Dental Insurance

Dental Insurance

Some plans offer dental coverage, and others do not. The Bulletin MÉDIC Construction for each plan gives a short description of coverages offered and amounts that may be reimbursed. Specific conditions, limitations, or exclusions may apply to reimbursement of some coverage. Only the Règlement sur les régimes complémentaires d'avantages sociaux dans l'industrie de la construction has legal force. Amounts reimbursed are limited to those set in the “Guide des tarifs et nomenclature des actes buccodentaires” published by the Association des chirurgiens dentistes du Québec and in the “Guide des tarifs courants" published by the Association des denturologistes du Québec.
  • Diagnosis and Prevention
  • Minor Treatments
  • Endodontics and Periodontics
  • Major Restoration
  • Orthodontics
  • Non-reimbursable Care
  • Reimbursement

The reimbursement for basic dental care (diagnosis, prevention, and minor treatments) is limited to a maximum of $600 per person (insured person, spouse, or dependent child aged under 21 years) per insurance period for all plans offering this coverage (basicsupplementary, or retirees’ plan). To find out the refundable amount for different treatments, especially if their cost is over $500, it is recommended that you submit a treatment plan (cost estimate) to MÉDIC Construction. The amounts are limited according to the rates set in the “Guide des tarifs et nomenclature des actes buccodentaires” published by the Association des chirurgiens dentistes du Québec and in the Guide des tarifs courants of the Association des denturologistes du Québec.

Coverage for dental care includes the following:

  • Complete oral examination (once every 36 months*)
  • Recall oral exam, including x-ray and cleaning performed during the examination (maximum once every 9 months*)
  • Certain special examinations (maximum once every 12 months*)
  • Emergency examination with specific diagnosis
  • Interproximal x-rays (maximum once every 12 months*)
  • Panoramic x-rays (maximum once every 60 months*)
  • Fluoride application (patient aged under 16 years; maximum once every 9 months*)
  • Installation of space maintainers following premature loss of primary teeth (baby teeth) and installation of apparatuses to correct harmful habits
  • Polishing of the tooth crown (prophylaxis) (maximum once every 9 months*)
  • Consultations required by the attending dental surgeon
  • Certain examinations, lab tests, and x-rays for diagnostic purposes (except during complete or recall oral exams)
  • Bacteriological test (maximum once every 12 months*)
  • Diagnostic waxing (except for cosmetic purposes)
  • Application of sealing material to pits and fissures on permanent teeth (patient aged under 16 years; maximum once per tooth)

* Example of calculation of treatment frequency:

  • If the treatment frequency is 9 months, the person must not have received the same treatment over the 9 preceding months to have the right to a reimbursement. For example, to obtain a reimbursement for a dental exam received on August 15, 2019 the person must not have had such an exam since November 15, 2018.

The Bulletin MÉDIC Construction for each plan gives the reimbursable amounts.

Specific conditions, limitations, and exclusions other than those mentioned above may apply to the reimbursement of certain types of coverage; only the Règlement sur les régimes complémentaires d'avantages sociaux dans l'industrie de la construction has legal value.

The reimbursement for basic dental care (diagnosis, prevention, and minor treatments) for all insureds with this coverage is limited to a maximum of 600 $ per person (insured person, spouse, and dependent child aged under 21 years) per insurance period for all plans (basicsupplementary, and retirees insurance plan). To find out the refundable amount for different treatments, especially if their cost is over $500, it is recommended that you submit a treatment plan (cost estimate) to MÉDIC Construction. The amounts are limited according to the rates set in the “Guide des tarifs et nomenclature des actes buccodentaires” published by the Association des chirurgiens dentistes du Québec and in the Guide des tarifs courants of the Association des denturologistes du Québec.

Coverage for dental care includes the following minor treatments:

  • Amalgam or composite fillings and retentive pins. The eligible expenses are limited to the usual and customary cost for this kind of dental care. Exception: for a child under 10 years of ageMÉDIC Construction does not reimburse amalgam fillings (grey fillings), because they are reimbursable by the RAMQ
  • Simple or complex extraction of teeth and roots
  • Surgical treatments such as alveolectomy, alveoloplasty, osteoplasty, tuberplasty, ablation of hyperplasic tissue, and frenectomy
  • Surgical ablations of tumours, cysts, and neoplasms, including incision and drainage of abscesses
  • General anaesthesia for dental surgery (maximum $300 per session)

Specific conditions, limitations, and exclusions other than those mentioned above may apply to the reimbursement of certain types of coverage; only the Règlement sur les régimes complémentaires d'avantages sociaux dans l'industrie de la construction has legal value.

