Hour Bank Benefit Plan: Dental Care Benefit
The Hour Bank Benefit Plan's Dental Care benefit is self-insured. Claims are adjudicated by Great-West Life.
It is recommended that you take your benefit booklet with you whenever dental care or treatment is required so that your practitioner is aware of your coverage details.
There are no specific guidelines determining the fees that dentists may charge for their services. Therefore, it is recommended that you ask your dentist the cost of any procedures prior to undergoing treatment. The payment of dental claims is subject to any benefit levels and maximum benefit amounts.
To be covered, all services must be provided by a health care professional who is licensed, certified or registered to practice their profession by the appropriate licensing, certification or registration authority.
Some examples of eligible expenses are provided in the Basic Services, Major Services, Orthodontic Services and Accidental Services sections. For additional details regarding eligible expenses, refer to your benefit booklet.
If a dental procedure is eligible for coverage under this plan, the amount of the charge that will be reimbursed is the amount specified for that procedure in the current provincial General Practitioners or Denturist Society Fee Guide for the province where treatment is provided, except for when treatment is provided in the province of Alberta. If services are provided by a dentist in Alberta, the eligible portion of the charge will be the current Great-West Life representative price. If dental services are provided by a dental specialist, then the eligible amount will be based on the applicable specialist fee guide.
If the practitioner you have chosen charges more for a service than the amount indicated in the applicable fee guide, any excess amount charged by the practitioner is not eligible for reimbursement.
The amount of the eligible expense that will be reimbursed, based on the applicable fee guide cost, is:
- Basic and Major Services combined - $2,500 every calendar year
- Orthodontic Services - $2,500 lifetime (under age 19 only)
- Accidental Services - $10,000 per incident
Alternate Courses of Treatment
When two or more courses of dental treatment are available to correct a dental condition, reimbursement will be based on the the cost of the least expensive alternative treatment that, in the opinion of the plan, provides a professionally adequate result.
Pre-Determination of Benefits
If you are planning extensive dental treatment, it is recommended that your dentist submit the proposed course of treatment to Great-West Life before treatment begins. The plan will not determine the appropriateness of treatment, but will advise you of the amount that will be payable.
Dental Expenses Outside Canada
Expenses incurred for dental services outside Canada will be eligible if:
- they represent the usual, customary and reasonable charges for the procedures in the locality where they are performed; and
- charges for such procedures would have been paid under this plan had the procedures been performed in your province of residence.
All Dental Care claims for any calendar year must be received by Great-West Life no later than June 30 of the following year to be eligible for reimbursement.
Claim submission can be made by the following methods:
Electronic Submission by Dental Office: Dental practitioners have the option to direct-bill Great-West Life electronically. Please confirm with your practitioner whether this service is offered. It is the employee's responsibility to verify with the practitioner that Great-West Life has received the transmission of any electronic claims.
Online Claims: Employees may submit claims online via the Great-West Life website GroupNet for Plan Members. Online claims receive expedited processing. Once approved, payment is deposited to the employee's bank account within 1 to 3 business days of claim submission.
Paper Claims: A Merit Standard Dental Claim Form can be found in the Forms section, or by clicking here. Forms must be fully completed by your dental practioner and by the employee and mailed to Great-West Life along with original receipts. Once claims are approved, Great-West Life will mail a cheque to the employee. Payment can be expected within approximately two weeks.
Coordination of Benefits
If you or your eligible dependents are also eligible for benefits under another dental plan, any claim under this plan will be coordinated and limited to the extent that benefits payable from all plans do not exceed 100% of eligible expenses.
For more information on coordinating benefits, click here.
For more details regarding Dental Care, including a list of exclusions, please refer to your benefit booklet.