About this Benefit
Seeing an oral health care provider regularly can help you catch dental problems before they get too serious and require more extensive procedures. Oral health is directly linked to general health and wellness. Dental infections can make certain conditions, such as diabetes, heart disease and pregnancy, more complicated. Health Benefits has partnered with Pacific Blue Cross (PBC) to offer a comprehensive dental plan to First Nations people in BC.
A Dental Benefit factsheet is available here. For detailed information of all products and services covered under your dental Benefits, visit the Fee Supplement here.
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What My Plan Covers
Your plan covers certain dental items and services under the following categories:
- bridges
- crowns, inlays, onlays, veneers
- dental surgery
- dental sedation
- dentures
- exams and x-rays
- fillings
- night guards
- orthodontic services (coverage has age restrictions and medical criteria)
- periodontal services
- preventive services
- root canals and related services
You can find detailed information about your dental benefits through your PBC Member Profile, which you can access online or through the PBC app.
How Do I Access Coverage?
When you make an appointment, the best way to access your coverage and avoid out-of-pocket costs is to discuss your treatment plan and billing details with your provider.
1. Ask your dental provider if they are registered with PBC. Providers who are registered can bill directly. If you see a provider who is not registered with PBC you will need to pay out of pocket and request reimbursement.
2. Make sure any prior approval requests for items or services have been approved. Some items and services require prior approval, which your provider can request directly from PBC.
3. Check if your dental provider requires payment up front. Some providers ask their clients to pay for items and services before undergoing treatment.
4. Talk to your provider about which items and services are fully covered by your plan. Some providers charge more than the dental benefit maximums. Make sure you are aware of all charges before undergoing treatment.
If you have any questions about your dental plan, how to access coverage, or why a claim was denied, call Health Benefits at 1-855-550-5454.
What My Plan Does Not Cover
Some items and services are considered Exclusions. Exclusions cannot be covered as an exception and cannot be appealed. Dental benefit Exclusions include, but are not limited to:
- cosmetic treatments
- implants
- ridge augmentation
Appeals
When a coverage request for a dental item or service has been denied, you have the right to appeal the decision. Items and services that are Exclusions cannot be appealed. See the Appeals page for more information about the appeals process.