The reimbursement for all periodontics and endodontics is limited to a maximum that varies according to the insurance planTo find out the refundable amount for different treatments, especially if their cost is over $500, it is recommended that you submit a treatment plan (cost estimate) to MÉDIC Construction. The amounts are limited according to the rates set in the “Guide des tarifs et nomenclature des actes buccodentaires” published by the Association des chirurgiens dentistes du Québec and in the Guide des tarifs courants of the Association des denturologistes du Québec.

Coverage for dental care includes the following:

  • Root canal treatments
  • Endodontic surgery
  • Scaling of teeth (maximum 4 time units per 4 months*)
  • Treatment for gum disease (maximum 1 treatment per tooth every 60 months*)
  • Occlusal adjustment (maximum once a year* for minor treatments and once every 5 years* for major treatments)
  • Gingival curettage and surfacing (maximum 1 treatment per tooth per 60 months*)

*For an example showing how the frequency of reimbursement is calculated, see the Diagnosis and Prevention section.

Specific conditions, limitations, and exclusions other than those mentioned above may apply to the reimbursement of certain types of coverage; only the Règlement sur les régimes complémentaires d'avantages sociaux dans l'industrie de la construction has legal value.

Reimbursement for major restorations is limited to a maximum that varies depending on the insurance plan. The amounts are limited according to the rates set in the “Guide des tarifs et nomenclature des actes buccodentaires” published by the Association des chirurgiens dentistes du Québec and in the Guide des tarifs courants of the Association des denturologistes du Québec. Major restorations are not reimbursed by all plans. To find out the refundable amount for different treatments, especially if their cost is over $500, it is recommended that you submit a treatment plan (cost estimate) to MÉDIC Construction. The employee then receives a letter from MÉDIC Construction containing information on the amount that may be reimbursed. Under certain conditions, the MEDIC Construction card can be use to pay the major restoration expenses.

Coverage for dental care includes the following:

  • Veneers and inlays or onlays in porcelain, resin, ceramic or, if such restoration cannot be done with other substances, gold; the replacement of these elements only if they have been in place at least 5 years
  • Initial installation of a complete or partial removable prosthesis (denture) provided that it is permanent, and of a transitional or immediate denture following an extraction
  • Initial installation of a fixed prosthesis supported by natural teeth (bridge, crown, cast element) provided the prosthesis is permanent and the installation is part of an extraction and replacement process within one year following the extraction. If the placement is done after this time period, the maximum reimbursement is the cost of a standard removable prosthesis per maxilla
  • Replacement of a permanent prosthesis identical to the one currently in the mouth, if this prosthesis has been in place for at least 5 years
  • Rebasing or repair of a permanent prosthesis as well as the addition of teeth or of a structure to a prosthesis
  • Initial installation, following congenital absence of a tooth, of a fixed permanent prosthesis
  • Laboratory fees up to 50% of eligible costs
  • Pipefitter's insurance plans AT, BT, RT1, and RT2 cover reimbursement of certain treatments related to dental implants. Consult the Bulletin MÉDIC Construction for more information

Specific conditions, limitations, and exclusions other than those mentionned above may apply to the reimbursement of certain types of coverage; only the Règlement sur les régimes complémentaires d'avantages sociaux dans l'industrie de la construction has legal value.

These treatments involve the use of apparatuses to correct an abnormal position of the teeth and jaws in order to prevent an anomaly or to prevent the appearance or deterioration of a malformation. Only dependent children under 21 years of age are covered.

The MÉDIC Construction card cannot be used for reimbursement of orthodontics costs. A treatment plan giving the date that treatment begins, its duration, and its cost must first be authorized by the Commission de la construction du Québec (CCQ).

Orthodontics treatments are reimbursable in a single payment following the payment at the time aparatus is installed. Certain conditions apply:

  • You must send to MÉDIC Construction the original receipt for payment that you made to the orthodontist.
  • The insurance plan that you have at the time the appartus is installed must include reimbursement for orthodontic care.
  • The maximum reimbursable annuity per child under your insurance plan must not have been reached.

If the treatment plan is interrupted, you must notify the CCQ and reimburse all overpayments.

The Bulletin MÉDIC Construction for each plan indicates the amounts that may be reimbursed.

Specific conditions, limitations, or exclusions may apply to reimbursement of certain coverage. Only the Règlement sur les régimes complémentaires d'avantages sociaux dans l'industrie de la construction has legal value.

