Your UBC Dental Plan covers a wide range of dental services, from regular check-ups to major procedures such as root canals and crowns. These procedures may be provided by a licensed dentist, denturist, dental hygienist or anaesthetist.
If you want to receive Dental Plan benefits, you need to meet eligibility requirements and enrol in the plan. There is no cost to you, as UBC pays the monthly premiums associated with this plan. (Sessional Lecturers working less than 50% FTE or in an appointment of four months or less pay half of the monthly premiums for Dental Plan benefits.)
What dental costs are covered?
Your reimbursement will be based on the percentage levels described below and the fee stated in the BC Dental Association Fee Guide for General Practitioners that is current at the time of the treatment. If services are provided by a dental specialist, then the allowed fees are those outlined in the BC Dental Association Fee Guide for General Practitioners, plus 10%.
You need to obtain a predetermination from Sun Life for all dental procedures that cost more than $500.
What dental costs are not covered?
Your dental plan does not cover:
- procedures primarily to improve appearance,
- replacing lost or stolen dental appliances,
- charges for completing forms,
- supplies intended for sport or home use, and
- experimental treatments
What is my deductible?
You do not have to pay a deductible for dental coverage.
What are my coverage limits?
For all employee groups there is no overall coverage limit for preventive, basic or major procedures.
For all employee groups, the maximum reimbursement for orthodontic procedures in a person’s lifetime is $3,000.
If you receive any temporary dental service, these costs will be included as part of the final dental procedure, and not as a separate procedure. That is, the fee for the permanent procedure will be used to determine the usual and reasonable charge for the dental work.
If your dental coverage ends, you will still be covered for procedures to repair natural teeth damaged in an accident if the accident occurred while you were covered, and the procedure is performed within six months after the date of the accident.
When Sun Life is deciding to pay for a dental procedure, they will investigate if there is a viable alternate treatment. If the alternate procedure will result in an equivalent level of success, then Sun Life will pay the amount for the least expensive alternate procedure.
When do I need a predetermination for dental work?
You must receive a predetermination from Sun Life before you receive treatment for:
- dental care procedure(s) in excess of $500, and
- all orthodontic work.
To receive a predetermination for this work, ask your dentist to complete the Dental Claim form, detailing the dental procedure(s) or orthodontic treatment plan, and then have them send this form to Sun Life for you. Your dentist can also submit this form electronically.
Your dentist should include supporting information, such as x-rays or pictures of models or molds, to illustrate the services that are being recommended. If your dentist does not provide this information with the form, your predetermination for services will be declined until this information has been received and reviewed by Sun Life. Sun Life may also request further information from your dentist as part of its review process.
Once the review process is complete, Sun Life will send you a Claims Statement outlining what part of the cost is covered by the plan and what you will have to pay.
It’s your responsibility to request a predetermination in advance of receiving dental treatment in order to know what the Dental plan will cover and how much you will be expected to pay out of pocket. If you obtain dental services without a predetermination, you are responsible for what the plan does not cover. In the case of major dental work, this could be a significant and unexpected amount.
How do I make a claim?
Your dentist can often submit a claim for your dental procedure directly to Sun Life. You will need to provide your dentist with your UBC Group Number (025205) and your Member ID (your seven-digit UBC employee number).
If your dentist submits the claim on your behalf to Sun Life, reimbursement will occur as follows depending on your dentist:
- you pay your dentist the full amount of the service and Sun Life will reimburse you for the amount covered by the Dental plan; or
- you pay your dentist the amount not covered by the Dental plan and Sun Life will reimburse the dentist for the balance.
Some dentists may ask that you pay first and then submit a claim yourself. In this case, please visit the Claims page for more information on how to submit a UBC Dental claim.
For more information
The outline above is a descriptive summary of the plan and is not a contract. All terms and conditions are governed by Contract Number 025205 with Sun Life Assurance Company of Canada. In the event of a discrepancy, benefits will be paid according to the official document and applicable legislation.
For complete details about your Dental Plan, refer to the Sun Life benefits booklet for your employee group:
- BCGEU Okanagan
- CUPE 116
- CUPE 2950
- IUOE 115
- Faculty: includes Faculty, Academic Executive and Postdoctoral Fellows (Employees)
- Management and Professional: includes Management & Professional, Service Unit Director and Administrative Executive
- CUPE 2278 (ELI), Executive Administrative, Farm Workers and Non-Union Technicians and Research Assistants
- BCGEU Child Care
- Postdoctoral Fellows (Award Recipients)