General
Some Expenses Require Pre-Determination
Dental Injury/Accident
Eligible Dental Care Expenses
Not Eligible Dental Care Expenses
Claimsecure

DENTAL CARE

General

Dental Care reimbursement is based on two components:

  1. Dental services covered under the AFBS dental formulary.
  2. Current Dental Association Fee Guide in the province where you reside.

If dental services are provided outside Canada they will be reimbursed based on the current Ontario Dental Association Fee Guide.

The AFBS dental formulary has been designed to cover usual and customary dental procedures, as determined by AFBS, as well as to ensure a high level of Dental Care. Not all dental procedures are available under the AFBS dental formulary. There are limits on the frequency of some of the services and the amount that can be reimbursed.

We encourage you to share your coverage information with your dentist.

Standard Comprehensive
All Years Year One Year Two Subsequent Years
Reimbursement Percentage for each Insured Person 50% 60% 60% 60%
Annual Maximum for each Insured Person $800 $800 $1,250
Basic Services $400 combined all services $300 $300 $500
Major Services (crowns, bridges, dentures) including Periodontal (gum disease) and Endodontic (root canal) $500 $500 $750


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Some Expenses Require Prior Pre-Determination

If your dentist recommends dental work that will cost more than $500 or includes procedures such as crowns, bridgework, veneers, implants, onlays or inlays, the proposed work must be reviewed by AFBS’ dental consultant before any reimbursement can be made. When the pre-determination is done, you will have confirmation of the amount that will be reimbursed by AFBS. Your dentist will be familiar with the pre-determination process and must provide AFBS with specific information about the proposed work as well as X-ray photograph, study moulds or casts.

Please advise your dentist’s office that pre-determination requests MUST be sent to AFBS. Pre-determinations sent elsewhere, including ClaimSecure, may not reach AFBS and will delay claims adjudication.

Pre-determination is not required if treatment is the result of an emergency. If the emergency treatment is for a crown or bridge, you must submit x-rays with your claim. Pre-determination is not necessary for a crown if a root canal has been performed on the tooth. The dentist needs to indicate this on the claim form.

Pre-determination

Pre-determination is required for treatment that will cost $500 or more.
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Dental Injury/ Accident

If you require Dental Care as a result of an accident, you will be insured for any expenses not paid by your provincial health care plan up to the available annual maximum. In many instances, payment may be made under the Extended Health Care plan and will not affect your Dental Care annual maximums.*

*AFBS may require supporting documentation as deemed appropriate.

Dental Injury/Accident

Dental Care Due to an Accident means the treatment resulting from a breakage of a tooth or teeth by a direct accidental blow to the mouth and not by an object placed in the mouth, deterioration of the teeth or by any other cause.
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Eligible Dental Care Expenses

The Plan reimburses up to the usual and customary cost of these items:

Basic Services

Complete examination and full series of X-rays or panoramic films Standard Comprehensive
Reimbursement 50% per claim 60% per claim
Important Benefit Information
  • This is a covered Dental Care expense.
  • Limited to once every three Benefit Years or when a new dentist is involved in your dental care.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Recall examination by the dentist Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense.
  • Limited to once every nine months.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Topical application of any anti-carcinogenic agent (e.g. stannous fluoride) or polishing of teeth Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense.
  • Limited to once every nine months.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Routine diagnostic and laboratory procedures Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense.
  • A pre-determination request must be provided to AFBS by the dental office when the cost of the anticipated dental work exceeds $500. Submitted procedure codes are subject to review and approval by AFBS prior to any reimbursement.
  • Laboratory fees are limited to a maximum of 50% of the total cost of the dental procedure.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Prophylaxis, including scaling Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • Limited to basic dental codes only; periodontal services are excluded.
  • Limited to 10 units per Benefit Year; additional units may be approved based on the submission of a pre-determination request by your dental office.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Bitewing X-rays Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense.
  • Limited to once each Benefit Year.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Oral hygiene instruction Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense as specified.
  • Limited to once per Lifetime.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Filings (amalgam, silicate, acrylic and composite), retentive pins and pit and fissure sealants Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Space maintainers Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense as specified.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Treatment of diseases of the gums and other supporting tissues of the teeth (excluding splinting), including surgery and post-surgical treatment and appliances Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense.
  • A pre-determination request must be provided to AFBS by the dental office when the cost of the anticipated dental work exceeds $500. Submitted procedure codes are subject to review and approval by AFBS prior to any reimbursement.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Root canal therapy, root amputation, apexifications and periapical services Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense as specified.
  • A pre-determination request must be provided to AFBS by the dental office when the cost of the anticipated dental work exceeds $500. Submitted procedure codes are subject to review and approval by AFBS prior to any reimbursement.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.

