Dental Coverage Chart

Dental Benefits

SFSS Dental Plan Coverage Chart

	Insured Portion¹	Studentcare Dental Network Savings	Total Coverage
Preventive Services - recall exams² - cleanings²	70%	30%	100%
Extraction of impacted teeth	70%	20%	90%
Basic Services - fillings³ - oral surgery - endodontics (root canal) - periodontics⁴ (gum treatment)	60%	20%	80%
Major Restorative - crowns - bridges - posts	Not Covered	20%	20%

The maximum paid by Pacific Blue Cross per policy year on the insured portion of the Dental Plan is $700.

¹ Percentage of Provincial Dental Fee Guide Cost for General Practitioners (in the province where service was performed).

² Recall exams are covered once per 12 months. Cleaning/polishing, bitewing x-rays, oral hygiene instruction, and the application of fluoride are covered once per 9 months. Scaling is covered up to 3 units per policy year. A complete exam (sometimes called a new patient exam) is only covered once per 36 months.

³ Fillings in amalgam (metal) are covered for all teeth. Composite (white) fillings are covered for the front teeth and pre-molars only. If you choose to have your back teeth filled in composite, your claim will be reimbursed according to the amalgam fee.

⁴ Certain maximums exist. Contact Studentcare for more details.

Certain exclusions and limitations may apply. Prior to dental treatment for work that is expected to cost $500 or more, students should submit a treatment plan (obtained from your dentist) to Pacific Blue Cross for approval.

Note: Services performed by an orthodontist are not covered by the Dental Plan.