Question

Fryda has dental coverage under her extended health coverage. Her plan covers 80% for regular maintenance, 50% for restorative procedures, and no coverage for cosmetic procedures. Fryda goes to the dentist for a regular check-up and cleaning. During the visit, the dentist discovers that Fryda has a cracked molar. A second visit is scheduled and Fryda’s cracked molar is extracted. Fryda then returns for several visits over the year to have a dental implant put in to replace her extracted molar. The total cost of her dental work is $4,525: $150 for the check-up and cleaning, $875 for the molar extraction, and $3,500 for the dental implant. If the provincial dental schedule sets the price of extractions at $750 and her dental plan considers the dental implant cosmetic, what is the total amount of Fryda’s dental work that will be covered under her extended health coverage?
a)		$495
b)		$720
c)		$1,025
d)		$2,245

Answer 1

The expenses are:

1) $150 - Check up and Cleaning - Considered as maintenance - of this 80% is eligible.

2) $875 - Extraction - Considered as restorative procedure - even though $875 was actual for insurance only $750 as per schedule will be considered - of this only 50% is eligible

3) $3500 - Implant - Considered as Cosmetic - not covered or 0% of this is eligible.

Total amount covered = (150× 80%) + (750×50%) + (3500×0%)

= 120 + 375 + 0

= $ 495

Hence, a) $495 is the