Considering orthodontics? Here’s what you need to know.
March 17, 2023
Teen boy with braces.
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 using braces.
While orthodontics may be necessary and improve overall oral health, it’s important to note that the treatment can be lengthy and expensive.
What you need to know
Before you spend your money on expensive orthodontics, we encourage you 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 beginning expensive treatments and paying out-of-pocket for claims. An estimate or pre-determination will prevent any unnecessary hardships from out-of-pocket expenses. When you submit a pre-determination or pre-treatment plan, you will be 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. Each orthodontic appointment is considered a service. All claims must be received within 12 months of the date of service, or 90 days from the termination of a plan member’s dental benefit coverage.
- Coordinate your benefits. In families with two working adults, you may have access to more than one benefits plan. The two plans can be coordinated to share the responsibility of paying for eligible health and dental expenses, like orthodontics. Benefits are coordinated between the two plans to ensure that you receive reimbursement for up to 100% of your eligible expenses.
- IMPORTANT: Your ETFO ELHT benefits plan does not allow for lump sum reimbursements of orthodontic services. Reimbursements for orthodontic services will be paid on a monthly/quarterly basis as services are rendered, provided you have eligible dental coverage.
- Check your benefits booklet for full details about your orthodontic coverage under your plan.
To learn more about orthodontic care options under your ETFO ELHT benefits plan, check your benefits booklet. You can also visit the OTIP Help Centre for answers to common questions, such as how to submit a pre-determination.
Questions? If you have additional questions about your orthodontic coverage, contact OTIP Benefits Services at 1-866-783-6847.