
- root planning
- periodontal surgery
- tissue grafts
- periodontal appliances
- Only one periodontal appliance (upper or lower) will be eligible when both are submitted within 60 days of one another
- Periodontal appliances for children aged 16 and under are not covered
The plan covers 70% of the cost of the following major procedures:
- Crowns and repairs to crowns, other than preformed stainless steel crowns (see the Restorative section above).
- Dentures and Bridges,
- the initial, complete or partial, fixed or removable prostheses (bridges or dentures), in the case of teeth extracted while the person is covered under the plan
- replacement of complete or partial, fixed or removable prostheses following the extraction of natural teeth, provided the person is covered under the plan at the time
- replacement of an existing prothesis that can no longer be used: Bridges every 7 years; Dentures every 5 years.
- inlays and onlays
- rebasing or relining of an existing partial or complete denture
- repair of bridges and dentures.
- Oral surgery
- alveolectomy, alveoloplasty, osteoplasty and tuberoplasty
- other oral surgery and related local anesthesia other than for implants, transplants or repositioning of the jaw
- repair of soft tissue laceration
- surgical excision (cysts and tumours)
- surgical removal of erupted and impacted tooth
- treatment of salivary glands
- uncomplicated removal of erupted tooth
The 'lab fee' is the amount the commercial laboratory charges to the dentist to provide the service. Lab fees are typically 50%-60% of the total cost of the procedure. This amount is then reimbursed according to the same coinsurance as the procedure itself.
The plan covers 50% of the cost of comprehensive orthodontic treatment, using removable or fixed appliance (or a combination of the two), for dependent children under 21 years of age to a lifetime maximum of $2,500 per person.
- diagnostic procedures
- corrective orthodontics treatment
- orthopaedic and/or myofunctional appliances
- control of oral habits
- interceptive, interventive or preventive orthodontic services other than space maintainers (see "Restorative").
Note: Coverage is for dependent children under age 21 only. Your orthodontist may set an overall fee at the beginning of a course of treatment expected to extend beyond a year. In this case, the insurer may spread this fee over the entire treatment period and reimburse your expenses periodically over that period.
Implants & related services
Effective August 1, 2013, the cost of implants and all implant related services will be reimbursed based on the alternative treatment option.
What does this mean?
Implant and related services (including mesostructures, periodontal surgery, post surgical services, anesthetic, placement of attachments, crowns, dentures and bridges attached to implants) will be reimbursed based on the least expensive treatment option, such as the cost of a regular bridge or denture. Refer to section D. Major (70%) - Dentures and Bridges (same limitations apply).
The actual cost of the implant and related services will not be covered.
Reimbursement will be made only once all stages of the implant treatment have been completed and a claim is submitted.
Payments will not be made under this plan for expenses or charges relating to the following:
- dental care covered in whole or in part under the provisions of any hospital, medical or dental plan in your province of residence, except for those expenses in excess of those provided under such provisions
- dental care arising directly or indirectly from
- war, insurrection or the hostile action of the armed forces of any country
- participation in a riot, civil commotion, or commission of a criminal offence
- any cause for which indemnity or compensation is provided under any workers' compensation law or similar legislation
- actual cost for implants and related services, alternative treatment option applies
- missed appointments or the completion of claims forms
- replacement of lost, misplaced or stolen dentures
- services or supplies
- normally intended for sport or home use (such as, but not limited to, mouthguards)
- rendered for full mouth reconstructions, vertical dimensions corrections, and temporomandibular joint dysfunction or splinting
- services that are not clinically required, are given for cosmetic purposes, or exceed ordinary services given in accordance with current therapeutic practice.
- periodontal appliances for children aged 16 and under will generally be ineligible for coverage. Bruxism in children is usually not treated because children's mouths are still constantly growing and changing.
- desensitization when performed at a hygiene appointment.
Paying for your coverage
The amount you pay for your coverage will depend on whether you select coverage for:
- you alone ("single" coverage) or
- you and your eligible spouse and children ("family" coverage).
Reimbursement of your dental charges - dental fee guide
It is important to note that all reimbursements under the plan are limited to the current fee guide for dental services provided by general practitioners published by the Quebec Dental Surgeons Association. If your dentist charges more for a given service or procedure than the amount recommended under the fee guide for general practitioners, you must pay the difference.
If the total treatment is expected to cost more than $400, you should ask your dentist to submit a treatment plan to the insurer before the treatment begins. A treatment plan is simply a description of the proposed procedure, which, in the dentist's opinion, will be required, including any related radiographs or study models, when required, and the cost of the treatment.
The insurance company will review the plan and report back to you on what portion of the cost (if any) is covered under the McGill plan. This will keep you from having to pay for an expensive treatment that you thought was covered under the plan, but isn't.
Alternate treatment plan
If more than one type of treatment exists for your dental condition, you will be reimbursed for the lesser fee — provided that the treatment given is clinically acceptable and appropriate.
Your coverage under the plan will end when you leave the University (before retirement), fail to qualify for coverage under the terms of the plan or opt out of the plan.
Coverage for your eligible spouse and children will end when yours does. In addition, coverage will end for your family members when they are no longer eligible under the terms of the plan — for example, when a son or daughter marries or assumes full-time employment.
If you (or a covered spouse or child) are undergoing a course of treatment that requires multiple appointments when you leave the University, you can claim expenses related to that procedure — provided the expenses are incurred within 31 days of your departure.
If you become disabled
Your coverage under the Dental Plan will continue while you are eligible for benefits under the Long Term Disability Plan, provided you continue to pay your share of plan costs.