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Dental

VMware provides comprehensive Dental Coverage through Great West Life. The plan covers you on reasonable and customary charges to the extent they do not exceed the dental fee guide schedule on the date of treatment that is approved and published by the provincial dental association of the province of residence of the insured person and are incurred for necessary dental services which are performed or prescribed by a licensed dentist or a denturist licensed to practice denture therapy. If an allowance for an expense is not included in the fee schedule, Great-West Life will determine the reasonable and customary allowance.

Treatment Plan (Predetermination)

Before incurring any large dental expenses over $500, or beginning any orthodontic treatment, ask your dentist to complete a treatment plan predetermination and submit it to Great-West Life. Great-West Life will calculate the benefits payable for the proposed treatment, so you will know in advance the approximate portion of the cost you will have to pay.

Reimbursement Levels

• Basic Services: 100%
• Restorative Services: 50%
• Orthodontic Services: 50%

Reimbursements Maximums

• Basic & Major Services: $3,000 combined maximum each calendar year
• Orthodontic Services: $3,000 lifetime maximum

 Basic Services: 100% Reimbursement

• Routine examinations
• X-rays
• Fillings
• Extractions
• Oral surgery
• Polishing, once every 9 months
• Scaling, once every 9 months
• Fluoride treatments
• Periodontal treatment of the soft and hard tissue supporting the teeth, including provisional intracoronal splinting, but excluding any other type of splinting, appliances, or orthodontic treatment
• Endodontics, root canal therapy
• Space maintainers and retainers for missing primary teeth
• Re-basing, relining, and repair of dentures

Restorative Services: 50% Reimbursement

• Inlays and onlays
• Crowns
• Fixed bridges
• Dentures, excluding a duplicate set and equilibrated dentures
• Bridge repair

Orthodontic Services: 50% Reimbursement

• Orthodontic treatment
• Orthodontic appliances

Exclusions

No benefit will be paid:

• For a covered expense otherwise payable under another benefit of the Great-West Life group insurance policy
• For an expense incurred for cosmetic purposes
• For an expense incurred for the removal of an amalgam restoration and its replacement with an alternate material unless there is evidence of recurrent decay or significant breakdown
• For injury or disease for which a covered person is entitled to payment under any Workers= Compensation or similar coverage
• For an expense for which a covered person is not required to pay, or for which the covered person is entitled to  reimbursement under any non-contractual agreement
• For an expense for an injury or disease resulting from war or hostilities of any kind
• For more than one examination for a covered person during any period of nine consecutive months
• For an expense incurred for construction of an inlay, on-lay or crown unless there is extensive decay, breakdown or fracture of the tooth at the time of construction where an amalgam or similar restorative material cannot adequately restore the tooth
• For an expense incurred for replacement of an inlay, on-lay, crown or fixed bridge unless there is extensive decay or breakdown which cannot be repaired by use of amalgam or similar restorative material
• For an expense incurred for a precision attachment or for dental restorations for the purposes of:
  • Periodontal splinting;
  • Full mouth rehabilitation;
  • Altering of the vertical dimension; and
  • Modifying the occlusion

If there are alternative choices for dental procedures for the treatment of any specific condition covered under your dental benefit, benefits will be payable on the least expensive procedure that is consistent with quality dental care.

How to Make a Dental Claim

Submit your claims online.  Sign into your GroupNet for plan members account on canadalife.com or on the GroupNet app. If you are new to your plan, go to canadalife.com to register for GroupNet.

Submit claims no later than 15 months after you incur the expense. Keep a copy of all receipts for your records.