Dental Articles - Waterdown

Using Your Dental Benefits Before They Expire

Every year a large amount of dental coverage goes unused, and it is not because people did not need treatment. It is because nobody told them the clock was running.

Most private dental plans work on a calendar year. On 1 January the counter resets, and whatever you did not use is gone. It does not roll over, it does not accumulate, and there is no credit for having been healthy. If your plan allows a certain amount of coverage a year and you used none of it, you did not save it. You forfeited it.

Four things resetting at the same time

The annual maximum. The ceiling on what your plan will pay in a year. This is the big one, and it is the part that disappears.

The deductible. If you have already paid it this year, treatment now is cheaper for you than the identical treatment in January, when you will have to pay it again.

Frequency allowances. Cleanings, examinations and radiographs are usually limited to a set number of units or visits per year. An unused cleaning allowance is simply lost.

Any pre-approval you were given. Predeterminations do not stay valid indefinitely. If you had treatment approved earlier in the year and never booked it, the approval may need redoing.

One caveat worth checking rather than assuming: not every plan runs on the calendar year. Some run from an anniversary date or a company benefit year. Your plan booklet or your HR department will tell you which, and it changes your deadline entirely.

When does dental insurance reset?

For most people in Ontario with a workplace plan, on 1 January. That is the short answer, and it is right for the majority of group plans. The exceptions are worth knowing:

• Benefit year plans. Some employers run the plan on a different twelve month cycle, for example from 1 July or from the month the company's policy began.
• Student plans. McMaster and Mohawk student plans run from 1 September to 31 August, so they reset at the start of the academic year. See student dental insurance.
• The Canadian Dental Care Plan. Its benefit year runs from 1 July to 30 June and you must renew each year. See our CDCP page.

Your plan booklet, your insurer's app or your HR department will confirm which applies to you.

What "rolling months" means on a dental plan

This one causes a lot of confusion. Some limits are counted by calendar year, and some by rolling months. A limit of one examination "every 9 rolling months" does not reset on 1 January. It is counted from the date of your last examination. If your last one was on 15 March, the next one the plan will pay for is on or after 15 December, whatever the calendar says.

So in December it is worth checking two different things: how much of your annual maximum is left, which does reset on the plan date, and when each of your frequency limits next becomes available, which may not. Our front desk can check both for you when you book.

Why December is the wrong month to leave it

Everyone realises at the same time, so December is the hardest month of the year to get an appointment. That matters more than it sounds, because a lot of treatment is not a single visit. A crown is usually two appointments with laboratory time between them. Root canal treatment followed by a crown is more. Starting on 20 December does not get it finished and claimed by 31 December.

If you want treatment to count against this year, the work has to be completed and submitted within this year. Booking in October or early November is what makes that possible.

What to do, in order

Find out what you have left. Call the number on your benefits card or log into your insurer portal and ask for your remaining annual maximum and which frequency allowances you have not used. It takes a few minutes.

Book an examination if you are due one. You cannot plan around a balance you cannot spend, and you cannot know what treatment is needed without an examination. If nothing needs doing, at least the cleaning allowance gets used.

Ask us for a predetermination. For anything beyond routine care we can send the treatment plan to your insurer and get written confirmation of what they will pay before you commit. That tells you exactly how much of your remaining maximum the treatment will consume. See dental costs and fees for how this works.

Ask whether treatment should be split. This is the part people miss. If you need more work than your remaining maximum covers, completing one phase in December and the next in January uses two annual maximums instead of one. Where it is clinically sensible to stage treatment that way, we will say so. Where delaying is a bad idea for the tooth, we will say that instead, because a tooth does not wait for a benefit year.

What tends to be worth doing now

Anything already diagnosed and postponed. A filling that was flagged at your last visit does not improve while it waits, and the difference between a filling and a root canal is often a matter of months.

Outstanding cleanings and examinations, which are typically the best covered category on any plan and the least likely to be used.

Treatment where the plan pays a percentage rather than the full fee, since the remaining maximum is what determines how much of that percentage you actually receive.

If you have no private insurance

The Canadian Dental Care Plan operates separately from private benefits and does not follow the same calendar year reset, so none of the urgency above applies in the same way. It is worth checking whether you qualify: eligibility rests on adjusted family net income under $90,000, no access to private dental insurance including through a spouse, a parent or a pension, Canadian residency for tax purposes, and a filed tax return. There is no longer any age restriction. See our Canadian Dental Care Plan page.

If you are not currently registered anywhere, we are accepting new patients, and we have evening and Saturday appointments which are considerably easier to get in the autumn than in December.

Panacea Dental is at 105 Clappison Ave #103 in Waterdown, open Monday to Friday from 10:00 am to 7:00 pm and Saturday from 10:00 am to 3:00 pm. We are accepting new patients. Call 289-408-5100 or book online.

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