A dental insurance policy will typically become effective on the first day of the month following payment. If you are setting up a plan very close to the end of the month, it could potentially be issued a month later.
To be eligible for a health and dental insurance plan in Ontario, one must:
- Be covered under your provincial/territorial health insurance plan, such as OHIP;
- Be a resident of Canada; and
- Be at least 18 years of age on the date of the application for the policy, unless you are a dependent child of a plan member
Anniversary year means the consecutive twelve (12) month period following the effective date of the policy, and each twelve (12) month period thereafter.
Benefit year means the consecutive twelve (12) month period following the date a claim is incurred. It can also be defined as the twelve (12) consecutive months commencing on the effective date of coverage, and each twelve (12) month period thereafter.
Calendar year means the twelve (12) month period commencing January 1st and ending on December 31st.
Dentist or Denturist:
A Dentist or Denturist means a practitioner of dentistry lawfully qualified and licensed to practice in the jurisdiction in which he or she has provided the services or supplies for which the charges are incurred.
Eligible expenses are expense incurred by an insured that are payable by the insurer based on the provisions, terms limitations and exclusions of their own specific policy.
The effective date is the day on which coverage under your insurance contract takes effect.
A government plan is any plan or arrangement provided by or under the administrative supervision of any government or agency which provides coverage or reimbursement for any health care service or supply, including but not limited to the Ontario Health Insurance Plan, home care program, assistive devices program or workplace safety and insurance board or tribunal of the covered person’s province of residence.
Medically necessary means a treatment, service or supply which is generally accepted by the medical profession as essential, effective, and appropriate in the care and treatment of a medical condition, sickness, or injury.
A spouse is a person who is covered under a government health insurance program (“OHIP”) and to whom the insured is legally married or with whom has cohabited in a conjugal relationship for at least 12 consecutive months (common-law).
Usual, Reasonable, and Customary:
Usual, reasonable, and customary means, in relation to charges, the usual charge for a service given or supplied by a provider (“usual”); those charges which are consistent with representative fees and prices which would normally be made in the absence of coverage under your insurance policy (“reasonable”); and that range of usual charges by providers with similar expertise and services with the geographic area (“customary”).
A dependent is a child of the insured who is listed on their application and who is a natural child, adopted child, stepchild, foster child, or a child for whom the insured is by law responsible, who is unmarried, unemployed, and dependent on the insured for financial support and is under 21 years of age.
This article is simply a guide and we hope that is of help to you, but one must always refer to their actual insurance policy wording. If you are unsure, please consult the appropriate professional regarding your specific questions.