Orthodontics is different from dental care.
Dental care provides general dental and oral health care by a dentist or dental hygienist. A dentist diagnosis and treats dental problems and diseases affecting your teeth and gums.
Orthodontics is a branch of dentistry that specializes in the practice of straightening misaligned teeth or facial irregularities, also known as malocclusions.
One of the common benefits of orthodontic care is straightened teeth through the use of braces.
According to the Canadian Association of Orthodontics, more than four million people in Canada and the U.S. are in the care of an orthodontist – with one in every four brace-wearers over the age of 21.
Although orthodontics can improve your smile and overall oral health, it can be a lengthy and costly process.
What you need to know
Before you spend your money on expensive orthodontics, we encourage you to:
Check your benefits booklet for full details about your orthodontic coverage under your Employee Life and Health Trust (ELHT) benefits plan.
Take the time to do some comparison shopping. Not all orthodontic specialists charge the same amount. You can reduce your out-of-pocket expenses by requesting quotes for costs of treatments and services.
Get an estimate or pre-determination before paying out-of-pocket for claims. An estimate or pre-determination will prevent any unnecessary hardships for out-of-pocket expenses. The submission of a pre-determination, or pre-treatment plan, includes you being asked to provide:
Type of malocclusion and class
Duration of orthodontic treatment
Breakdown of fees and payment plan
Keep copies of all claim receipts if you are submitting claim(s) online in case of audit. NOTE: Each orthodontic appointment is considered a service. All claims must be received within 12 months of the date of service.
Thinking of making a lump sum payment? Check to ensure your benefits coverage is not ending in the near future or that your plan allows for lump sum payments. Some plans will advise you that lump sum reimbursement is not available and payment will be based on a treatment plan and monthly fees.
Questions? We’re here to help. To learn more about orthodontic care options under your ELHT benefits plan, check your benefits booklet. You can also visit the OTIP Help Centre or call OTIP Benefits Services at 1-866-783-6847.