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Dental

Our dental coverage encourages you and your dependants to proactively manage your oral health through basic preventative and restorative treatments (e.g. check-ups, X-rays and cleanings, etc.). Select ASEBP plans also cover major restorative dental work (e.g. bridges and crowns, etc.) and orthodontic treatments (e.g. braces and appliances, etc.). You can find your plan details on your Alberta School Employee Benefit Plan (ASEBP) ID card on My ASEBP or the My ASEBP Mobile App.

Watch this short video for a quick overview of ASEBP dental benefits and to learn how to make the most of your dental coverage.

It’s important to note that dental fees in Alberta aren’t regulated. Learn more about what this means and how it affects your out-of-pocket costs in the Dental Fees section below.

Note that the following is a comprehensive summary of the official, legally binding ASEBP insurance policies and plan documents, which are available through your employer or by contacting us.

What's Covered?

00Basic Preventative/Restorative Dental Treatments

For basic treatments over $800, a dental predetermination (treatment plan) is recommended.

Plan 2 Plan 3
100% up to the Alberta Dental Association’s dental fee guide for basic treatments up to $2,500* per person per calendar year 100% up to the Alberta Dental Association’s dental fee guide for basic treatments per person per calendar year

*Dental Plan 2 has a combined yearly maximum for Basic Preventative/Restorative and Major Restorative dental treatments.

Below is a list of some common basic preventative and restorative procedures and coverage limitations:

Dental Exam (recall and specific exams)

One recall or specific exam is eligible for coverage every six months from the date of last service for people under 19 and every 12 months for those 19 and older. Additional exams may be covered for people with certain health conditions—please see the Oral Health Exception Process section for details.

Complete Dental Exams

Complete dental exams are eligible for coverage once every 30 months from the date of last service.

Emergency Exams

Emergency exams are covered anytime, but only in conjunction with other emergency services, like extractions, or a written explanation on the claim form from your dental provider regarding the nature of the emergency. For example, it’s not considered an emergency if an x-ray is performed and no resulting emergency procedures are performed.

Fillings

Fillings are limited to five surfaces per tooth every 24 months from the date of the last service.

Fluoride Applications

Fluoride applications are eligible for coverage once every six months from date of last service for people under 19. Additional fluoride applications may be covered for people with certain health conditions—please see the Oral Health Exception Process section for details.

Polishing

One half unit of polishing is eligible for coverage once every six months from the date of last service for people under 19.

X-Rays (Bitewing)

Bitewing X-rays are eligible for coverage once every six months from the date of last service for people under 19 and once every 12 months for those 19 and older.

Panoramic and Full-Mouth X-Rays

Panoramic and full-mouth X-rays are eligible for coverage once every five years from the date of last service.

Scaling and Root Planing

Scaling and root planing are limited to 12 units of time (one unit of time is equal to 15 minutes) per person, based on a rolling one-year period from the date of last service.

General Anesthetic

General anesthetic and nitrous oxide are eligible for coverage only in conjunction with eligible surgical procedures (e.g. surgical extractions) and excludes anesthetic facility (such as a recovery room), equipment and supply fees.

Extractions

There are no specific limitations for tooth extractions.

Root Canals (Endodontics)

Root canals for the same tooth are only covered once every 24 months. Treatment of previously-completed root canals require a dental predetermination (treatment plan) to be completed prior to treatment.

Specialist Referral Exam

Specialist referral exams are limited to once every 12 months per dental specialty from the date of last service. Referral to a specialist is made by your family dentist. Orthodontic referrals are covered under orthodontic services.

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01Major Restorative Dental Treatments

For major restorative treatments over $800, a dental predetermination (treatment plan) is recommended.

Plan 2 Plan 3
50% of the Dental Benefit List fees up to $2,500* for major treatments per person per calendar year 60% of the Dental Benefit List fees up to $2,500 for major treatments per person per calendar year

*Dental Plan 2 has a combined yearly maximum for Basic Preventative/Restorative and Major Restorative dental treatments

Below is a list of some common major restorative procedures and coverage limitations:

Bridges

Bridge replacements must be seven years old from the date of last placement.

