Who is eligible?
If you have been hired as a permanent employee to work at least 40% of a regular work week, you are entitled to coverage for you, your spouse and dependents.
If you have been hired for a term position for a period of no less than 12 months, to work at least 40% of a regular work week, you are entitled to coverage for you, your spouse and dependents.
Your spouse is defined as someone to whom you are married legally or common law (defined as having lived with your partner for 12 months or more). This includes a spouse of the same sex.
Your dependent child is defined as an employee's or spouse's child who:
- is either under age 21 or under age 26 and a full-time student at an accredited school, college, or university; and
- is unmarried (legally or common law); and
- is not employed on a full-time basis; and
- is not eligible for benefits as an employee under this or any other group plan.
- A child who is incapable of employment due to a mental or physical condition that occurred before reaching the maximum age will continue to be covered if approved by the insurance company.
Note: Dependents between ages 21 and 26 have the same coverage and restrictions as adults and not the same as dependents under age 21.
If you meet the eligibility requirements you MUST participate in this benefit unless you have coverage elsewhere.
When will coverage begin?
Dental Coverage starts the first of the month following your date of eligibility.
When will coverage end?
Dental Coverage ceases when you are no longer eligible, retire, or at the end of the month if your employment ends, whichever comes first.
What is covered?
The Health Association’s Dental plan covers dental services based on the amounts specified in the current Nova Scotia Dental Association Fee Schedule for general practitioner dentists. Specialist fees are not covered. The reimbursement you receive depends on the category of dental services:
• 100% coverage for Basic services
• 80% coverage for Major services
• 50% coverage for Orthodontic services
There is a maximum of $1,500 per person in each calendar year for Basic and Major services combined. There is a lifetime maximum of $2,000 per person for Orthodontic services.
All dental services must be performed in Canada.
Basic Dental Services
The Plan provides 100% coverage to a calendar year maximum of $1,500 per person for all Basic and Major services combined. This includes:
- Complete Oral Examination: Extensive exam including patient history, clinical examination and diagnosis of oral conditions. Limited to one in any 24 consecutive months.
- Recall Examination: Periodic examination to maintain oral health and diagnose oral conditions. Limited to one in any 12 consecutive months for adults and two in any 12 consecutive months for dependent children.
- Complete Mouth X-rays or Panographic X-rays: Limited to one in any 24 consecutive months.
- Bite-Wing X-rays: Limited to two sets (a set is 2 films) in any 12 consecutive months for adults and dependent children.
- Polishing and Fluoride Treatments: Limited to one in any 12 consecutive months for adults, and twice in any 12 consecutive months for dependent children.
- Scaling: Limited to two units (a unit of time is based on increments of 15 minutes) in any 12 consecutive months for adults, and two units twice in any 12 consecutive months for dependent children.
- Pit and Fissure Sealants: Dependent children only.
- Oral Surgery: Includes simple extractions and surgical extractions of teeth, removal of roots, surgical incision or excision and other oral surgical procedures including pre-operative and post-operative care.
- Minor Restorative: Includes sedative dressings, temporary restorations, amalgam acrylic, composite resin, silicate restorations and retentive pins.
- Adjunctive Dental Services: Includes emergency treatment not classified elsewhere in the Dental Fee Guide, conscious sedation (includes intravenous or nitrous oxide) and professional consultation.
- Anaesthesia is eligible provided it is being rendered in conjunction with other dental services.
- Mouth guards: Includes one mouth guard in a calendar year.
- Teeth Extractions: Extractions of any tooth are covered.
- Wisdom Teeth Extractions: The wisdom teeth extractions are covered. Specialist consult fees are not eligible. Manulife strongly recommends the submission of a predetermination to confirm coverage and eligibility for wisdom teeth extraction, as this will include the specific procedure codes for the treatment.
