Provincial dental fee increases for 2011
#261
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It’s that 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 2011 by the provincial dental associations (except for the Alberta Dental Association and College, which doesn’t publish an annual fee guide).
| Province | Percentage cost increase | Details of increase | 2011 effective date | |||
|
British Columbia |
1.80% overall |
Procedure codes |
Classification |
Percentage cost increase |
February 1 | |
|
00000-09999 |
Diagnostic |
3.6% |
||||
|
10000-19999 |
Preventive |
1.6% |
||||
|
20000-23999 |
Restorative - Amalgams - Composites |
|
||||
|
24000-29999 |
Restorative - Crowns |
1.7% |
||||
|
30000-39999 |
Endodontics |
1.3% |
||||
|
40000-49999 |
Periodontics |
1.0% |
||||
|
50000-59999 |
Prosthodontics - Removable |
1.4% |
||||
|
60000-69999 |
Prosthodontics - Fixed |
1.1% |
||||
|
70000-79999 |
Oral surgery |
2.0% |
||||
|
80000-89999 |
Orthodontics |
1.5% |
||||
|
Alberta |
4.93% * |
Overall increase * For more information please refer to the information following this chart. |
February 1 | |||
|
Saskatchewan |
3.00% |
Overall increase | January 1 | |||
|
Manitoba |
3.49% |
Overall increase for General Practitioner, Endodontic, Periodontic, Oral & Maxillofacial and Prosthodontic services. 9.5% increase for Pediatric services. |
January 1 | |||
|
Northern Manitoba |
3.49% |
Overall increase for General Practitioner, Endodontic, Periodontic, Oral & Maxillofacial and Prosthodontic services. 9.5% increase for Pediatric services. This guide has adjusted fees that are about 10% higher than those in the Manitoba guide. |
January 1 | |||
|
Ontario |
2.00% overall |
Service category |
Percentage cost increase |
January 1 | ||
| Diagnostic |
3.3% |
|||||
| Preventive |
1.6% |
|||||
| Restorations - Amalgam - Composite |
|
|||||
| Restorations - Crowns |
|
|||||
| Endodontics |
1.3% |
|||||
| Periodontics |
0.9% |
|||||
| Prosthodontics - Fixed |
5.9% |
|||||
| Oral surgery |
6.1% |
|||||
| Other |
4.7% |
|||||
|
Quebec |
1.6% |
Average increase. | January 1 | |||
|
New Brunswick |
2.0% |
Overall increase (General Practitioners) | January 1 | |||
|
Nova Scotia |
|
Not yet available | February 1 | |||
|
Prince Edward Island |
2.27% |
Overall increase | January 1 | |||
|
Newfoundland & Labrador |
6.0% |
General increase, not on all services | January 1 | |||
|
Northwest Territories |
2.50% |
Overall increase | April 1 | |||
|
Nunavut |
0% |
No changes for Nunavut in 2011 | April 1 | |||
|
Yukon |
|
Not yet available | April 1 | |||
How we reimburse dental expenses in Alberta Since the Alberta Dental Association and College doesn’t 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 |
2011 increase over 2010 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) |
6.0% |
|
23000-24999 |
Composite fillings |
6.0% |
|
25000-29999 |
Restorative – Major (eg. crowns) |
6.0% |
|
30000-39999 |
Endodontics (e.g. root canal treatment) |
5.0% |
|
40000-49999 |
Periodontics (e.g. gum treatment) |
4.0% |
|
50000-59999 |
Prosthodontics – Removable (e.g. dentures) |
6.0% |
|
60000-69999 |
Prosthodontics – Fixed (e.g. bridges) |
5.0% |
|
70000-79999 |
Oral and maxillofacial surgery |
5.0% |
|
80000-89999 |
Orthodontics |
0% |
|
90000-99999 |
Adjunctive general services |
5.0% |
Plan sponsors in Alberta
Dental fees in Alberta vary significantly because the province doesn’t 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.
We are also including a communication for your plan members. “Making the most of your dental benefits 2011” explains how we reimburse dental services in Alberta.
Questions?
Please contact your Sun Life Financial group representative.
