Orthodontic treatment is the diagnosis and correction of teeth irregularities and malocclusion of jaws, by wire appliances, braces or other mechanical aids, also known as straightening of the teeth. This includes active space retainers or orthodontic appliances used to reposition or move teeth.
It applies to children who are at least 6 years old but not yet age 18 at time treatment commences.
There is a lifetime maximum benefit of $3,000 per individual for Orthodontic coverage.
Charges for the following services provided by an orthodontist are eligible
- Orthodontic examinations and records
- Removable or cemented appliances for active treatment or retention Fixed appliances (braces)
Reimbursement for Orthodontic Services
The payment of orthodontic claims will be made according to one of the following methods:
- If a single charge is estimated for the entire course of treatment and you pay this charge to the orthodontist in pre-arranged instalments over an estimated period of treatment, the Plan will reimburse you each time you submit a receipt for any pre-arranged instalment.
- If a single charge is estimated for the entire course of treatment and you pay this charge to the orthodontist in one lump sum, the Plan will will reimburse up to 1/3 of the total cost initially and equal payments thereafter over the entire treatment period.
- If instead of a single charge, each treatment is charged as it is performed; the Plan will reimburse you as each charge is incurred. Any variation in the actual billing procedure of the orthodontist and the reimbursement from the Plan must be arranged between the member and the orthodontist.
You must remain covered under the Plan throughout the treatment period for the Plan to continue to reimburse orthodontic expenses.