Eligible expenses are those which are recommended as necessary by a physician or dentist and are based on the 2020 Newfoundland and Labrador Dental Association Suggested Fee Guide.
Starting in January 2021, in situations where Dental Offices charge more than the 2020 Newfoundland and Labrador Dental Association suggested fees for services (e.g. 2021 suggested fees) the teacher portion of the cost will increase as the NLTA Dental program will only pay 80% of the 2020 suggested fee.
Situations may arise where alternate methods of treatment may be available. The insured and their dentist may decide which method will be used. However, the underwriter reserves the right to use the least expensive method of treatment that will provide a professionally adequate result as the basis for determining the eligible expense. It is recommended that insured members obtain a pre-determination of eligible expenses from the Plan Administrator, Johnson Inc.
(Pre-determination of eligible expenses recommended)
A treatment plan is a plan of dental treatment (including x-rays if required) showing the patient’s dental needs, a written description of the proposed treatment necessary in the professional judgement of the dentist and the cost of the proposed treatment. The insured member should submit a copy of the treatment plan to the Plan Administrator, Johnson Inc., who will provide a pre-determination of eligible expenses covered under the plan, and the amount payable by the member in excess of the plan’s coverage. This treatment plan identifies coverage and limitations for specific services. It also clarifies insurance percentages, specific limits and the Dental Fee Guide allowance, before dental treatment commences. The treatment plan is not intended to limit a member in their choice of dentist or to tell the member or the dentist what treatment should be performed. The intent is to avoid any misunderstanding as to the extent of coverage.