Provincial dental fee increases for 2013

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It’s that time of year when most provincial and territorial dental associations release their annual fee guides. Typically there is an increase across the board for dental services performed by general practitioners. The information in provincial fee guides helps us establish reimbursement levels for the dental services your plan members receive.

This chart summarizes fee guide increases announced for 2013 by the provincial dental associations (except for the Alberta Dental Association and College, which does not publish an annual fee guide).

Province

Percentage cost increase

Details of increase

2013 effective date

 

 

British Columbia

 

 

2.4% overall

Procedure codes

Classification

Percentage cost increase





February 1

00000-09999

Diagnostic

2.5%

10000-19999

Preventive

0.5%

20000-23999

  Restorative
  - Amalgams
  - Composites


3.4%
1.9%

24000-29999

  Restorative
  - Crowns

5.0%

30000-39999

Endodontics

5.5%

40000-49999

Periodontics

3.4%

50000-59999

Prosthodontics - Removable

Not available

60000-69999

Prosthodontics - Fixed

1.4%

70000-79999

Oral surgery

2.8%

80000-89999

Orthodontics

Not available

Alberta

3.72% *

Overall increase

* For more information please refer to the information following this chart.

February 1

Saskatchewan

4.17%
overall

Procedure codes

Classification

Percentage cost increase

January 1

00000-09999

Diagnostic

4.2%

10000-19999

Preventive

3.3%

20000-23999

  Restorative
  - Amalgams
  - Composites


7.8%
2.1%

24000-29999

Restorative - Crowns

4.0%

30000-39999

Endodontics

8.0%

40000-49999

Periodontics

13.0%

50000-59999

Prosthodontics - Removable

Not available

60000-69999

Prosthodontics - Fixed

Not available

70000-79999

Oral surgery

4.6%

80000-89999

Orthodontics

9.3%

Manitoba

3.2%

 

7.0%

5.4%

3.2%

General Practitioner.

Specialty Fee Guides:

  • Pediatric
  • Oral Surgery
  • All other specialties
January 1

Northern Manitoba

3.2%

This guide has adjusted fees that are about 10% higher than those in the Manitoba guide. January 1

 

 

Ontario

 

 

2.14% overall

Classification

Percentage cost increase





January 1
Diagnostic

3.02%

Preventive

1.68%

Restorations
 - Amalgam
 - Composite


1.77%
2.15%

Restorations  - Crowns

2.84%

Endodontics

0%

Periodontics

2.57%

Prosthodontics – Removable

2.41%

Oral surgery

2.92%

Orthodontics

2.99%

Quebec

3.12%

Average increase January 1

New Brunswick

2.0%

Overall increase (General Practitioners) January 1

Nova Scotia

2.63%

Overall increase February 1

Prince Edward Island

2.73%

Overall increase January 1

Newfoundland & Labrador

5.0%

Overall increase January 1

Northwest Territories

 

Not yet available April 1

Nunavut

 

Not yet available April 1

Yukon

 

Not yet available April 1

 

How we reimburse dental expenses in Alberta

Since the Alberta Dental Association and College does not publish a dental fee guide, insurers must establish their own reimbursement levels for dental services in Alberta.

At Sun Life Financial, we use our own Alberta-based claims data from the two most recent consecutive calendar years to determine appropriate fee increases for each category of dental service.

Our application of these reimbursement levels may not always result in full reimbursement of the charges by some dentists in Alberta, nor will they necessarily match the reimbursement levels set by other carriers.

For group contracts that provide benefits on a current fee guide basis, the following reimbursement levels will apply:

 

Procedure codes

Classification

2013 increase over 2012 reimbursement guide

00000-09999

Diagnostic (e.g. examinations)

4.0%

10000-19999

Preventive (e.g. cleaning, scaling)

4.0%

20000-22999

Restorative – Basic (e.g. fillings)

3.0%

23000-24999

Composite fillings

3.0%

25000-29999

Restorative – Major (eg. crowns)

4.0%

30000-39999

Endodontics (e.g. root canal treatment)

3.0%

40000-49999

Periodontics (e.g. gum treatment)

3.0%

50000-59999

Prosthodontics – Removable (e.g. dentures)

5.0%

60000-69999

Prosthodontics – Fixed (e.g. bridges)

2.0%

70000-79999

Oral and maxillofacial surgery

5.0%

80000-89999

Orthodontics

0%

90000-99999

Adjunctive general services

10.0%

 

Plan sponsors in Alberta

Dental fees in Alberta vary significantly because the province does not publish a provincial dental association fee guide. 

Our recommended reimbursement guide is developed to cover fees that are representative of what the majority of patients are charged.  However, did you know that our dental claims system allows you the flexibility to amend your plan so that dental claims can be reimbursed at a higher or lower level than the options provided in our Alberta reimbursement guide? Please contact your Sun Life Financial group representative to explore your choices.

And to assist plan members in comparing their dentist’s fees against other dentists in the same postal code, we’ve included a link to our new Alberta dental fee finder report.  We’ve featured 15 of the most common dental procedures plan members send us claims for.

We are also including a communication for your plan members who reside in Alberta. “Know your dental coverage and the cost of services” explains how we reimburse dental services in Alberta.

Questions?

Please contact your Client Service Administrator at 1-877-786-7227.