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Dentist

A dentist is a licensed healthcare professional who diagnoses, treats, and helps prevent conditions affecting the teeth, gums, and mouth. Dentists play a key role in maintaining oral health through preventive care, restorative treatments, and patient education. Common services include cleanings, fillings, crowns, root canals, extractions, and oral examinations.

In the context of dental insurance, only services performed by a licensed dentist or an approved dental specialist are eligible for reimbursement. Insurance plans typically require that the dentist be licensed in the province or territory where treatment is provided and follow the provincial dental fee guide when billing. Dentists may also refer patients to specialists such as orthodontists, endodontists, periodontists, or oral surgeons for more complex procedures.

Regular dental care provided by licensed professionals helps prevent more serious health problems and ensures that claims are processed smoothly under your insurance plan.

Example:

If you visit a licensed dentist for a filling that costs $250, and your plan covers 80 percent for basic restorative services, your insurer reimburses $200 and you pay $50.

What to Watch For:

Confirm that your dentist is licensed and in good standing with the provincial dental association. Some plans require that the dentist use specific claim forms or electronic systems for direct billing. If you receive treatment outside of Canada, coverage may depend on whether the dentist’s qualifications meet your insurer’s standards.

Related Terms

Deductible

A deductible is the fixed dollar amount you must pay each benefit year before your plan starts reimbursing eligible expenses. Think of it as your yearly participation in costs - once met, your plan covers claims according to its coinsurance. Some individual health plans in Canada have no annual deductible, while others apply one only to certain benefits (often $25–$100 per person).

Dental Accident

A dental accident is a sudden, unexpected event that causes injury to the mouth, teeth, or jaw, resulting from an external force rather than from decay, chewing, or normal use. Examples include being struck in the face, falling and hitting your mouth, or suffering an impact during sports. Dental accident coverage helps pay for the repair or replacement of natural teeth damaged in such incidents.

Dental Fee Guide

A dental fee guide is a provincially issued schedule that lists the standard or recommended prices for dental procedures. Each province and territory in Canada publishes its own guide annually, outlining suggested fees for everything from cleanings and fillings to crowns and dentures.

Dental Insurance

Dental insurance is a type of health coverage that helps pay for the cost of preventive, basic, and major dental services. It is designed to make oral care more affordable and to encourage regular checkups that prevent costly procedures later on. Dental insurance is offered through group employee benefits, individual plans, or conversion plans for people leaving workplace coverage.

Dependent

A dependent is a person, usually a family member, who qualifies for coverage under someone else’s insurance plan. Dependents are typically the spouse or children of the primary insured person, also known as the plan member or policyholder. Some plans may also cover other individuals who rely on the plan member for financial support, such as a common-law partner or a child with a permanent disability.

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