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How does dental insurance define 'missing teeth' and why does that matter?
How does dental insurance define 'missing teeth' and why does that matter?

Here we explain what is meant by 'missing teeth' and how that may impact your coverage

Chris avatar
Written by Chris
Updated over 10 months ago

Defining missing teeth

When purchasing the Advanced dental plan, one of the questions you are asked is "Do you have any permanent teeth missing that have not been replaced?". This is an important question to answer correctly when signing up, as it may impact your eligibility and coverage for procedures related to tooth replacement.

We define missing teeth as any adult teeth that have been completely and permanently extracted, and not replaced by an implant or other prosthesis. Wisdom teeth do not fall into this category, so if you had those removed, you do not need to count them as missing. Damaged teeth that have yet to be fully removed also would not count as missing teeth.

Why this matters

Our Advanced plan offers benefits for tooth replacement procedures, which includes implants, bridges, crowns, onlays, inlays, and medically necessary veneers. There is a combined yearly reimbursable limit for this type of work. Your yearly limit is based on the amount of missing teeth you have (when purchasing the policy) and how many calendar years you've held the policy:

Those with 4 or more missing teeth are ineligible for the Advanced plan. You will likely still receive benefits for tooth replacement from your statutory health provider, though that coverage is likely very limited. In this case, your best option is to purchase a Basic dental plan. Since the Basic plan does not offer benefits for tooth replacement, missing teeth does not impact the plan's eligibility or coverage.

If you are unsure if you should count something as a missing tooth or not, or have questions about coverage, we recommend booking a call with one of our dental experts to discuss your situation before purchasing the policy.

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