Orthodontic coverage includes diagnostic services and treatment such as orthodontic examinations, diagnostic casts and diagnostic photographs, and fixed and removable appliances for orthodontic treatment. It also includes related charges for observations, adjustments, repairs, alterations, removal and retention.
The benefit has a 50% reimbursement level for eligible expenses to a maximum of $2,000 per person’s lifetime. This maximum is separate form the annual plan maximum of $3,000 per calendar year per insured, for the basic and major dental services.
Orthodontic treatment that commences prior to the effective date is eligible for consideration.
Ex. If treatment commenced in January and the claimant was in arrears with the payments to the dentist in July, no part of the expense associated with the claim that is attributed to June 30th or earlier would be considered.
Note: Great-West Life will not pay for any expenses unless a treatment plan is submitted.
A treatment plan outlines the course of treatment, as well as the total cost and length of time the orthodontist anticipates the treatment will continue for. This must be on file prior to Great-West Life paying for the initial down payment and monthly fees.
At the time the treatment plan is reviewed, a letter is sent to the employee approving the treatment and costing associated with the claim, along with outlining limitations of the plan (coinsurance and maximums).
If an employee/dependant is already receiving orthodontic treatment, an orthodontic treatment plan must still be submitted to Great-West Life for reimbursement.