Major Dental Services
The Plan provides 80% coverage to a calendar year maximum of $1,500 per person for all Basic and Major services combined. This includes:
- Periodontal Scaling, Preventive Scaling and Root Planing: Limited to 8 (15 minutes) time units (in combination with basic scaling) in 12 consecutive months. More frequent service may be considered on a case-by-case basis for severe periodontal conditions. A treatment plan (pre-determination) should be filled in and approved by Manulife before you have these services carried out.
- Relining or Rebasing of Dentures: Limited to once in any 36 consecutive months.
- Repair of Partial or Complete Dentures and Re-cementing of Crowns, Inlays and Onlays, and Bridgework: Covered.
- Major Restorative: Includes crowns and veneers, inlay and onlay restorations or gold fillings when teeth cannot be treated with other material. Replacements are covered only after five years from the initial placement, and the existing restoration cannot be made serviceable.
- Prosthodontics: Includes fixed bridgework, partial and complete dentures and surgical services associated with placement of prosthodontics listed in the dental fee schedule.
- Replacement of a Denture or Bridge: Covered after five years from the initial placement and the existing prosthodontic appliance cannot be made serviceable.
- Endodontic Services: Includes treatment of pulp chamber, root canal therapy, and periapical services.
- Dental Implants: Implants and any services rendered in conjunction with implants are covered.
Orthodontic Dental Services
The plan provides 50% coverage to a lifetime maximum of $2,000 per person. This includes, orthodontic appliances, orthodontic observations and adjustments.
Predetermination: A treatment plan is required for orthodontic claims.
What are the dental exceptions?
Expenses not covered include:
- A charge, or a portion of a charge, which is eligible for reimbursement under any other part of this plan, or through a government plan or legally mandated program.
- Self-inflected injuries.
- War, insurrection, the hostile action of any armed forces or participation in a riot or civil commotion.
- The committing of or the attempt to commit an assault or criminal offence.
- Injuries sustained while operating a motor vehicle, either while under the influence of any intoxicant or if the covered person’s blood contained more than 820 milligrams of alcohol per 100 milliliters of blood at the time of injury.
- Charges for broken appointments, third party examinations, travel to and from appointments, or completion of claim forms.
- Services or supplies which are received from a medical or dental department maintained by an employer, association or trade union.
- Services or supplies which are performed or provided by the covered person, an immediate family member or person who lives with the covered person.
- Cosmetic treatment unless needed because of an accidental injury.
- The replacement of removable appliances which are lost, mislaid or stolen.
- Anti-snoring or sleep apnea devices.
- Treatment which is not generally recognized by the dental profession as an effective, appropriate and essential form of treatment for the dental condition.
- Laboratory fees which exceed reasonable and customary charges.
- Specialist fees.
- Treatment rendered for a correction of temporomandibular joint dysfunction, other than temporomandibulary joint (TMJ) appliances.
How do I make a claim?
Payment is subject to any maximum amounts and to any limit on benefits.
Lifetime maximums apply to all periods combined in which a person is covered by the Plan sponsor.
In determining if an expense is covered, Manulife may require the following information:
- X-rays and a complete dental chart showing any extractions, fillings, or other work performed prior to the date of the incurred expenses for which claim is being made;
- Itemized bills from the dentist or other sources of services or treatments; and
- Laboratory or hospital reports, casts, molds or study models, or other similar evidence of the condition or treatment of the teeth or mouth.
Pre-determination of benefits: To ensure a smooth claim process, we believe there is value in knowing the cost of planned treatment; therefore we do encourage you and your dentist to consider requesting a pre-determination of benefits.
When a proposed course of treatment is expected to cost more than $500, a treatment plan should be filed with Manulife before treatment begins. Manulife will advise you of the amount covered and you will share this with your dental professional. Dental charges over and above insurance benefits remain the responsibility of the claimant.
Many dentists will bill Manulife directly and bill you for any remaining balance. However, in those instances where you do need to submit a claim, your dental professional should complete the Standard Dental Claim Form.
