| Major Procedures | |
|---|---|
|
Crowns & Bridges Dentures Replacement Bridge and Crowns |
50% 50% 50%, must be 5 years old to be replaced |
Major Procedures
- crowns, other than stainless steel
- metal inlays and crowns, used to restore natural teeth to their normal functions where the tooth, as a result of extensive caries or fracture, cannot be restored with a filing. When a tooth can be restored with silver amalgam, silicate or synthetic restorations, benefits will be determined based on the usual costs of such a restoration. Replacement of existing crowns only provided after a minimum of 5 years.
- repairs to dentures
- initial installation of partial or full removable dentures, if required because of the extraction of additional natural teeth while insured under the plan
- replacement of existing partial or full removable denture(s) providing:
- (a) it is required because of the extraction of additional natural teeth while insured under the Plan and the existing appliance could not have been made serviceable, only the expense for the portion of the replacement appliance replacing the additional teeth extracted is covered; or
- (b) the existing appliance is at least 5 years old and cannot be made serviceable;or,
- (c) the existing appliance is replaced as a result of the initial placement of an opposing denture.
- initial installation of fixed bridgework, if required because of the extraction of additional natural teeth while insured under the plan
- bridge repairs and recementation
- replacement of existing fixed bridgework providing:
- (a) the existing fixed prosthetic device is at least 5 years old and cannot be made serviceable; or,
- (b) the replacement is required because of extraction, loss or fracture of one or more sound natural teeth after the individual became insured under this plan; or
- (c) A temporary bridge is considered to be permanent if not replaced within 12 months from the date the temporary bridge was inserted.