7B.2. Emergency Dental Coverage for Adults

POLICY  

Authority OW Act: Sec. 8 and 74(4) & OW Directives: Dir. 7.2 

Emergency is defined as being an unscheduled event where an individual appears in immediate distress requires care, and immediate appropriate treatment is needed to correct the problem. 

The Director of Integrated Social Services may approve costs for dental services provided to adult members of the benefit unit for: 

• emergency dental care (i.e., dental services which are necessary to relieve pain or for medical or therapeutic reasons); 
• dental care which supports the person’s employability or participation requirements (e.g., orthodontic and denture services); 
• Any exceptional circumstances where deemed medically necessary at the discretion of the Director of Integrated Social Services taking into consideration the Health and Welfare of the individual. 

This service is available to participants and beneficiaries who are not dependent children. Dental coverage for dependent children is a mandatory item of assistance under OW. (See Section 12-10 on Dental Coverage for Dependents)
 

PROCEDURE

Participants/dependent adults are not to be charged for services under the plan. However, they may be charged for services not covered under the dental plan. 

According to the contract, the participant/dependent adult is to have the Emergency Dental Card in their possession when they go for treatment and must present the card to the dentist before any services are performed. In exceptional circumstances a faxed dental card may be used, the original will be mailed where required. Dental Cards for adults and children are now part of the monthly OW cheque. The Dental card attached to the monthly cheque will include the names of all family members who are eligible for benefits. Adults requiring emergency dental work can simply bring the dental card, which is attached to their monthly cheque, to a dental office.

The Dental office will determine if the procedure required is covered by the card. The dental card is valid for one month only.