January 2007 Focus Update #105

In this issue ...

Provincial dental fee increases for 2007

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. We use this information to help establish what we’ll reimburse your plan members for dental services they receive. 

The chart below shows a breakdown of the cost increases for 2007. It’s followed by a section on how we determine the increase for Alberta, which doesn’t publish a fee guide.

Province

% cost increase

Details of increase

Effective date in 2007

British Columbia

3.19%

Procedure Codes

Classification

% cost  increase

00000-09999

Diagnostic

2.0%

10000-19999

Preventive

3.34%
Excluding hygiene services)

20000-23999

Restorative
(Amalgams)
(Composites)


3.0%
3.35%

24000-29999

Restorative (Crowns)

3.4%

30000-39999

Endodontics

2.98%

40000-49999

Periodontics

4.0% (excludes root planing)

50000-59999

Prosthodontics (Removable)

4.99%

60000-69999

Prosthodontics (Fixed)

3.4%

70000-79999

Oral Surgery

3.11%

 

80000-89999

Orthodontics

4.0%

90000-99999

Adjunctive

2.0%

 

Feb. 1

 

 

 

 

 

 

 

 

 

 

 

 

 

Alberta

4.76%

Overall increase. For more information on our approach please refer to the information following this chart.

Feb.1

Saskatchewan

6.23%

Overall increase

Jan. 1

Manitoba

3.79%

Overall increase

Jan. 1

Northern Manitoba

3.79%

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

Jan. 1

Ontario

3.6%

Service category

% cost increase

Diagnostic

0.5%

Preventive

1.5%

Restorations

Amalgam

Composite

 

2.0%

10.2%

Crowns

0.0%

Endodontics

0.0%

Periodontics

2.4%

Fixed Prosthodontics

0.0%

Oral Surgery

8.0%

Other

3.7%

Jan. 1

 

 

 

 

 

 

 

 

Quebec

3.10%

Overall increase

Jan. 1

New Brunswick

3.0%

Overall increase

Jan. 1

Nova Scotia

3.46%

Overall increase

Feb. 1

Prince Edward Island

2.8%

Overall increase.

Jan. 1

Newfoundland and Labrador

3.0%

Overall increase

Jan. 1

N.W.T.

Not available

 

April 1

Nunavut

Not available

 

April 1

Yukon

Not available

 

April 1

How we reimburse dental expenses in Alberta

Because the Alberta Dental Association doesn’t publish a dental fee guide, insurers establish their own reimbursement levels for dental services in Alberta using aggregate data compiled on an industry basis through the CLHIA. At Sun Life Financial we base our reimbursement schedule on an analysis of dental service fees in Alberta, derived from the experience of our entire dental plan business, and as a reflection of dental fees being charged generally.   

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  2007 increase over 2006 reimbursement guide
 00000-09999  Diagnostic (e.g. examinations)  4.5 %
 10000-19999  Preventive (e.g. cleaning, scaling  4.5 %
 20000-22999  Restorative – Basic (e.g. fillings)  4.5 %
 23000-24999  Composite Fillings  4.5 %
 25000-29999  Restorative – Major (e.g. crowns)  6.0 %
 30000-39999  Endodontics (e.g. root canal treatment)  4.5 %
 40000-49999  Periodontics (e.g. gum treatment)  5.0 %
 50000-59999  Prosthodontics-removable (e.g. dentures)  4.0 %
 60000-69999  Prosthodontics-fixed (e.g. bridges  4.0 %
 70000-79999  Oral and Maxillofacial Surgery  6.0 %
80000- 89999 Orthodontics  4.5 %
90000-99999 Adjunctive General Services  10.0 %

If you have any questions regarding the information in this bulletin, please contact your group benefits representative.

We’ve also included with this communication a second one that you can share with your plan members. Making the most of your dental benefits will help them understand how we reimburse them for dental services in Alberta

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Making the most of your dental benefits
Know your dental coverage and the cost of services

Dentists’ fees in Alberta vary significantly because the province doesn’t publish a provincial dental association fee guide. While we do our best to provide reimbursement levels that reflect what dentists in the province are charging, your dentist may charge you more than what is covered under your dental plan. Any difference between what your dentist charges and what we pay under your plan is your responsibility.

We recommend that you ask your dentist about his or her fees before you receive treatment, and have your dental office send us a predetermination (fee estimate) so we can let you and your dentist know in advance how much will be covered. That way, if you do have to pay any additional charges, you will be prepared ahead of time and can choose to negotiate a better price, get a cost estimate from another dentist, or agree to pay your dentist’s extra fees.

Here are examples of how much we may pay for some common dental treatments in Alberta. Please note that the amount you actually receive may be different, depending on your plan’s deductibles, co-insurance, and other plan design factors.

Type of Service Amounts covered effective Feb. 2007
Adult checkup, which typically includes a recall exam, 2 bitewing radiographs, 15 minutes of scaling and 15 minutes of polishing $178.30
Complete examination (Adult) $73.98
Recall examination $49.31
One x-ray (periapical) $19.70
Three x-rays (periapical) $45.95
Two x-rays (bitewing) $32.78
Tooth extraction (uncomplicated) $77.13

For more information about your dental plan

Please check your benefits booklet or ask your benefits administrator. Or use our convenient Plan Member Services website at www.sunlife.ca.

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