A reminder of what’s changing
We’re introducing new dental administrative practices for certain examinations (exams) and desensitization services.
Recall examination vs. emergency/specific examination
A recall examination (exam) occurs when a patient returns to their dental provider for their regular appointment and receives a cleaning and an exam. A recall exam is different from an emergency or specific exam.
An emergency exam occurs separately from a recall appointment when:
- a dental provider is required to check a patient’s pain points or discomfort, and/or
- an infection in a localized area requires immediate treatment.
A specific exam also occurs separately from a recall appointment. We pay for both emergency and specific exams but not as recall exams.
Desensitization with a routine hygiene appointment
During a hygiene appointment, a dental provider might apply a varnish to reduce sensitivity. There’s no needle involved. We don’t consider this eligible for an additional fee when claimed with scaling or root planing. We’ll decline the fee for desensitization if performed in conjunction with these services.
What does this mean for plan members?
Most plan members won’t see any changes in their claim payments. However, if they do see a change, we encourage them to read their claim statement. They can refer to this statement for more details on our payment decisions. We’ll notify plan members of these administrative practices on mysunlife.ca, starting in September.
We’ve also prepared a flyer for you to share with your members.
Questions? We’re here to help.
For Clients with less than 50 employees, please contact your Client Service Administrator at 1-877-786-7227.
For Clients with more than 50 employees, please contact your Sun Life Group Benefits representative.