Crowns

Crown replacements must be five years old from the date of last placement. Re-cementation of a crown is limited to twice per tooth per lifetime.

Dental Implants

Surgical procedures, such as a dental implant, are limited to a maximum of $3,500 payable at the percentage noted in the above plans. You can find your plan coverage in your My ASEBP account or on your benefit ID card. Replacements must be 12 years old from the date of the last placement.

Dentures – Full and Partial

Denture replacements must be five years old from the date of the last placement.

Inlays and Onlays

Inlay and onlay replacements must be five years old from the date of the last placement.

Veneers

Veneer replacements must be five years old from the date of the last placement. Re-cementation of a veneer is limited to twice per tooth per lifetime. Veneers for cosmetic purposes are not covered.

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02Orthodontics

With the exception of diagnostic tests, ASEBP requires an orthodontic predetermination (treatment plan) be in place and the patient be under the direct care of a licensed dental provider before reimbursing orthodontic services. Note that the treatment plan should also include payment arrangements. Please see Orthodontic Predetermination and Payment Arrangements for details.

Plan 2 Plan 3
Not covered 100% of the Dental Benefit List fees for examinations and diagnostics and 60% of the Dental Benefit List fees for all other treatments (e.g. appliances, banding, etc.) up to $3,000 per person per lifetime
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For basic treatments over $800, a dental predetermination (treatment plan) is recommended.

Plan 2 Plan 3
100% up to the Alberta Dental Association’s dental fee guide for basic treatments up to $2,500* per person per calendar year 100% up to the Alberta Dental Association’s dental fee guide for basic treatments per person per calendar year

*Dental Plan 2 has a combined yearly maximum for Basic Preventative/Restorative and Major Restorative dental treatments.

Below is a list of some common basic preventative and restorative procedures and coverage limitations:

Dental Exam (recall and specific exams)

One recall or specific exam is eligible for coverage every six months from the date of last service for people under 19 and every 12 months for those 19 and older. Additional exams may be covered for people with certain health conditions—please see the Oral Health Exception Process section for details.

Complete Dental Exams

Complete dental exams are eligible for coverage once every 30 months from the date of last service.

Emergency Exams

Emergency exams are covered anytime, but only in conjunction with other emergency services, like extractions, or a written explanation on the claim form from your dental provider regarding the nature of the emergency. For example, it’s not considered an emergency if an x-ray is performed and no resulting emergency procedures are performed.

Fillings

Fillings are limited to five surfaces per tooth every 24 months from the date of the last service.

Fluoride Applications

Fluoride applications are eligible for coverage once every six months from date of last service for people under 19. Additional fluoride applications may be covered for people with certain health conditions—please see the Oral Health Exception Process section for details.

Polishing

One half unit of polishing is eligible for coverage once every six months from the date of last service for people under 19.

X-Rays (Bitewing)

Bitewing X-rays are eligible for coverage once every six months from the date of last service for people under 19 and once every 12 months for those 19 and older.

Panoramic and Full-Mouth X-Rays

Panoramic and full-mouth X-rays are eligible for coverage once every five years from the date of last service.

Scaling and Root Planing

Scaling and root planing are limited to 12 units of time (one unit of time is equal to 15 minutes) per person, based on a rolling one-year period from the date of last service.

General Anesthetic

General anesthetic and nitrous oxide are eligible for coverage only in conjunction with eligible surgical procedures (e.g. surgical extractions) and excludes anesthetic facility (such as a recovery room), equipment and supply fees.

Extractions

There are no specific limitations for tooth extractions.

Root Canals (Endodontics)

Root canals for the same tooth are only covered once every 24 months. Treatment of previously-completed root canals require a dental predetermination (treatment plan) to be completed prior to treatment.

Specialist Referral Exam

Specialist referral exams are limited to once every 12 months per dental specialty from the date of last service. Referral to a specialist is made by your family dentist. Orthodontic referrals are covered under orthodontic services.

