If you are eligible for coverage and belong to a participating facility, you are required to participate in the Health Association Dental plan. You may opt-out of the Health Association plan, however, if you have dental coverage under your spouse’s plan.
Dental coverage is available to active employees who are:
- Permanent employees hired to work at least 40% of a regular work week, or
- Term employees hired to work at least 40% of a regular work week for a guaranteed term of one year or more.
Your family members are considered eligible if they meet the following definitions:
- Your spouse is defined as someone to whom you are married legally or married by common law and have lived together for at least one year. This includes spouses of the same sex.
- Your dependent children are defined as those who are under 21, or under 26 if attending a full-time, accredited learning institute. A child who is incapable of employment due to a mental or physical condition that occurred before age 21 is considered a dependent child. The child must be primarily dependent upon you for maintenance and support. To enrol your disabled dependent in the program for the first time, you must complete and submit the Application for Over-Age Dependent Coverage.
You are covered for three categories of dental services:
- Basic Services - 100%
- Major Services - 80%
- Orthodontic services - 50%
Please note: There is a COMBINED yearly maximum of $1,500 per person for Basic AND Major Services, and a $2,000 lifetime maximum for Orthodontic Services.
Health Association Nova Scotia's Dental plan covers dental services based on reasonable and customary charges, up to the amounts specified in the Nova Scotia Dental Association Fee Schedule for General Practitioner dentists.
We recommend that you have your dentist fill out a treatment plan (also known as a pre-determination of benefits summary) before any major or orthodontic services are completed. Send it to Manulife to make sure the prescribed services are covered under your Plan.
Employees have 60 days to enrol in the Plan. Late applicants will be limited to $125 for the first 12 months of coverage.
Many dentists will bill Manulife directly and send you a bill for any remaining balance. However, in those instances where you do need to submit a claim, your Dentist should complete the Standard Dental Claim Form. Send it to Manulife along with your receipts within 12 months. Write your name, policy number and certificate number on the receipts.
Send all claim forms and original receipts to:
Manulife Financial, Group Health Claims, PO Box 1653, Waterloo ON N2J 4W1
For your convenience, you can also contact the Manulife Customer Service Centre toll-free at 1-855-626-4267 with questions about your dental claims. Please have your benefits card as you will need to provide them your policy and certification number.
Canadian insurance companies follow a process called Coordination of Benefits (CoB) when both partners have family coverage. CoB ensures you receive the maximum benefit available from your health and dental policies. In fact, two policies can be combined to give you up to 100% reimbursement of eligible claims.
Here's how Coordination of Benefits works when both the employee and their spouse has family coverage:
- Submit your health and/or dental expenses first to your Health Association benefits program. You can then submit any unpaid portion of your claim to your spouse’s plan.
- Submit your spouse’s health and/or dental expenses first to your spouse’s benefits program. You can then submit any unpaid portion of your spouse’s claim to your Health Association benefits program.
- If your dependent children are covered under your and your spouse’s benefit programs, you must submit their health and/or dental expenses first to the benefit program of the parent whose birth date falls earliest in the calendar year (the month, then day). Any remaining balance can then be reimbursed from the other plan. When parents are separated or divorced, the custodial parent claims under his or her plan first, then their spouse’s plan, and then the plan of the parent without custody.
- When you submit a claim for an unpaid balance from another insurance company, Manulife will need a copy of the receipt and a copy of the statement showing the portion of the claim paid by the other company. Although you have 12 months to claim any remaining balances, your receipts should be submitted as soon as possible.
If you need help determining the order in which your claims should be submitted, call the Manulife Customer Service Centre toll-free at 1-855-626-4267.
For further information, please check out our Benefits Information Coordination of Benefits document available on our Benefits Communication page.
Your Dental coverage ends at the end of the month in which you are no longer considered an employee, or when the Plan is terminated, whichever comes first.
Your dependents' coverage also ends at the end of the month in which you are no longer considered an employee, when they no longer meet the eligibility requirements, or when the Plan is terminated, whichever comes first.
Yes, you have the option to convert your and your family's Dental coverage to an individual plan. This conversion option is also available to your dependents if they are no longer considered dependents.
If you want to convert your dental coverage, you or your dependents must apply to do so within 60 days after your Health Association coverage ends. Just ask your Plan Administrator for details.
Yes, your spouse and dependent children can continue their dental coverage for up to two years. No premiums are required for this coverage.
Your dental coverage ends when you retire.