Periodontal, Endodontic, Major Services

Oral surgical procedures, including removal of teeth Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense as specified.
  • A pre-determination request must be provided to AFBS by the dental office when the cost of the anticipated dental work exceeds $500. Submitted procedure codes are subject to review and approval by AFBS prior to any reimbursement.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
General Anathesthesia and X-rays Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense as specified.
  • X-rays are limited to three per Benefit Year.
  • For adult patients, general anaesthetic services are paid in conjunction with eligible oral surgical procedures.
  • For child patients and when a pre-determination is submitted by the dentist, general anaesthetic services may be paid in conjunction with routine basic services.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Crowns, inlays and onlays Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense as specified.
  • A pre-determination request must be provided to AFBS by the dental office. Submitted procedure codes are subject to review and approval by AFBS prior to any reimbursement.
  • Covered only when tooth function is impaired due to cuspal or incisal angle damage caused by trauma or decay.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Replacement of crowns, inlays and onlays Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense.
  • A pre-determination request must be provided to AFBS by the dental office. Submitted procedure codes are subject to review and approval by AFBS prior to any reimbursement.
  • Limited to once every five years.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Implants Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense as specified.
  • A pre-determination request must be provided to AFBS by the dental office. Submitted procedure codes are subject to review and approval by AFBS prior to any reimbursement.
  • Reimbursement may be limited to that of the generally accepted alternatives.
  • Cost may not be applied across Benefit Years.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Initial provision for fixed bridgework Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense as specified.
  • A pre-determination request must be provided to AFBS by the dental office. Submitted procedure codes are subject to review and approval by AFBS prior to any reimbursement.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Replacement of fixed bridgework or additional teeth to bridgework Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense as specified.
  • A pre-determination request must be provided to AFBS by the dental office. Submitted procedure codes are subject to review and approval by AFBS prior to any reimbursement.
  • Replacement or addition must be due to one of the following:
    • A natural tooth is extracted and the existing appliance cannot be made serviceable;
    • The existing appliance is at least 5 years old and cannot be made serviceable;
    • The existing appliance is temporary and within 12 months of its installation a permanent bridge replaces it. The total amount payable for both the temporary and permanent bridge is the amount which would have been allowed for a permanent bridge.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Initial provision of full or partially removable dentures Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense as specified.
  • A pre-determination request must be provided to AFBS by the dental office. Submitted procedure codes are subject to review and approval by AFBS prior to any reimbursement.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Repair or re-cementing of crowns, onlays, inlays, bridgework and dentures or relining and rebasing dentures Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense as specified.
  • A pre-determination request must be provided to AFBS by the dental office when the cost of the anticipated dental work exceeds $750. Submitted procedure codes are subject to review and approval by AFBS prior to any reimbursement.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Replacement of removable dentures Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense as specified.
  • A pre-determination request must be provided to AFBS by the dental office. Submitted procedure codes are subject to review and approval by AFBS prior to any reimbursement.
  • Replacement must be due to one of the following:
    • A natural tooth is extracted and the existing appliance cannot be made serviceable;
    • The existing appliance is at least 5 years old and cannot be made serviceable;
    • The existing appliance is temporary and within 12 months of its installation a permanent denture replaces it. The total amount payable for both the temporary and permanent dentures is the amount which would have been allowed for permanent dentures.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Addition of teeth to an existing partial denture or fixed bridgework previously removed Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense as specified.
  • A pre-determination request must be provided to AFBS by the dental office. Submitted procedure codes are subject to review and approval by AFBS prior to any reimbursement.
  • Requires the replacement of one or more teeth.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.
Procedures involving the use of gold Standard Comprehensive
Reimbursement 50% per claim 50% per claim
Important Benefit Information
  • This is a covered Dental Care expense.
  • A pre-determination request must be provided to AFBS by the dental office. Submitted procedure codes are subject to review and approval by AFBS prior to any reimbursement.
  • Available only when there is no alternative consistent with generally accepted dental practices.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued. For services provided outside of Canada reimbursement is based on the current Ontario dental association fee guide.
  • There is a cumulative annual reimbursement maximum of $400 for Basic and Major Services in the Standard Plan for all dental claims paid each Benefit Year.
  • There is a cumulative annual reimbursement maximum of $300 for Basic Services and $500 for Periodontal, Endodontic and Major Services in Year 1 and Year2. $500 for Basic Services and $750 for Periodontal, Endodontic and Major Services in Subsequent Years for all dental claims paid each Benefit Year for the Comprehensive Plan.

Limitations are generally-accepted guidelines, but where a situation is warranted, a review by the AFBS dental consultant may be requested.

Claims for some procedures cannot be processed electronically. When claims are not processed electronically a standard dental claim form must be submitted to AFBS.

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Not Eligible Dental Care Expenses

  • Cosmetic dentistry, including dental bleaching.
  • Replacement of lost, stolen or misplaced dentures.
  • Prosthetic devices ordered prior to being insured.
  • Prosthetic devices ordered while covered under the Plan but installed more than 60 days after the Insured Person is no longer covered under the Plan.
  • Fees charged by a dentist that are in excess of the Dental Association Fee Guide in the province of residence of the Insured Person.
  • Fees charged by a dentist for completion of a dental claim form, missed appointments, or for x-rays and study moulds required for pre-determination.

Not Eligible Dental Care Expenses

The AFBS dental formulary has been designed to cover usual and customary dental procedures, as determined by AFBS, and to ensure a high level of dental care. Not all dental procedures are available under the AFBS dental formulary and limitations are in place on the frequency and availability of some of the services that will be reimbursed by AFBS. We encourage you to make your dentist aware of the dental benefits that are available to you.
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ClaimSecure

ClaimSecure has been contracted by AFBS to provide on-line claims service for the adjudication and reimbursement of eligible dental expenses. If you have any questions about your claim, contact AFBS not ClaimSecure. 1.855.934.2355

Claimsecure

Provides online claims adjudication and reimbursement of eligible dental expenses. If you have questions regarding a claim, contact AFBS, not Claimsecure.
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