For major restorative treatments over $800, a dental predetermination (treatment plan) is recommended.

Plan 2 Plan 3
50% of the Dental Benefit List fees up to $2,500* for major treatments per person per calendar year 60% of the Dental Benefit List fees up to $2,500 for major treatments per person per calendar year

*Dental Plan 2 has a combined yearly maximum for Basic Preventative/Restorative and Major Restorative dental treatments

Below is a list of some common major restorative procedures and coverage limitations:

Bridges

Bridge replacements must be seven years old from the date of last placement.

Crowns

Crown replacements must be five years old from the date of last placement. Re-cementation of a crown is limited to twice per tooth per lifetime.

Dental Implants

Surgical procedures, such as a dental implant, are limited to a maximum of $3,500 payable at the percentage noted in the above plans. You can find your plan coverage in your My ASEBP account or on your benefit ID card. Replacements must be 12 years old from the date of the last placement.

Dentures – Full and Partial

Denture replacements must be five years old from the date of the last placement.

Inlays and Onlays

Inlay and onlay replacements must be five years old from the date of the last placement.

Veneers

Veneer replacements must be five years old from the date of the last placement. Re-cementation of a veneer is limited to twice per tooth per lifetime. Veneers for cosmetic purposes are not covered.

With the exception of diagnostic tests, ASEBP requires an orthodontic predetermination (treatment plan) be in place and the patient be under the direct care of a licensed dental provider before reimbursing orthodontic services. Note that the treatment plan should also include payment arrangements. Please see Orthodontic Predetermination and Payment Arrangements for details.

Plan 2 Plan 3
Not covered 100% of the Dental Benefit List fees for examinations and diagnostics and 60% of the Dental Benefit List fees for all other treatments (e.g. appliances, banding, etc.) up to $3,000 per person per lifetime
Form
Claim Form: Dental Care
Form
Oral Health Exception Request: Health Conditions – Fillable
Form
Oral Health Exception Request: Permanently Disabled Over-age Dependant – Fillable

What's not covered?

The following are a number of products and services not covered under the plan. Note that this list isn't exhaustive. 
  • Appliances which have been lost, stolen or broken because of an incident that did not involve accidental bodily injury
  • Charges for broken or missed appointments
  • Correction of temporomandibular joint (TMJ) dysfunction
  • Cosmetic treatment, such as teeth bleaching or diastema (gap) closure, unless necessitated by an accidental injury
  • Dietary planning, plaque control or oral hygiene instructions
  • Full mouth reconstructions and vertical dimension correction
  • Mouth guards worn for safety protection for sports, work or other related activities
  • Services or supplies that weren’t provided by a dentist or other dental professional (e.g. services or supplies provided by an online or kiosk distributor)
  • Treatment that’s experimental, educational or for the purpose of research
  • Treatment where expenses aren’t considered necessary for the prevention of a dental disease or correction of a dental defect
  • Treatment provided free of charge
  • Services provided by a family member if the family member has been given a discount. If you or your dependant is required to pay a portion of the cost of the services, you must pay for that portion or have your entire claim deemed ineligible (for example, if a dentist bills $300, we pay $180 (60 per cent) and you pay the remaining $120 (40 per cent). If the dentist doesn’t require you or your dependant to pay your portion, we won’t pay either)
  • Expenses covered through a government program, whether or not you or your dependants choose to participate in the program
  • Where charging for services or supplies is prohibited under legislation
  • Expenses incurred while on active duty in any military or peacekeeping force
  • All expenses incurred as a result of conduct that would constitute an indictable offence within Canada

Additional Information

00Dental Accidents

Your plan doesn’t include additional coverage for dental accidents; however, you may be eligible for additional coverage through Accidental Dental, depending on the circumstances of the accident and the type of injury. To be eligible for Accidental Dental, you must have Extended Health Care coverage.

