With more than 30,000 different dental benefit plans in Ontario, there is no one-size-fits-all approach. Your benefits provider and/or employer will provide you with information about your coverage.
Your dentist is your partner in taking care of your dental health. He or she will discuss your treatment options considering both your clinical and financial needs, helping you to make decisions about your oral health care. While it is important to understand your dental plan, it is also important to make choices about treatment based on all available information.
Dental insurance basics
Some patients will buy their own dental plan, but most have dental benefits provided by their employer. When your employer chooses your insurance plan, they consider things like the plan’s cost and how often employees use their benefits.
Although they choose the plan, your employer is not responsible for administering your dental plan. Instead, they enter into a contract with an insurance company who then acts as your dental plan administrator. Your dental plan administrator must reimburse you based on the terms of the dental plan contract.
Dental plans vs treatment plans
A dental plan is usually part of a health benefits package you get through your workplace. It can also be purchased on its own. Dental plans define which treatments are eligible for reimbursement.
A treatment plan is a personalized approach you and your dentist develop to treat your dental health needs. It serves as your roadmap to good oral health and should not be limited by what your dental plan covers.
Keep in mind that all benefit plans have limitations. Even though treatment may be necessary, it is not always covered in your dental plan.
