Your DGC Benefits Plan provides you and your family with valuable, affordable mental and physical health coverage and financial protection if you experience an illness, injury or disability. In this section, we explain how the plan works and what’s covered under each level.
We all need dental care. But how much we need can vary dramatically depending on our teeth and dental history. With that in mind, the DGC Benefits Plan offers a range of preventative, routine and restorative procedures designed to keep you and your family smiling.
The DGC Benefits Plan provides four distinct levels of coverage. See the Coverage Level Overview for a summary of each coverage level and Life Member coverage.
Each year, during the re-enrolment period, you’ll be assigned an automatic coverage level for the upcoming plan year based on your producer contributions. If your automatic coverage level doesn’t meet your benefit needs, you can, if you wish, arrange to upgrade your coverage. If you upgrade your coverage, keep in mind that your new coverage level will apply to all of your DGC Benefits — except STD. Dental expenses will be reimbursed (based on your coverage level and reimbursement rates), provided they are:
Charges above those shown in the current general practitioner’s fee schedule will not be covered.
If a reimbursement amount is not shown in the applicable fee schedule, the insurer will determine a reasonable amount.
Remember, you can use your Healthcare Spending Account (HSA) to offset the cost of those services and procedures not covered (or not fully covered) under your coverage level.
Benefit maximums and deductibles run on a calendar year, with the exception of orthodontics, which has a lifetime maximum.
Remember, you can use your HSA to offset the cost of those services and procedures not covered (or not fully covered) under your coverage level.
The following services and supplies are covered (based on your coverage level and reimbursement rates):
LEVEL I | LEVEL II, III & ENHANCED LIFE MEMBER | |
|---|---|---|
Complete oral examination | — | 1x every 3 years |
Emergency, oral pathology, periodontal, surgical, prosthodontic and endodontic examinations | — | As required |
Limited oral examinations | 1x/calendar year | 2x/calendar year, but 1x in years when you have a complete oral exam |
Limited periodontal examinations | 1x/calendar year | 2x/calendar year |
Complete series of x-rays | — | 1x every 3 years |
Intra-oral x-rays — up to 15 images | — | 1x every 3 years |
Panoramic x-ray | — | 1x every 3 years, except provided in same year as complete series |
Sialography | — | |
Extra-oral x-rays (other than panoramic and sialography) | — | |
Radiopaque dyes used to pinpoint lesions | — | |
Interpretation of x-rays | — | |
Microbiological, histological, cytological, and pulp vitality tests | — | |
Laboratory reports | — |
LEVEL I | LEVEL II, III AND ENHANCED LIFE MEMBER | |
|---|---|---|
Preventative scaling (one time unit = 15 mins) | 1 unit/calendar year | Scaling units included in “periodontal” |
Polishing | 1x/calendar year | 2x/calendar year |
Fluoride treatments | 1x/calendar year | 2x/calendar year |
Bitewing x-rays | 1x/calendar year | — |
Oral hygiene instruction | 1x/lifetime | 1x/lifetime |
Pit and fissure sealants on bicuspids and permanent molars | — | 1x every 5 years |
Space maintainers | — | For missing central or lateral teeth |
Appliances for the control of harmful habits | — | |
Finishing restorations | — | |
Interproximal disking | — | |
Recontouring of teeth | — |
Minor restorative services, including:
Denture maintenance, including:
Oral surgery, including:
Adjunctive services, including:
Periodontal services, including:
Endodontics, including:
Find out how much reimbursement you can expect — before your treatment begins.
For anything other than routine dental care, it is highly recommended that you ask your dentist to provide Canada Life with a treatment plan before the treatment begins. A treatment plan is simply a description of the proposed procedure and its related cost. Canada Life will review the plan and report what portion of the cost (if any) is covered.
Regardless of your coverage level, the DGC Benefits Plan will not pay any benefit or accept liability for any dental claims relating to expenses such as (but not limited to) the following:
Your coverage will continue as long as you earn producer contributions, use money from your dollar bank, or pay out of your pocket to buy coverage (provided you are a member in Active Good Standing).
Your spouse’s coverage ends when your coverage ends, or if you move to Level I coverage, which does not include family coverage.
Coverage for a dependent child ends when your coverage ends, you move to Level I, or the child no longer qualifies as a dependant… whichever comes first.
If you die while a member in Active Good Standing, the Trustees may offer to continue coverage to your dependants (spouse and dependant children) for a period of time based on your years of membership in the DGC (see table below).
The minimum coverage is Level II, which includes family coverage. If you have Level I or II coverage at the time of your death, your survivors will receive Level II coverage. If you have Level III coverage at the time of your death, then your survivors will receive Level III.
YEARS OF DGC MEMBERSHIP | PERIOD OF CONTINUING COVERAGE |
|---|---|
Less than 15 years | 3 years |
15 – 19 years | 4 years |
20+ years | 5 years |
