Basic Dental Benefits:
- Diagnostic: procedures to assist the dentist in evaluating the existing condition and the dental care required.
- Preventive: procedures or techniques to prevent the occurrence of dental abnormalities or disease.
- Restorative: procedures to restore the teeth by use of amalgam, silicate, plastic or composite.
- Oral Surgery: procedures to treat supporting tissues.
- Periodontics: treatment of the tissues supporting the teeth.
- Endodontics: pulpal and root canal therapy.
Major Dental Benefits
- Predetermination: all major procedures totalling more than $500 will require a predetermination to be submitted for authorization.
- Restorative: gold restorations, crowns and jackets will be provided when teeth cannot be restored with other material.
- Prosthodontics: provides the necessary procedures associated with the construction, placement or repair of bridges, and partial and complete dentures.
Pacific First adjudicates all claims and takes the dental professionals opinion into account
Though the workings of dental and orthodontic coverage are similar, there are some differences that should be kept in mind. In general, orthodontic claims will be larger and span over a greater length of time. Below is an outline of how the orthodontics coverage provided in the Pacific Rim Administration Services Ltd. plan works.
Pre-approval: Prior to beginning orthodontic treatment, the plan member will need to obtain a written estimate or treatment plan from the orthodontist, stating the total amount of estimated charges and how they are to be paid.
Payments: As per Orthodontic Association by-laws, the orthodontist is not able to receive service payments from any insurer or benefit provider directly. Therefore, direct payment may be requested from the covered employee, for which they will be accordingly reimbursed by their plan coverage, as set out in the treatment plan.