The Canadian Guide to Green Shield Dental Insurance

Every year, Canadians spend approximately $12 billion on dental services.

62% of Canadians have private dental insurance to help cover those dental care costs. Green Shield Dental is one of the most popular providers of private dental insurance in Canada.

If you're among the 32% of Canadians that don't have dental insurance, Green Shield Dental can provide the coverage you need. And if you already have dental insurance, we'll help you understand how Green Shield Dental works.

Keep reading to learn more.

Who Is Green Shield?

Green Shield has been providing private dental and health insurance to Canadians since 1957. They're a not-for-profit provider that works through employee benefits programs as well as individual plans.

Terms to Know

Reading through your coverage can be confusing. Below we've listed the terms you should know.

• Benefit year. The 12 consecutive months between April 1 and March 31.
• The calendar year. The 12 consecutive months between January 1 and December 31.
• Plan member. The person enrolled for coverage,
• Covered person. The plan member enrolled in the benefits plan as well as the dependents who are enrolled under the plan member.
• Dependents. Includes spouses, children (usually under 21 years old), and relatives that are dependent on you for support.
• Co-pay. The amount paid by you or your dependents before you receive reimbursement.
• Deductible. The amount paid by you in any benefit year before you qualify for reimbursement.
• Emergency. Defined by an occurrence such as disease or injury that requires immediate attention.
• Injury. An unexpected event resulting from a violent, sudden, or unexpected action from an outside source.
• First paid claim. The date you receive service for an initial or prior claim paid by Green Shield Dental.
• Rendered amount. The amount a provider has charged you for a service.

Know these terms before reading through your coverage. It will help you understand who is covered and how your coverage works.

What's Covered by Green Shield Dental?

Your employer determines what you're covered for. That includes your eligibility, the dollar amounts, and the frequency limitations.

All of this is outlined in your employer's master contract with Green Shield. But we've included some of the basic service plans you might expect to be covered for. These are also available under individual plans.

Basic Services

This includes the basic diagnostic and preventative services offered by a dentist. Below is a more detailed list of what you are likely covered for:

• Oral examination
• Emergency examinations
• X-rays
• Teeth cleaning
• Flouride
• Space Maintainers

Basic Restorative Services

Restorations services may also be covered by your basic services plan. This includes:

• Amalgam
• Temporary sedative fillings
• Tooth coloured filling restorations
• Inlay restorations

Basic Oral Surgery

Sometimes, basic oral surgery is covered by your dental insurance. If you have to have teeth extracted, you might be covered. That also includes residual roots from previous oral surgery.

Usually, your dental insurance will cover the anesthesia involved in sedating you for oral surgery as well.

Denture Services

For those with dentures, some dental insurance plans will cover your care. This can include:

• Repairing your dentures
• Adding tooth or teeth
• Relining and rebasing your dentures
• Denture adjustments
• Conditioning of the soft tissue and gums
• Partial remakes of dentures (with an existing framework)

Your Benefit Booklet

Your benefits booklet explains everything that you're covered for in more detail. Your coverage might not include all of the above.

It might also include more than what's listed here. Be sure to reference your booklet before booking any procedures or treatments that you're not covered for.

Beyond Group Coverage

If you're not covered by your employer or if you're losing the coverage provided by your employer, you may consider investing in private dental insurance.

For those who were previously covered under an employer, you qualify for a guaranteed issue plan. That means that you qualify for coverage without having to fill out a medical questionnaire. Be sure to apply within 60 days of losing employer coverage to be eligible.

When purchasing Green Shield dental privately, you have 2 options. You can purchase directly from Green Shield or you can work with an advisor.

If you'd like to purchase from Green Shield, you can use their SureHealth program. These economical plans cover both health and dental insurance. There's a variety of coverage options in this direct-to-consumer service.

An advisor can help you shop around as well. Green Shield partners with advisors to offer individual products based on your needs. Instead of shopping around, an advisor can make suggestions based on the information you provide.

Eligibility

If you're looking to purchase private dental insurance, you must meet the minimum eligibility requirements.

Eligible persons must be residents of Canada. For your dependents to be eligible, you must be covered before they receive any treatment.

If you're covered by an employer, you typically need to complete a probation period before you're covered. This period is usually 6 months after continuous employment. You and your dependents are covered as soon as you've completed this period.

ID Cards

Your identification card is an important part of your insurance coverage. You'll need the Green Shield Identification Number that's displayed on your card in order to make your claims. You'll also need it when corresponding with Green Shield.

You can find your ID Number underneath your name on the front of your ID card. Your ID number will end with -00.

As for any dependents that are covered under your plan, they also have a unique ID Number. These are on the backside of your card. Each dependent will have its own code for claims and correspondence.

If you notice that there are errors or omissions on your card, you should have these fixed immediately. Your benefits administrator can fix those errors for you so you and your dependents don't have issues when making claims.

When you lose your ID card, you can replace it easily. Make sure you register for online services - this allows you to print a card right away. You will also have an electronic version of your card if you download the Green Shield on the Go app.

Submitting a Green Shield Dental Claim

When submitting a claim to Green Shield dental, you need to include the name and signature of the plan member as well as the name of the patient who was treated. You'll also need your ID Number, which we'll talk more about below.

Be sure you include proof of payment. Retain your receipt in order to confirm how much you paid and when you paid it.

You're only eligible for coverage within 12 months of the treatment. Send your claims in right away to ensure you receive your reimbursement.

You can expect the claim to be processed within 4 business days of Green Shield receiving your information. If you're submitting a claim online and have direct deposit, you'll receive an email when the claim has been processed. Otherwise, a cheque will be sent within 2 days of Green Shield processing your claim.

Direct Deposit and Payment

You can receive payment for your claims by direct deposit. Direct deposit means that payments will be made directly into your bank account or the account that you have chosen. You can then view statements online but will not be able to access them via conventional mailing methods.

To make life easier, you can also sign up to have Green Shield pay your provider directly. Talk to your provider about billing Green Shield directly. That means no more claim forms and (potentially) not more paying out of your own pocket.

Pre-Authorization

Outside of basic services, you may require more extensive dental treatment. When the cost of these treatments is expected to exceed $300, you should talk to Green Shield in advance.

Before receiving any treatment costing over $300, submit a treatment plan to Green Shield. Your service provider can give you the detail of your treatment plan. If you don't do this, you might not be covered and could end up paying for your treatment out of your own pocket.

Online Services

The internet makes accessing your coverage and submitting your claims far easier. Green Shield has a secure website that gives you access to a number of time-saving benefits.

This includes:

• Accessing your benefit plan booklet
• Accessing your ID number and the ID Number's of dependents
• Personalized claim forms for printing
• Claim history information for you and your dependents
• Claim history for your tax deductions
• Claim history for coordinating multiple benefits programs
• Eligibility information

To access these services, all you need to do is register.

More On Dental Insurance

Your oral health has a significant impact on your overall health. Yet 6 million Canadians every year avoid going to the dentist because of the costs.

Green Shield dental offers dental coverage through employers as well as individual plans. They help you offset the costs of your dental care so you can get the treatment you need when you need it.

For more information on dental insurance, check out our blog for advice and tips.