Covered Dental Expenses

Charges for reasonable and customary services and specified supplies shall be considered covered expenses when incurred by you or a covered Dependent. Eligible expenses include Basic and Preventive Treatment, Endodontics, Periodontics, Oral Surgery, Major Restorative and Prosthodontics. An expense is eligible to the extent that coverage is not prohibited by provincial health insurance plans or because of other limitations described below.

Percent Payable

Basic Procedures

Calendar Year Maximun for both Basic and Major procedures combined

Complete examination

Recall or Specific exam

Full mouth x-ray

Bitewing x-rays

Scaling or root planning

Pit & Fissure sealants

study casts

relining and rebasing of existing dentures



once every 24 months

once every 9 months

once every 24 months

once every 6 months

8 units per year

once per tooth, under 18

once every 12 months

once every 12 months


Reimbursement Note:

Provincial Fee Guide of Member’s home province for the year determined from time to time by the Trustees.

The following are considered Basic Procedures:

  • oral examinations including scaling and cleaning of teeth
  • topical application of sodium or stannous fluoride
  • dental x-rays: single diagnostic x-rays; Panorex/complete series
  • consultations
  • extractions
  • oral surgery including excision of impacted teeth
  • amalgam, acrylic, silicate or composite fillings
  • retentive pins
  • anaesthesia where reasonably and customarily required in connection with other covered procedures
  • occlusal equilibration
  • periodontal scaling
  • treatment of periodontal and other diseases of gums and tissues of the mouth
  • caries, trauma and pain control
  • emergency endodontic procedures and root canal therapy
  • prefabricated full coverage restorations for primary teeth
  • stainless steel crown restorations on primary teeth
  • space maintainers for missing primary teeth and habit breaking appliances
  • pit and fissure sealants for Dependent Children under the age of 18 only
  • study casts, once every 12 months
  • relining and rebasing of existing dentures, once every 24 months

Insulators Local 95 Benefit Trust Fund c/o Benefit Plan Administrators 
90 Burnhamthorpe Road West, Suite 300 Mississauga, Ontario L5B 3C3