The claimant's insurance must be in force when treatment is rendered for benefits to be payable.
For online submission, Plan members must be registered on the Manulife Plan Member Secure Website and signed up for direct deposit and electronic claims statements.
Not registered yet?
- Go to www.manulife.ca/planmember click on “Login/register” and you’ll be directed to the site access page.
- On the site access page, click on “register” and provide the required information (If you’re not sure of your plan and certificate numbers, check your Manulife group coverage benefits card or find the numbers on a previous claims statement).
- Submit the completed information and follow the directions on the page.
Once you’ve received your personal activation information, you’ll have access to all online information available to your plan.
For dental services not direct billed by your dentist you can submit either on-line or by mail.
For on-line claiming, login at www.manulife.ca/planmember
and select Claims from the top navigation bar and then Online claims. Enter the details of your claim found on your receipt from your provider, along with details on your provider’s name, address and their contact information.
For paper claims, mail your claim form to Manulife at the address listed on the form along with your receipts within 18 months of date of service. Write your name, policy number and certificate number on the receipts. For plan members in Halifax, you may drop-off your paper claim at the Manulife drop-off box located at the Manulife Security Desk, 2727 Joseph Howe Drive, Halifax, NS.
What if my spouse also has coverage?
Canadian insurance companies follow a process called Coordination of Benefits (CoB) when a plan member is covered under more than one health and/or dental plan. CoB ensures you receive the maximum benefit available from your policies. In fact, two policies can be combined to give you up to 100% reimbursement of eligible claims.
When you are covered under your plan and under a spouse’s plan, here's how Coordination of Benefits works:
1. Submit your expenses first to your benefits plan. You can then submit any unpaid portion of your claim to your spouse’s plan.
2. Submit your spouse’s expenses first to your spouse’s benefits plan. You can then submit any unpaid portion of your spouse’s claim to your plan.
3. If your dependent children are covered under your and your spouse’s benefit plans, you must submit all their claims first to the benefit plan 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 (where applicable), then the plan of the parent without custody, and then their spouse’s plan.
4. When you submit a claim for an unpaid balance from another insurance company, you plan will need a copy of the receipt and a copy of the statement (Explanation of Benefits (E0B)) showing the portion of the claim paid by the other company. Although you have 18 months to claim under the HANS plan any remaining balances, your receipts should be submitted as soon as possible.
If you need help determining the order claims should be submitted, call the Manulife Customer Service Centre toll-free at 1-855-626-4267.
If you are covered by more than one plan, please call Health Association Nova Scotia toll-free at 1-866-886-7246 regarding any changes or updates to your Coordination of Benefits information.
CONTINUATION OF COVERAGE
What happens during a leave of absence?
If you take an approved paid leave of absence, you must continue coverage for up to 12 months
If you take an approved unpaid leave of absence, you may continue for up to 12 months. If you take an approved maternity or parental leave, you may continue for the duration of the leave. If you choose not to continue the benefit during your leave, coverage is reinstated on your return to work.
If you are on an approved unpaid sick leave you may continue benefits.
If you are approved for your employer sponsored Long Term Disability benefits, you may continue coverage. For cost sharing arrangements, please check your collective agreement or contact your employer for more details.
What happens If I lose coverage under another plan?
If you had opted-out of the dental plan because you were covered under another plan, you MUST join the Health Association plan if you lose the other coverage. If you apply late, after 60 days, your coverage will be restricted to $125 for the first 12 months.
What happens to coverage if I die before retirement?
In the event of your death before retirement, your spouse and dependent children may continue their coverage for up to 24 months after your death. No premiums are required for this coverage.
What happens to my coverage when I retire?
There is no dental plan for Retirees. Dental Coverage ceases when you retire.
Can I convert my coverage?
Call the Manulife Customer Service Centre toll-free at 1-855-626-4267 for options.