Overview

Basic Dental Services Reimbursement: 100% 
Maximum: There is a combined maximum of $2,000 per person per calendar year for Basic and Major services.
Major Dental Care Reimbursement: 50% 
Maximum: There is a combined maximum of $2,000 per person per calendar year for Basic and Major services.
Orthodontic services Reimbursment: 50%
Maximum (lifetime): either: $3,000 if under age 19, or $2,000 if age 19 or older.

For each dental procedure, only reasonable expenses will be covered, up to the usual charge for the most economical alternate procedure, service or treatment consistent with accepted dental practice. See exclusions and limitations below.

Pre-Treatment Plan

If your dentist recommends any dental procedure that is expected to cost over $500, you should have your dentist complete a pre-treatment plan. Submit this plan to the insurer, and you will be advised of the benefits payable for the course of treatment.

Submitting a pre-treatment plan ensures that there are no misunderstandings about what reimbursement you will receive for expensive courses of treatment.

Fee Guide: The current fee guide for general practitioners approved by the Dental Association in the employee's province of residence.

Basic Services

Reimbursement: 100% 
Maximum: There is a combined maximum of $2,000 per person per calendar year for Basic and Major services.

Preventive dental procedures

  • complete exam once every 36 months
  • recall exam once every five months, to a maximum of two exams per benefit year
  • emergency or specific exams limited to two per benefit year per type of exam
  • complete series of X-rays OR one panorex once every 36 months
  • bitewing x-ray once every five months, to a maximum of two sets per benefit year
  • radiograph to diagnose or examine progress
  • required consultations with another dentist
  • polishing/cleaning and topical fluoride treatment every five months, to a maximum of two per benefit year
  • emergency or palliative services
  • diagnostic tests and lab exams
  • removal of impacted teeth and anaesthesia
  • space maintainers for primary teeth
  • pit and fissure sealants
  • oral hygiene instruction once per benefit year

Basic procedures

  • fillings:
    • amalgam (silver)
    • composite (white) on all teeth − acrylic (replaced by composite)
  • removal of teeth (except impacted teeth)
  • prefab metal restorations/crowns and repairs (not custom made)
  • endodontics (root canal therapy/fillings, treat disease of pulp tissue)
  • periodontics (treatment of bone and gum disease)
    • root planing and scaling (8 units each per year)
    • occlusal adjustment
    • provisional splinting
    • supplies usually intended for sport use (eg. mouthguards)
    • transplants and repositioning of the jaw
  • surgery and related anaesthesia (except removal of impacted teeth)
  • repair of bridges or dentures
  • rebase or reline denture

Major Services

Reimbursement: 50%
Maximum: There is a combined maximum of $2,000 per person per calendar year for Basic and Major services.

  • inlays and onlays
  • crowns
  • bridges and dentures (prosthodontic) – construction and insertion of bridges or standard dentures (not dentures with precision attachments). Replacement after five years

For an implant related crown or prosthesis, Sun Life will pay the benefit that would have been payable under this plan for a tooth supported crown or a non-implant related prosthesis, respectively. Sun Life will take into account any limitations that would have applied if there had been no implant. All other expenses related to implants, including surgery charges, are not covered.

Orthodontic Services

Reimbursment: 50% 
Maximum (lifetime): either: $3,000 if under age 19, or $2,000 if age 19 or older

  • interceptive, interventive or preventive services
  • comprehensive treatment

General Exclusions and Limitations

Sun Life will not pay for services or supplies payable or available (regardless of any waiting list) under any government-sponsored plan or program unless explicitly listed as covered under this benefit.

Sun Life will only pay for a procedure that has a reasonably favourable prognosis in the opinion of Sun Life.

Sun Life will not pay for:

  • procedures performed primarily to improve appearance.
  • the replacement of dental appliances that are lost, misplaced or stolen.
  • charges for appointments that a person does not keep.
  • charges for completing claim forms.
  • services or supplies for which no charge would have been made in the absence of this
  • coverage.
  • procedures or supplies used in full mouth reconstruction (capping all of the teeth in the mouth), vertical dimension corrections (changing the way the teeth meet) including attrition (worn down teeth), alteration or restoration of occlusion (building up and restoring the bite), or for the purpose of prosthetic splinting (capping teeth and joining teeth together to provide additional support).
  • charges related to the temporomandibular joint (TMJ) treatment, except otherwise indicated in the list of covered expenses.
  • experimental treatments.

Sun Life will also not pay for dental work resulting from:

  • the hostile action of any armed forces, insurrection or participation in a riot or civil commotion.
  • dental services required due to congenital malformation.
  • participation in a criminal offence.

Coordination of Benefits

If you and your eligible dependents are covered for similar benefits under two plans, you can maximize the amount of money you get back by coordinating your benefits.

Claims

View claim procedures including coordination of benefits and submission deadlines.

Eligibility and Coverage

Learn more about:

  • Eligibility and effective date of coverage for you and your dependents.
  • Termination of Coverage
  • Converting your benefits to an individual plan
  • Proof of Coverage for Health and Dental Benefits
  • Premiums

Getting Help

Sun Life Customer Call Centre

Sun Life has a Customer Call Centre that provides information directly related to your benefits, claims submitted and status of your claim. Other questions or scenarios that Sun Life can assist with are:

 1-800-361-6212 during the work week from 8am to 8 pm EST.

Or connect online through your MySunLife account. Visit www.mysunlife.ca and enter your access ID and password.