How Dental Insurance in Toronto Works

If you’ve ever paid close attention to basic health insurance plans in most countries, you might have noticed they rarely cover dental services, and if they do, it is only for emergency cases.

Well, dental insurance in Toronto is no different.

If you live in Ontario, you might know this to be true, especially if you are under the Ontario Health Insurance Plan (OHIP).  This plan generally does not cover dental services except for a few dental surgery cases done in a hospital.

So, if you want an individual dental insurance plan that covers dental procedures such as teeth and gum cleaning, cavity filling, wisdom teeth removal, and dental X-rays, you have to learn as much as you can about individual dental insurance in Ontario.

Actually, this is not such a bad thing as there are numerous Ontario insurance firms that can make this happen. If you are lucky, you may have dental coverage as part of your employee benefits package, which helps you pay for some dental procedures, like the ones mentioned above.

Understanding dental insurance in Toronto begins by knowing the difference between a dental and a treatment plan.

Dental Plan Vs Treatment Plan

Most Torontonians usually have a supplement insurance plan in addition to OHIP. This helps you have a tailored plan that can cover their individual or family’s health needs, including dental.

Now, when looking for the best dental insurance in Ontario, it is important to understand the difference between a dental plan and a treatment plan.

Most employers will provide some form of the dental plan as part of your employee perk. What this means is that they help you pay for the dental treatments in a bid to promote good health for their staff members.

Note that the majority of such plans hardly cover the full cost of dental procedures. Some will also be limited to a list of dentists provided by your employer.

A treatment plan, however, is the individual roadmap that you and your dentist arrive at in order to achieve the best dental health possible over time.  In essence, it may not be limited to what the dental plan covers.

So, if you have a dental plan, it’s your responsibility as a partner in your oral health care to find out how the plan works.

Other Important Things to Note About Dental Insurance in Ontario

1. The majority of insurance companies usually have a cap on insurance coverage for each patient. That means coverage may not be 100%.
2. Ontario Dental Association establishes fee guides.
3. Most insurance policies include a deductible (the amount a patient pays for their treatment before the coverage begins)
4. Dental insurance rarely covers the majority of dental services and treatments deemed clinically necessary.

How to Get Dental Coverage in Ontario

Before you go ahead and call an insurance firm or broker to find out what options they have in terms of dental plans, it would be great to do a bit of research and answer some vital questions for yourself.  

Preparing the right questions will ensure you get the best value. It allows you to define what your dental needs are and choose the best plan based on those needs.

Some of the factors you may want to consider before settling on a plan for individual dental insurance in Ontario include:

• Is there a cap on your insurance coverage? If so, what is it?
• Are there deductibles? If so, what are they?
• How many teeth cleaning and X-rays are you entitled to in the plan?
• Is there room to choose a dental procedure other than what is stipulated on the plan?
• Do you have the option to choose your own dentist, or is there a specific list to abide by?
• Does the plan cover root canals, fillings, dis-impactions, and other treatments such as dentures, crowns, and oral surgery? If so, to what extent are they covered?
• Would your dental plan be affected in the event that you change employers?
• Know what is covered every year. Do not assume what is covered this year is included next year. Always find out.

These are important questions and scenarios to consider before settling on a dental plan. What’s more, these questions also answer the extent of your coverage, what you would be liable to pay out of your pocket, what is covered under the plan, and what you are not supposed to pay for.

Your dentist can prove very helpful in giving you some advice on what is the best dental insurance in Toronto and which firm to go with based on what your individual dental needs are.

Moreover, as mentioned before, your treatment plan should not be dictated by your dental plan.

Normally, personal dental insurance plans consist of three tiers:

1. Basic (involves preventive or routine services such as oral examinations, x-rays, cleanings, fillings, etc.)
2. Comprehensive (involves extensive services such as oral surgery, periodontal services, endodontic services, anesthesia, space maintainers, etc.)
3. Major Restorative services (comprises of services like dentures, crowns, bridges, orthodontics, etc.)

It’s important to mention that the services offered under each of these categories vary from one insurer to another. Some will also use different language to describe the three tiers, say, bronze, gold, and silver. Etc.

How a Dentist Can Help You Find the Best Dental Plan

Your dentist will prove invaluable in making such a determination. It can be such a disappointment to go ahead with a dental procedure under the assumption that it is covered only to find that it is not and have to foot the bill out of pocket while you have been paying premiums all along.

To prevent this from happening, your dentist can help you estimate the cost before executing a treatment plan. He/she can further submit a proposed treatment plan to your insurance administrator for a predetermination of benefits.

This simply serves to give you clarification needed as to whether a procedure or course of treatment would be covered.

Whereas the answer from your insurance admin may not always be positive, it does drastically reduce the chances of your claim for reimbursement being declined or limited.

More importantly, your claim for reimbursement would be smooth, having received a pre-approval from the insurance for the treatment.

Family Members & Colleagues Can Help Too

Although there are numerous insurance firms to be found online in Ontario offering dental plans, it does not hurt to find out from family members or colleagues what dental plan they are on and which firm they use. This way, you are likely to get a good referral to a proven firm that has a positive review from someone you know. This is a good point to start from in trying to find decent dental coverage in Ontario with ease.

Conclusion

There’s no doubt that dental needs often vary from one person to another. Thankfully, most health insurance firms in Toronto and Ontario at large are bound to have a package that suits your dental needs. As observed, asking your friends who have an individual dental cover as well as your dentist for advice in regards to a dental plan can prove helpful. In the end, you will get some insight that, coupled with your own research, will help you arrive at the most suitable dental plan not just for yourself but for your family as well.