Abutment

A tooth used to support and anchor a fixed or removable denture prosthesis.

Amalgam Filling

A mixture of mercury, silver, and other materials, used to restore teeth.

Beneficiary

The person(s) designated by a plan member to receive Group Life or Accidental Death benefits upon the plan member’s death.

Calendar Year Maximum

A calendar year maximum can apply to certain types of coverage within your plan. It may limit the number of visits to a particular practitioner or the number of times that a specific procedure can receive payment. It may also limit a practitioner or procedure to a specific dollar maximum. The limitations are assessed and accumulate within a calendar year. When the next calendar year begins, the maximums reset to their full value.

Composite Filling

A white plastic material used to restore teeth.

Crowns

Also called a cap, a crown is needed on a tooth when the tooth is weakened by decay, fracture or a very large restoration. A crown is usually made of porcelain and or metal. You will need to submit x-rays with your claim before it can be considered for payment.

Deductible

If your plan includes a deductible, it must be paid first before benefits become eligible for payment by Manulife (see also coinsurance).

Dental Coverage Maximum

Some dental services may be combined to calculate your coverage maximum.

Example:

A plan may have a $500 maximum for Preventative Services, and a $500 maximum for Basic Restorative Services. This means that meeting the maximum for Preventative Services also reaches the maximum for Basic Restorative Services.

See your benefit booklet for details.

Denture

A denture is a synthetic replacement for some or all of your teeth in either your upper or your lower jaw.

Diagnostic Cast

Also called a study model, a diagnostic cast is a replica of the form of the teeth and tissues made from an impression.

Drugs

Elastic Stockings

Elastic stockings or support hose are specialized medical compression garments sometimes used to support the legs of a patient with a circulation disorder.

Check your benefit booklet to find out if your plan's coverage includes elastic stockings.

Endodontics

Endodontics is a branch of dentistry that involves treating the inside of a tooth. Many teeth can be saved by the removing the pulp inside the tooth rather than the whole tooth itself.

Fluoride

Fluoride is applied to teeth to reduce or prevent decay.

Homeopathy

This system of medical practice stands by the principle that any substance that can make you ill, can also cure you. Homeopathic therapy treats a disease by administering doses of a remedy that would produce symptoms similar to those of the disease in a healthy person. Manulife has basic and major categories of homeopathy.

Check your benefit booklet to find out if your plan's coverage includes homeopathy.

Inlays / Onlays and Pins

An inlay or onlay is a gold, porcelain, or composite custom-made filling cemented to the tooth. A pin helps to stabilize the tooth and support the inlay or onlay in the restoration.

International Travel Assistance (ITA)

International Travel Assistance is provided in partnership with Allianz Global Assistance.

Check your benefit booklet to find out if your plan's coverage includes International Travel Assistance.

Late Applicant or Application

An application is considered late if you:

• Apply for insurance on any person after having been eligible for more than 31 days; or
• Re-apply for insurance for yourself or a dependent whose insurance had earlier been cancelled.

If you apply for benefits that were previously waived because you were covered under similar benefits with your spouse's plan, your application is considered late if you:

• Apply for insurance more than 31 days after the date benefits terminated under your spouse's plan

Late Filed Limits

Most plans include a deadline for submitting claims. After the deadline has passed, claims will be declined as late filed.

Example:

Your plan may state that all claims must be submitted within 12 months of the date the expense was incurred. In this case, if you submit a claim where the date of service was over 12 months ago, the claim will be declined.

Maximums

A maximum for a benefit can refer to the

• age limit,
• dollar limit and/or
• time limit

to which you and your covered family members are eligible to receive benefit coverage.

Example of an age maximum: A plan member and the covered family members are eligible to receive health benefit coverage under the plan until the member reaches 65 years of age.

Example of a dollar and time maximum: A plan covers a plan member's prescription drugs up to $10,000 per calendar year.

Medical Services, Supplies and Equipment

The following medical services may be covered:

• private duty nursing,
• diagnostic procedures,
• medically necessary ambulance services,
• dental treatment for accidental injuries to teeth.

The following medical supplies and equipment may be covered:

• medically necessary equipment rentals such as wheelchairs and hospital beds,
• non-dental prostheses, supports and hearing aids,
• ileostomy, colostomy and incontinence supplies,
• medicated dressings, burn garments, oxygen.

See your benefit booklet for more information.

Occlusal Equilibriation

Occlusal equilibriation or occlusal adjustment is a procedure that involves reshaping the occlusal (biting) surfaces of teeth to create even contact between upper and lower teeth. The procedure is performed quadrant by quadrant (one section of the mouth at a time) and may require several appointments to fully equalibriate a patient's whole mouth.

Occupational Therapy

Occupational therapy is the therapeutic use of self-care, work, and play activities to increase independent function, enhance development, and prevent disability. This may include adaptation of tasks or environment to achieve maximum independence and to enhance quality of life. Manulife has basic and major categories of occupational therapy.

Check your benefit booklet to find out if your plan's coverage includes occupational therapy.

Open Space Limitation

The Open Space limitation may apply to certain dental procedures that use appliances to replace extracted teeth. When a dentist recommends placing a prosthodontic appliance – such as a bridge or a denture – as part of the patient's treatment plan, Manulife needs to know the extraction date for each tooth that the appliance will be replacing. If your plan includes this limitation, and any of the teeth involved were extracted before the patient became insured under the plan, Manulife will not pay for the treatment. Check your benefit booklet to see if your plan includes the Open Space limitation.

Oral Hygiene Instruction

Oral hygiene instruction provides information about how to brush, floss, and care for teeth.