You can confirm the benefits you have by checking your ASEBP ID card on My ASEBP or the My ASEBP Mobile App.

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01Coverage Outside of Alberta and Canada

If you’re travelling outside Alberta or Canada, you can submit routine and emergency dental expenses to ASEBP to be reimbursed. Expenses will be paid according to plan provisions defined by your Dental Care coverage.

Note that your Dental Care plan doesn’t include additional coverage for dental emergencies while travelling outside Canada; however, if you have Extended Health Care coverage, you’ll be eligible for additional coverage through the dental portion of your Travel Emergency benefit. In the event of a dental emergency while travelling outside Canada, please submit your claim through your Travel Emergency benefit first. You can confirm the benefits you have by checking your ASEBP ID card on My ASEBP or the My ASEBP Mobile App.

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02Dental Fees

Dental fees are the amounts your dentist charges for the services they provide. In 2017, the Alberta Dental Association (ADA) introduced a dental fee guide to help mitigate the rising costs of oral health services in Alberta. While the ADA encourages dental providers to use this guide to set prices for their practice it is not mandatory, which means the cost of services can still vary between dental offices.

ASEBP dental fees follow the Alberta Dental Association’s previous year’s Dental Fee Guide. By using the previous Dental Fee Guide, ASEBP protects premiums and avoids unanticipated dental fee increases throughout the calendar year. For example, for 2026, ASEBP uses the Alberta Dental Association’s 2025 Dental Fee Guide.

While you may have 100% coverage for certain dental services, 100% of your dentist’s bill may not be covered if they charge more than what is outlined in the ASEBP Dental Benefit List.

To avoid surprises, become informed about how the expected dental fees align with your plan:

  • Before your visit, talk to your dental provider and ask them if they charge according to the ASEBP Dental Benefit List—the dental office can check coverage levels for services and procedures electronically before they submit your claims
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03Dental Predetermination

You should discuss any proposed basic or major restorative treatments with your dentist to understand both the cost of the treatment and to determine if a proposed treatment plan (dental predetermination) is needed. To avoid surprise out-of-pocket expenses, we recommend having your dentist submit a dental predetermination in advance of any proposed treatment, especially if the cost is $800 or more.
On occasion, ASEBP may request pre-treatment X-rays or other information from your dentist to support a treatment plan. Where two or more courses of treatment are submitted, reimbursement will be based on the least expensive of the proposed treatments.

Here are some important things for you to know:

  • You can find your dental predeterminations online on My ASEBP under Documents.
  • Receiving a predetermination isn’t a pre-approval for the reimbursement of your expenses. It’s a confirmation that the prescribed treatment you’re considering is included as part of your ASEBP coverage.
  • Predeterminations only take into account the costs that have been accumulated against your maximum at the time of the authorization—they don’t include any costs that haven’t yet been billed to ASEBP or coordination of benefit rules, etc.
  • To be reimbursed for the amounts confirmed, you or your dependants must start the treatment within 90 days of your dentist submitting the predetermination to ASEBP. If your treatment began prior to you receiving ASEBP coverage, please submit a predetermination with the start date of your current treatment plan. Note that treatments incurred prior to your effective date of coverage won’t be eligible for reimbursement.
  • Depending on the cost of your proposed treatment plan (whether it’s above or below $800) as well as how your dental provider submits the predetermination (e.g. mail or electronically), you may or may not receive your own copy of the predetermination. If you don’t receive a copy and would like to review the predetermination and how much your ASEBP Dental Care benefits will cover, please speak with your dental provider as they’ll receive confirmation of payment coverage breakdowns for all submitted predeterminations.
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04Oral Health Exception Process

People with certain health conditions may require additional oral health support to ensure they’re able to maintain their overall health and well-being. Recognizing this, we’ve introduced an oral health exception process, which will allow covered members and their dependants to request coverage for additional oral health treatments.

Who’s eligible?

