Dental Policy Framework

Version 1 - October 2005

Help on accessing alternative formats, such as Portable Document Format (PDF), Microsoft Word and PowerPoint (PPT) files, can be obtained in the alternate format help section.

---

This document provides important information about the dental benefits available under the Non-Insured Health Benefits (NIHB) Program.

Table of Contents

Introduction

1. General Principles
   
   
2. Benefit Description and Conditions
   
   
   • NIHB Regional Dental Grid
   • Terms and Conditions of Services
     • Diagnostic Services
     • Preventive Services
     • Restorative Services
     • Endodontics
     • Periodontics
     • Prosthodontics
       • Non-Inserted Denture Policy
       • Prosthodontics - Removable
       • Maryland Bridge Policy
       • Prosthodontics - Fixed
     • Oral Surgery
     • Orthodontics
     • Adjunctive services
       • General Anaesthesia and Facility Claims
       • Intravenous or Inhalation Sedation
         
         
3. Policies
   
   
   • Crown Policy
   • Endodontic Policy
   • Periodontic Policy
   • Periodontic Policy - Québec Region
   • Orthodontic Policy
     
     
4. Predetermination
   
   
   • Predetermination
   • Preverification
     
     
5. Payment and Reimbursement
   
   
   • Claims Payment Policy
   • Client Reimbursement Policy
   • Coordination of Benefits Policy
   • Electronic Data Interchange (EDI)
     
     
6. Exceptions
   
   
7. Exclusions
   

Appendix A - Definitions

Appendix B - Client Eligibility

Appendix C - Privacy

Appendix D - Appeal Process

Appendix E - NIHB Audit Program