Oral Surgery

This branch of dentistry deals with the surgical treatment of diseases or defects of the mouth. Manulife has two categories of oral surgery:

• Basic – Examples of basic services include tooth extractions and removal of cysts or tumors.
• Major – Examples of major services include transplanting erupted teeth and alveoplasty (reshaping and trimming the bone in an area where there are no teeth present).

Check your benefit booklet to find out if your plan's coverage includes both categories of oral surgery.

Orthodontics

This area of dentistry is concerned with the growth of the jaw, development of the bite, and correction of dental and facial abnormalities. Orthodontic treatment involves the placement of braces, retainers, and orthodontic appliances to eliminate dentofacial abnormalities in patients.

Orthotherapy

This system of medical practice is concerned with determining the nature of disorders based on an understanding of the functions of muscles and skeletal systems. Manulife has basic and major categories of orthotherapy.

Check your benefit booklet to find out if your plan's coverage includes orthotherapy.

Orthotics

These specialized devices can be inserted into footware to correct misalignments in a patient's gait. Orthotics must be prescribed by a medical doctor, chiropodist, or podiatrist.

Check your benefit booklet to find out if your plan's coverage includes orthotics.

Osteopathy

An osteopath treats impaired function within joints and tissue abnormalities.

Check your benefit booklet to find out if your plan's coverage includes osteopathy.

Periodontal Disease / Periodontitis

Periodontal disease is an advanced gum disease resulting in the deterioration of the supporting structures of the teeth.

Periodontal Appliance

Also known as a habit-breaking appliance, a periodontal appliance is designed for a patient who grinds or clenches his or her teeth. Using a periodontal appliance can relieve jaw pain and prevent further tooth damage.

Perio-scaling / Periodontal Scaling

Perio-scaling removes deposits of plaque, tartar, and food debris that have accumulated on teeth or beneath the gum tissue.

Pit and Fissure Sealants

Pit and fissure sealants are plastic coatings applied to grooves of molars to prevent decay.

Podiatrist

A podiatrist specializes in foot care and is licensed to prescribe medicine and perform surgery.

Check your benefit booklet to find out if your plan's coverage includes treatment by a podiatrist.

Polishing

Polishing a tooth's surface makes it smooth and therefore more difficult for plaque and debris to accumulate and cause decay or gum disease.

Pre-determination of Benefits

When a proposed course of dental treatment is expected to cost more than $300, a treatment plan should be filed in advance with Manulife. The dentist outlines the treatment plan, and Manulife issues an Explanation of Benefits (EOB) to the plan member describing the exact amount covered by the benefit plan for the treatment.

This provision is a service feature allowing the plan member to make an informed decision before proceeding with an expensive dental procedure. If a plan member does not have his or her dentist submit the treatment plan, this will not compromise or invalidate the eligibility of the claim. However, only eligible expenses will be reimbursed as defined in the plan.

Preventative Services

Preventative services are dental procedures and actions that keep your teeth healthy and prevent disease and decay. Regular dental examinations and oral hygine instruction are examples of preventative services.

Professional Services

The following professional services may be covered depending on your plan:

• chiropractors
• osteopaths
• podiatrists
• massage therapists
• naturopaths
• speech therapists
• physiotherapists
• psychologists.

Professional services can be subject to calendar year maximums for each practitioner, as well as reasonable and customary dollar maximums per visit.

For a professional services claim to be eligible for coverage, the following requirements must be met:

• the practitioner must be licensed in his or her field; and
• in most provinces, the overall maximum benefit (per visit and yearly maximum) under the provincial plan has been paid.

Note: Referral to a practitioner by a physician may be required. See your benefit booklet for the complete list of professional services covered under your plan.

Prophylaxis

Prophylaxis is cleaning your teeth.

Prosthetic

A dental prosthetic is an appliance that replaces missing teeth. Manulife has two categories of prosthetics: Basic and Major.

Prosthodontics

This branch of dentistry is concerned with replacing missing teeth and surrounding tissue using an artificial appliance, The appliance could either be fixed – like a bridge – or removable like a denture. Manulife has two categories of prosthodontic services:

• Basic – Relining, Rebasing, or Repairing of a Denture
• Major – Bridgework, Denture (partials and complete)

Check your benefit booklet to find out if your plan's coverage includes both categories of prosthodontics.

Reasonable and Customary (R&C)

A fee is reasonable and customary if its dollar value falls within the usual range of charges for the same or comparable services (or supplies) made by similar practitioners in an area.

Example:

The fee a dentist in Ontario charges for a check-up is reasonable and customary if it is within the range of fees that Manulife deems reasonable, based on information from the Ontario Dental Association.

Restorative

Restorative services are provided to repair and restore natural teeth to their normal function. Manulife has two categories of restorative services:

• Basic – An example of a basic restorative service is a filling.
• Major – Examples of major restorative services are inlays, onlays and crowns.

Check your benefit booklet to find out if your plan's coverage includes both restorative service categories.

Root Canal Treatment

A root canal treatment is a method of saving a tooth by cleaning out a damaged nerve within a root and filling in the resulting chamber.

Space Maintainers

A space maintainer is a dental device used to maintain a space in your mouth. A space maintainer may be used when a baby tooth is lost. The device holds a space in your mouth until a permanent tooth comes in to fill that space.

Spouse

A spouse is a plan member's legal spouse or a person living with the plan member in a role like that of a marriage partner.

Temporary crown

A temporary crown is made of metal, acrylic, or plastic, and is used over a prepared tooth until a permanent crown can be placed.

Veneer

Veneers are thin sheets of porcelain which are bonded onto the front side of teeth to make a cosmetic improvement in their appearance. Veneers can repair teeth that are stained, worn, chipped or slightly misaligned.

X-rays, Radiographs or Diagnostic Imaging