  • Covered members and dependants diagnosed with cancer or non-cancerous soft tissue tumours
  • Over-age dependants with mental or physical disabilities who are wholly dependent on a parent or guardian
  • Note: does not include MyRetiree Plan covered members

What additional treatments are covered?
Approved covered members and dependants with cancer or non-cancerous soft tissue tumours are eligible for:

  • Recall exams once every three months from last date of service

Approvals are granted for a period of two years. If access to additional oral health services are required past the two-year mark, a renewal can be requested.

Approved over-age dependants are eligible for:

  • Recall exams once every six months from last date of service
  • Fluoride applications once every six months from last date of service

Approvals for over-age dependants with permanent disabilities are in effect as long as you continue to participate in ASEBP Dental Care benefits. No renewal is required.

How do I request an exception?
If you’ve been diagnosed with cancer or a non-cancerous soft tissue tumour and would like to request coverage for additional oral health treatments, please download the Oral Health Exception Request form. This form needs to be completed by both you and your physician. Once complete, your physician can submit the form to us.

If you would like to request an oral health exception for an over-age dependant, aged 19 or 20, who is dependent on you due to a physical or mental disability, please download the Oral Health Exception Request: Permanently Disabled Over-age Dependant form. Note that your over-age dependant must be covered by your ASEBP benefits before you can request an oral health exception for them. Please contact us if you haven’t already informed us of your over-age dependant’s permanent disability status.

All exception requests will be reviewed by our specialty claims team and we’ll inform you in writing once a decision has been made.

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05Orthodontic Predetermination and Payment Arrangements

With the exception of diagnostic tests, ASEBP requires a proposed treatment plan (called a predetermination) be in place and you to be under the direct care of a licensed dental provider before reimbursing orthodontic services. The predetermination must be completed by your dental provider to determine what procedures are allowable and the amount covered under your plan.

For an orthodontic predetermination to be complete, your orthodontist must include the following information:

  • A description of the condition requiring treatment, including the classification and malloclusion (misalignment)
  • Length of time per course of treatment
  • Total cost of treatment and payment details, including:
    • if treatment will be paid as a one-time full payment, or
    • if payment will be broken down into an initial fee and instalment payments (include down payment and instalment—monthly or quarterly—amounts)

Here are some important things for you to know:

  • You can find your orthodontic predeterminations online on My ASEBP under Documents.
  • Receiving a predetermination isn’t a pre-approval for the reimbursement of your expenses. It’s a confirmation that the prescribed treatment you’re considering is included as part of your ASEBP coverage.
  • Predeterminations only take into account the costs that have been accumulated against your maximum at the time of the authorization—they don’t include any costs that haven’t yet been billed to ASEBP or coordination of benefit rules, etc.
  • To be reimbursed for the amounts confirmed, treatment must begin within 12 months of your orthodontist submitting the predetermination to ASEBP. If your orthodontic treatment began prior to you being enrolled in ASEBP dental coverage, a predetermination for any remaining work will need to be submitted and approved by ASEBP before any portion of the work will be paid.
  • If your approved treatment plan indicated you would pay an initial fee (down payment) plus instalment payments but the claim you submitted shows the treatment has been paid in one payment, your claim will be processed for the full amount you paid (up to plan limitations).
  • If your treatment plan has a specified payment plan (e.g. monthly, quarterly, etc.), the initial down payment or fee can’t exceed 1/3 of the overall cost of the treatment.
  • Please contact us if you’re currently making instalment payments for a treatment plan and would like to make more than one scheduled payment but less than the full balance.
  • If you’re currently making instalment payments for a treatment plan but decide you want to pay the remaining balance in full, you’ll need to submit a receipt indicating the full balance has been paid with your claim.
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06Rolling Period

Your plan maximum for root planing/scaling is 12 units based on a rolling one-year period by service date (the date you received the treatment, service or product being claimed—not the date it was paid for)—not calendar year. For example, if you claim eight units of time on March 31, 2017, and four units of time on September 1, 2017, you’ll be eligible for eight more units on March 31, 2018, and four more units on September 1, 2018.

