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Understanding Your Dental Benefits



In Ontario, dental benefit plans come in various forms, each with its unique nuances. Understanding these plans is essential for maximizing your benefits and maintaining great oral health without unnecessary expenses. In this blog post, we'll explore the key points you need to know about dental benefit plans. Read on to ensure you make the most of your coverage and keep your oral health in top shape.


1. Annual Expiration of Benefits:

  • Most dental benefit plans in Ontario expire annually.

  • Unused benefits do not carry over to the next year.

  • Typically, benefits expire on December 31st, so utilizing them before this deadline is crucial to avoid forfeiting them.

  • Being aware of this deadline is essential to use your coverage and maintain great oral health while spending less out of your pocket.


2. Understanding Your Plan:

  • To make informed decisions about your dental care, it is essential to understand your plan's coverage and limitations.

  • Obtain this information from your benefit provider or employer to effectively manage your dental benefits.

  • Does your benefit provider offer an app? If so, download the app to your phone and have as close to real-time information at your figure tips!

3. Payment Responsibility:

  • When visiting your dentist, you are responsible for handling the payment.

  • Some dental offices, like By The Lake Dental, offer the convenience of direct billing to your insurance as a courtesy service.

4. Co-Payment:

  • A co-payment represents the amount not covered by your insurance plan.

  • This can include an annual deductible, a percentage of coverage that is less than 100% or a plan that follows a fee guide not updated to the current year.

  • Understanding the co-payment amount is crucial, as it represents the portion of expense that is not reimbursed by your dental plan.

5. Treatment Based on Needs, Not Benefits:

  • Your dentist's treatment recommendations are based on your dental needs, not the extent of your benefits coverage.

6. Open Communication:

  • Do not hesitate to discuss treatment costs and plan coverage with your treatment coordinator. They can assist you in planning your treatment steps, costs and payment plans to maximize your benefits.


Benefit Plans and Their Expiration:

If you have dental benefits, it means that an insurance company is responsible for paying a certain portion of your dental treatment. Most dental benefit plans in Ontario follow a "use-it-or-lose-it" principle, with most benefits expiring at the end of each year. Remember: dental benefits are part of your compensation package and represent your hard-earned money. Therefore, it is crucial for you to understand and review your dental insurance benefit summary, to maximize your benefits and take care of your oral health before they expire.


Understanding Dental Plan Basics:

Your benefits are a contract between you, your employer, and the benefit company. Dental benefit plans are typically offered and chosen by employers and they contract with insurance providers, who act as plan administrators. These plans come with specific terms for reimbursement.


Dental Plans vs. Treatment Plans:

Dental plans and treatment plans serve different purposes. Dental plans define which treatments are eligible for reimbursement and are typically part of a benefits package. On the other hand, a treatment plan is a personalized strategy developed in collaboration with your dentist to address your oral health needs. It should not be restricted by what your dental plan covers.


Your Responsibilities:

It's crucial to understand the details of your dental plan, including coverage limits, deductibles, and co-payments. Insurance coverage is the responsibility of the patient. Dental offices are limited to the information insurance companies will share with the provider, due to privacy laws. Co-payment, also known as co-insurance, represents the portion of your dental expenses that your plan does not cover and, not paying it is considered insurance fraud. Your dental office may be not well-versed in your specific plan, so reading the materials provided by your benefits provider is essential.


Remember to update your dental office regarding any changes to your dental benefit policy, so they may process your claim on your behalf, in a timely manner. Ensure you inform your dental office if you've used benefits at another office within the same benefit year. This information is not provided to the dental office by your benefit provider and will affect your benefit maximums.


Your Dentist's Responsibilities:

Dentists tailor treatment plans based on your unique oral health needs, which may not always align perfectly with your plan's coverage. If your dental plan covers only part of your treatment plan, you'll be responsible for the remaining costs. Your dentist can guide you through your treatment plan, submit pre-treatment forms to your dental benefits administrator, and provide you with a "predetermination of benefits." This document outlines what services are covered and any limitations within your plan. However, it doesn't guarantee full coverage by your dental insurance plan. By The Lake Dental does its best to find out your insurance breakdown to help support and explain your benefits to you.


We can help to maximize your benefits and stay on top of your oral health. Book your appointment today and talk to our team.


By The Lake Dental offers:

✅ +10 years caring for our community’s oral health needs

✅ A Platinum Invisalign dental office

✅ Direct billing to benefit provider

✅ Cutting-edge technology

✅ Full service family care

✅ Concierge experience


𝗪𝗲´𝗿𝗲 𝗮𝗰𝗰𝗲𝗽𝘁𝗶𝗻𝗴 𝗡𝗘𝗪 𝗣𝗔𝗧𝗜𝗘𝗡𝗧𝗦


Call us today: Ajax 905-428-2111, Highland Creek 416-284-8282.



By The Lake Dental is a full service – ‘one-stop shop’ - dental experience, where you and your family will have your dream smile come true. Whatever your dental needs are, we will deliver the right treatment plan for you. For us every smile does matter and our dental team is able to take care of and transform every single one of them.

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