Common Questions - Dental Care

Dental care coverage varies from plan to plan. All Dental Care plans have coverage for basic preventative/restorative treatment and the majority of our plans include benefits for major restorative treatment. Covered members with Plan 3 benefits also have orthodontic coverage.

Refer to your ASEBP ID card to determine what your level of Dental Care coverage is.

First check your ASEBP ID card. If you have Dental Care Plan 3, then you are covered for orthodontic treatment up to the applicable limits described in the Dental Care Benefit Guide.

For your spouse or dependent children to be eligible for this coverage as well, they have to be listed as dependents under your plan. You can confirm which family members are listed as dependents using your ASEBP ID card. Any family member listed on your ASEBP ID card is also eligible for your Dental Care benefits.

If you feel there is an error with your ASEBP ID card, contact a Benefit Specialist.

When we say a procedure is covered at 100%, we mean 100% of the ASEBP coverage allowed for that procedure based on the ASEBP Dental Benefit List and not necessarily 100% of the dentist's bill.

At this time, there is no set Dental Fee Guide for Alberta dentists to follow so each dentist sets his/her own rates.

Although some dentists may charge exactly what is set out in the ASEBP Dental Benefit List for a given procedure, others may charge more.

You can talk to your dentist to determine the total cost. In some cases, you may want to get a pre-determination done prior to treatment showing how much ASEBP will cover and how much you are expected to pay.

Don’t be afraid to ask your dental office if there will be any additional costs prior to your appointment. Remember, you are responsible for paying all costs over those allowed by your ASEBP coverage.

A pre-determination is a proposed course of treatment submitted to ASEBP by your dentist or orthodontist to determine allowable procedures, eligible amount payable, and the maximum allowance for the calendar year (January to December).

We recommend you submit a dental pre-determination well in advance of any proposed treatment if the estimated cost is $500 or more.

Pre-determinations for amounts less than $500 are only accepted if the dentist or orthodontist submits them electronically.

For more information about predeterminations, see the "Predetermination" section of the Dental Care Benefit Guide.

Yes, your dentist or orthodontist must submit a pre-determination to ASEBP prior to the start of treatment for you to be eligible for reimbursement.

With the exception of the initial examination and diagnostic procedures, ASEBP does not reimburse for orthodontic services until the treatment plan has been approved.

For more information about orthodontic predeterminations, see the "Predetermination" section of the Dental Care Benefit Guide.

No, ASEBP does not pay for services in advance. You must submit a claim after the service has been rendered to receive any reimbursement from ASEBP.

When submitting your claim, you must include any other coverage held by a spouse or dependents, the name of the other carrier, and all individual identification numbers.

Your dental care benefit provider is always considered your prime (first) payer and your spouse's carrier is your secondary coverage.

The primary carrier for your children is determined by the birth date of the parent who is born first in the year (regardless of any age difference). If the father is born in February and the mother is born in July, the prime carrier for the children is the father's benefit plan.

Attach the "Explanation of Benefits" form which indicates the amount(s) already paid by the other carrier to your completed ASEBP Dental Care Claim form.

Yes, your dental coverage remains the same if you travel outside Alberta but stay within Canada.

If you travel outside Canada, you are covered for emergency services only. Please ensure all claim forms are filled out in English and you include an interpretation of the emergency and any necessary treatment in writing.

Dental plans with major restorative coverage reimburse at 50% of the ASEBP Dental Benefit List fees. Examples of some major restorative treatments are crowns, bridges, dentures, and implants.

As major restorative services are only partially covered by ASEBP, dental pre-determinations are recommended for services over $500.