DENTAL
Dental benefits are determined on an individual basis, taking into consideration current oral status, past history, accumulated scientific research and availability of alternative treatment.
WHAT IS COVERED?
- Diagnostic Services
Examinations: Complete, Recall, Specific or Emergency
Up to 4 examinations per 12-month period for children ages 17 years and under
Up to 3 examinations for adults 18 years and older
Radiographs (X-ray):
6 intraoral x-rays in a 12-month period
2 Panoramic x-rays in a lifetime without predetermination.
- Preventative Services
Cleaning (scaling and root planing):
4 units per year for children ages 12 and oler, including adults
1 unit per year for children ages 11 years and under
Topical Floride:
2 per 12-month period for children ages 17 years and under
Sealants (Preventative resins):
Available for children ages 14 years and under if eligible
Polishing:
1 per 12-month period for children ages 17 years and older
2 per 12-month period for children 16 years and under
- Restorative Services
Fillings:
5 surfaces per tooth for amalgam and tooth colored fillings
Primary/Baby Teeth:
Maximum allowable cost for stainless steel crown
Replacement fillings:
If request is submitted within a 2-year period it will be under review
Retentive pins, cores and posts:
1 every 36 months
Requires predetermination
- Endodontics; Root Canal treatment
Predetermination is not required for front or anterior teeth
Predetermination is required for all other teeth including bicuspids and molars
Procedure requested must fall within the NIHB Endodontive Policy criteria
Primary/baby teeth (4 front teeth; top and bottom) are not eligible for pilpotomy and pulpectomy (open and drain) procedures
- Periodontics; Treatment for inflamed of diseased gums
Requires predetermination where surgery is necessary
Pediatric dentistry is a benefit for children
- Prosthodontics: Removable Dentures; Fixed Bridges
Predetermination required
Client is eligible for the benefit every 8 years
- Procedure includes 3 month Post-insertion care including adjustments and modifications
- For immediate dentures an additional reline is allowed
- Case-by-Case exceptions may be considered
- Oral Surgery
Uncomplicated extractions are part of basic treatment and do not require predetermination
Complicated or "surgical" extractions require predetermination
- Orthodontics: Braces
Client must fall within the clinical criteria established by the NIHB Program
- Provide written evidence of a functional handicap such as
Maloculusion: Over bite
Dento-Facial abnormalities: Cleft lip and palate
- Adjunctive Services: Sedation
Predetermination is required
Benefit is limited to children ages 12 and under
Case-by-Case exceptions may be considered for older children and adults based on written evidence from a licensed Dentist/Orthodontist or Specialist
WHAT'S NOT COVERED?
- Extensive rehabilitation
- Implants
- Prefabricated/Composite veneers
- Bleaching (whitening the surface of the tooth)
- Cosmetic/aesthetic treatment
- Ridge augmentation for denture fitting
- Any other products and services not listed as a benefit or considered as meically necessary
WHO CAN PRESCRIBE AND PROVIDE BENEFITS?
Only a licensed professional registered to practice in the Province they are located are located in may dispense their expertise in a specific area as follows:
- Dentist
- Dental Therapist
- Dental Hygienist
- Denturist
- Any dental personnel specializing in a specific area of expertise
HOW CAN YOU ACCESS THE BENEFIT?
- Make an appointment
- The Provider will assess your needs, inform you about the procedures required to complete the process and advise you about your options as necessary.
- When the assessment is completed, the provider will telephone Bigstone NIHB for eligibility.
- If the request has to be predetermined or prior approved, the Dental office sends ALL the necessary paperwork/documentation to our Consultant for review and recommendation.
- For Orthoontics, we send the paperwork/documentation to the Orthodontic Review Centre for review and revommendation.
- If the request has been approved our office will will process the clain for the payment
- Ir the request has been denied, our office will send the Dental Office a letter
WHAT ARE YOUR RESPONSIBILITIES?
- Floss and brush your teeth at least twice a day
- Visit your dentist regularly
- Attend all your scheduled dental appointment
- Inform the provider that you are a member of Bigstone Cree Nation
- Inform the provider if you have coverage under another health care insurance plan.
Other information available to you:
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Heather Yellowknee - Dental Health Benefits Clerk
heather.yellowknee@bigstonehealth.ca
Marie Cardinal - Dental Health Benefits Clerk
Bigstone Non-Insured Health Benefits
Toll Free: 1-866-891-9719
Local: 780-891-1000
Direct Line: 780-891-4168
Orthodontic Review Centre
General Inquiries: 1-866-227-0943
Dental Benefits Framework:
 Dental Framework.pdf
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