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Your plan doesn’t include additional coverage for dental accidents; however, you may be eligible for additional coverage through Accidental Dental, depending on the circumstances of the accident and the type of injury. To be eligible for Accidental Dental, you must have Extended Health Care coverage.

You can confirm the benefits you have by checking your ASEBP ID card on My ASEBP or the My ASEBP Mobile App.

If you’re travelling outside Alberta or Canada, you can submit routine and emergency dental expenses to ASEBP to be reimbursed. Expenses will be paid according to plan provisions defined by your Dental Care coverage.

Note that your Dental Care plan doesn’t include additional coverage for dental emergencies while travelling outside Canada; however, if you have Extended Health Care coverage, you’ll be eligible for additional coverage through the dental portion of your Travel Emergency benefit. In the event of a dental emergency while travelling outside Canada, please submit your claim through your Travel Emergency benefit first. You can confirm the benefits you have by checking your ASEBP ID card on My ASEBP or the My ASEBP Mobile App.

Dental fees are the amounts your dentist charges for the services they provide. In 2017, the Alberta Dental Association (ADA) introduced a dental fee guide to help mitigate the rising costs of oral health services in Alberta. While the ADA encourages dental providers to use this guide to set prices for their practice it is not mandatory, which means the cost of services can still vary between dental offices.

ASEBP dental fees follow the Alberta Dental Association’s previous year’s Dental Fee Guide. By using the previous Dental Fee Guide, ASEBP protects premiums and avoids unanticipated dental fee increases throughout the calendar year. For example, for 2026, ASEBP uses the Alberta Dental Association’s 2025 Dental Fee Guide.

While you may have 100% coverage for certain dental services, 100% of your dentist’s bill may not be covered if they charge more than what is outlined in the ASEBP Dental Benefit List.

To avoid surprises, become informed about how the expected dental fees align with your plan:

  • Before your visit, talk to your dental provider and ask them if they charge according to the ASEBP Dental Benefit List—the dental office can check coverage levels for services and procedures electronically before they submit your claims

You should discuss any proposed basic or major restorative treatments with your dentist to understand both the cost of the treatment and to determine if a proposed treatment plan (dental predetermination) is needed. To avoid surprise out-of-pocket expenses, we recommend having your dentist submit a dental predetermination in advance of any proposed treatment, especially if the cost is $800 or more.
On occasion, ASEBP may request pre-treatment X-rays or other information from your dentist to support a treatment plan. Where two or more courses of treatment are submitted, reimbursement will be based on the least expensive of the proposed treatments.

Here are some important things for you to know:

  • You can find your dental predeterminations online on My ASEBP under Documents.
  • Receiving a predetermination isn’t a pre-approval for the reimbursement of your expenses. It’s a confirmation that the prescribed treatment you’re considering is included as part of your ASEBP coverage.
  • Predeterminations only take into account the costs that have been accumulated against your maximum at the time of the authorization—they don’t include any costs that haven’t yet been billed to ASEBP or coordination of benefit rules, etc.
  • To be reimbursed for the amounts confirmed, you or your dependants must start the treatment within 90 days of your dentist submitting the predetermination to ASEBP. If your treatment began prior to you receiving ASEBP coverage, please submit a predetermination with the start date of your current treatment plan. Note that treatments incurred prior to your effective date of coverage won’t be eligible for reimbursement.
  • Depending on the cost of your proposed treatment plan (whether it’s above or below $800) as well as how your dental provider submits the predetermination (e.g. mail or electronically), you may or may not receive your own copy of the predetermination. If you don’t receive a copy and would like to review the predetermination and how much your ASEBP Dental Care benefits will cover, please speak with your dental provider as they’ll receive confirmation of payment coverage breakdowns for all submitted predeterminations.

People with certain health conditions may require additional oral health support to ensure they’re able to maintain their overall health and well-being. Recognizing this, we’ve introduced an oral health exception process, which will allow covered members and their dependants to request coverage for additional oral health treatments.

Who’s eligible?

