CSI Dental Plan Coverage Chart
| Insured Portion1 | Studentcare Dental Network Savings | Total Coverage | |
|---|---|---|---|
| Preventive Services - recall exams2 - cleanings2 - scaling2 |
70% | 30% | 100% |
| Fillings3 and extraction of impacted teeth4 | 75% | 20% | 95% |
| Endodontics and periodontics5 | 10% | 20% | 30% |
| Major Restorative - crowns - bridges - dentures |
10% | 20% | 30% |
The maximum paid by Sun Life Assurance Company of Canada per policy year on the insured portion of the Dental Plan is $750.
1 Percentage of Provincial Dental Fee Guide Cost for General Practitioners (in the province where service was performed).
2 Recall exams, cleaning/polishing, bitewing x-rays, and the application of fluoride are covered once per policy year. Scaling is covered up to 4 units per policy year. A complete exam (sometimes called a new patient exam) is only covered once per policy year. A complete set of x-rays or panorex x-rays is covered once per 36 months.
3 Fillings in amalgam (metal) and composite (white) fillings are covered for all teeth. Tooth-coloured fillings are limited to once every two years on the same tooth surfaces.
4 The extraction of impacted teeth is considered to be part of preventative services by Sun Life Assurance Company of Canada. The Studentcare Dental Network reduction, however, will be 20%, as this is considered oral surgery in the Provincial Dental Fee Guide for General Practitioners.
5 Certain maximums exist. Contact Studentcare for more details.
Certain exclusions and limitations may apply. Prior to dental treatment for work that is expected to cost $300 or more, students should submit a treatment plan (obtained from your dentist) to Sun Life Assurance Company of Canada for approval.
Note: Services performed by an orthodontist aren't covered by the Dental Plan.