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Fact Sheets

The dental benefits plan co-payment.

Understanding your dental plan benefits will help you avoid surprise costs.

Pre-paid dental benefit plans are a valuable extended health benefit to offset some of the costs associated with dental care. Understanding your dental plan benefits in partnership with your dentist will help you avoid surprise costs.

What is the co-payment?
The co-payment is the difference between what your dental plan pays and what your dentist charges. Most dental plans cover a percentage of the cost of treatment. Regardless of the actual costs, dental plans may cover between 50% and 80% of the cost of dental care. Any portion not covered by the dental plan is called the co-payment and it is the patient's responsibility to pay the dentist this amount.

Can my dentist waive the co-payment?
Dentists and dental specialists are legally and ethically required to collect the co-payment from patients. When the dentist and patient sign the dental claim form they are confirming the treatment provided and the total fee charged to the patient.

Can I request that my dentist only provide care that's covered by my plan?
Your dentist or dental specialist is obligated to treat you, not your dental plan. Treatment recommendations are based on your dental health needs, which may differ widely from what your dental plan covers. You have the right to accept or refuse treatment but ensure you understand the implications of refusing or delaying any recommended treatment may have on your health. Base your decision on an informed discussion with your dentist around your dental needs as this decision can impact your health and should not be dictated by your dental plan benefits.

How much do I actually have to pay?
Benefits will vary based on the plan purchased for you by your union or employer (or yourself). Many plans cover the fee for dental exams, x-rays, cleanings, fillings and root canals at 80% and crowns, bridges, and dentures at 50%. Some plans might cover 100% of some treatment and 60% or 70% of other treatment. Some treatment may not be covered. The patient is responsible for all costs not covered by the dental plan benefits.

Know your dental plan benefits.
Your dentist can help you understand your benefits and assist you in getting pre-determination of benefits for your treatment. This will provide you with an estimate of what will be covered by your plan, and what you will have to pay— before the treatment starts.

As a convenience and a courtesy extended to trusted patients and reliable dental plan companies, some dental offices bill the dental plan directly for the covered portion of treatment. Dentists are not required to do this. The full cost of the procedure, including the co-payment, the deductible and the cost of any services not covered by the plan, are the patient's responsibility.

  • Know your dental plan benefits and what is covered before your dental appointment to understand your portion of costs.
  • Plan for the future. Consider all of your extended health costs when planning for your retirement.
  • Discuss all treatment options with your dentist to make an informed decision based on your dental health needs. Understand any health risks associated with delaying or refusing treatment

For more information talk to your dentist or visit www.ManitobaDentist.ca