  • Covered members and dependants diagnosed with cancer or non-cancerous soft tissue tumours
  • Over-age dependants with mental or physical disabilities who are wholly dependent on a parent or guardian
  • Note: does not include MyRetiree Plan covered members

What additional treatments are covered?
Approved covered members and dependants with cancer or non-cancerous soft tissue tumours are eligible for:

  • Recall exams once every three months from last date of service

Approvals are granted for a period of two years. If access to additional oral health services are required past the two-year mark, a renewal can be requested.

Approved over-age dependants are eligible for:

  • Recall exams once every six months from last date of service
  • Fluoride applications once every six months from last date of service

Approvals for over-age dependants with permanent disabilities are in effect as long as you continue to participate in ASEBP Dental Care benefits. No renewal is required.

How do I request an exception?
If you’ve been diagnosed with cancer or a non-cancerous soft tissue tumour and would like to request coverage for additional oral health treatments, please download the Oral Health Exception Request form. This form needs to be completed by both you and your physician. Once complete, your physician can submit the form to us.

If you would like to request an oral health exception for an over-age dependant, aged 19 or 20, who is dependent on you due to a physical or mental disability, please download the Oral Health Exception Request: Permanently Disabled Over-age Dependant form. Note that your over-age dependant must be covered by your ASEBP benefits before you can request an oral health exception for them. Please contact us if you haven’t already informed us of your over-age dependant’s permanent disability status.

All exception requests will be reviewed by our specialty claims team and we’ll inform you in writing once a decision has been made.

With the exception of diagnostic tests, ASEBP requires a proposed treatment plan (called a predetermination) be in place and you to be under the direct care of a licensed dental provider before reimbursing orthodontic services. The predetermination must be completed by your dental provider to determine what procedures are allowable and the amount covered under your plan.

For an orthodontic predetermination to be complete, your orthodontist must include the following information:

  • A description of the condition requiring treatment, including the classification and malloclusion (misalignment)
  • Length of time per course of treatment
  • Total cost of treatment and payment details, including:
    • if treatment will be paid as a one-time full payment, or
    • if payment will be broken down into an initial fee and instalment payments (include down payment and instalment—monthly or quarterly—amounts)

Here are some important things for you to know:

  • You can find your orthodontic predeterminations online on My ASEBP under Documents.
  • Receiving a predetermination isn’t a pre-approval for the reimbursement of your expenses. It’s a confirmation that the prescribed treatment you’re considering is included as part of your ASEBP coverage.
  • Predeterminations only take into account the costs that have been accumulated against your maximum at the time of the authorization—they don’t include any costs that haven’t yet been billed to ASEBP or coordination of benefit rules, etc.
  • To be reimbursed for the amounts confirmed, treatment must begin within 12 months of your orthodontist submitting the predetermination to ASEBP. If your orthodontic treatment began prior to you being enrolled in ASEBP dental coverage, a predetermination for any remaining work will need to be submitted and approved by ASEBP before any portion of the work will be paid.
  • If your approved treatment plan indicated you would pay an initial fee (down payment) plus instalment payments but the claim you submitted shows the treatment has been paid in one payment, your claim will be processed for the full amount you paid (up to plan limitations).
  • If your treatment plan has a specified payment plan (e.g. monthly, quarterly, etc.), the initial down payment or fee can’t exceed 1/3 of the overall cost of the treatment.
  • Please contact us if you’re currently making instalment payments for a treatment plan and would like to make more than one scheduled payment but less than the full balance.
  • If you’re currently making instalment payments for a treatment plan but decide you want to pay the remaining balance in full, you’ll need to submit a receipt indicating the full balance has been paid with your claim.

Your plan maximum for root planing/scaling is 12 units based on a rolling one-year period by service date (the date you received the treatment, service or product being claimed—not the date it was paid for)—not calendar year. For example, if you claim eight units of time on March 31, 2017, and four units of time on September 1, 2017, you’ll be eligible for eight more units on March 31, 2018, and four more units on September 1, 2018.