Costs incurred for the following treatments are not covered by MÉDIC Construction:

  • Dental care for children 21 years or over even if they are full-time student;
  • Replacement of a lost or stolen prosthesis duplication of a prosthesis or any other dental apparatus;
  • Nutritional counselling and recommendations, instructions for oral hygiene or plaque control;
  • Fees charged by a dentist for a missed appointment or to fill out a form;
  • Treatments reimbursed under the Act Respecting Occupational Health and Safety or any other provincial, federal, or foreign law to the same effect;
  • Fees in excess of those charged for the replacement of a prosthesis equivalent to the one the person already had;
  • All treatments regarding the vertical dimension of the temporo-mandibular articulation;
  • Cosmetic treatment or subsequent related treatment, including fixed prostheses (facing, crowns, inlays, etc.);
  • Dental implants (except for insurance plans AT, BT, RT1, and RT2);
  • Application of cavity-fighting substances;
  • Caries susceptibility test;
  • Polishing of fillings and grinding of teeth.

Specific conditions, limitations, and exclusions other than those mentionned above may apply to the reimbursement of certain types of coverage; only Règlement sur les régimes complémentaires d'avantages sociaux dans l'industrie de la construction has legal value.

MÉDIC Construction uses the current year’s rates published by the Association des chirurgiens dentistes du Québec(Québec association of dental surgeons and denturologists). These rates apply even if:

  • The treatments are performed by a specialist whose rate is higher
  • The dental care is received outside of Québec at a higher rate

Most dental care may be paid for by using the MÉDIC Construction card. If it is not the case, the insured may submit a claim with the MÉDIC Construction application, by using MÉDIC online at sel.ccq.org or by sending the form Claim for dental expenses by mail. A claim form approved by the Association des chirurgiens dentistes du Québec (ACDQ) may also be used. In this case, the insured (employee or retiree) must write their client number on the form. 

Specific conditions, limitations, or exclusions other than those described above may apply to reimbursement of some coverage. Only the Règlement sur les régimes complémentaires d'avantages sociaux dans l'industrie de la construction has legal force. 

The Bulletin MÉDIC Construction for each plan indicates the reimbursable amounts.

The main types of coverage are:

Some plans also cover orthodontics for the insured’s dependent children. It is important to note that dependent children 21 years of age or older, even if they meet the conditions for being a dependent (for example, if they are in school), are not covered by the dental insurance offered by MÉDIC Construction. As a consequence, dental care received starting on the date of the child’s 21st birthday is not reimbursed even if it is part of a treatment plan authorized by MÉDIC Construction.

Some dental treatments may be paid for with the MÉDIC Construction card. In other cases, the insured must pay the total cost for the treatment and submit a claim with the MÉDIC Construction application, by using MÉDIC online at sel.ccq.org or by mail.

  • Application for reimbursement

    The sections of the Commission de la construction du Québec (CCQ) site dealing with different insurance coverage explain how medical expenditures incurred may be paid. Applications for reimbursement must be sent to MÉDIC Construction within one year after the date on which the medical expenditure was made. If the expenditure is high, it is suggested that you ask MÉDIC Construction for an estimate of reimbursement before making the purchase. This enables you to know the amount that you will have to pay as an insured.

    A worker who feels that he or she has the right to a reimbursement different from that granted by MÉDIC Construction may make a complaint about this decision. To do this, he or she must contact Customer Services, which will send him or her the appropriate form. If the employee has taken this step and is still dissatisfied with the CCQ’s decision, the Act Respecting Labour Relations, Vocational Training and Workforce Management in the Construction Industry allows him or her to ask for a review. The CCQ’s Customer Services can guide the employee with this process and supply the appropriate form.

  • Additional details

    Coordinated insurance

    When the spouse of a worker or retiree insured under MÉDIC Construction is covered by another group insurance plan, it is possible for the other insurer concerned and MÉDIC Construction to share the reimbursement of claims. This is called coordinated insurance. It is legal and advantageous to make a claim to the spouse’s insurer and from MÉDIC Construction for a single expenditure; the amount reimbursed, however, may not surpass the total of the costs incurred.

    For coordinated insurance, MÉDIC Construction requires that all of its insureds produce a Declaration by the Spouse form.

    Following a work-related accident or an occupational disease

    If you are recognized or indemnified by the Commission des normes, de l'équité, de la santé et de la sécurité du travail (CNESST), including Indemnisation des victimes d’actes criminel (IVAC), you must claim reimbursement for medical care and medications related to your job-related injury or to the harm you have suffered as a result of a criminal act.

    MÉDIC Constrction does not reimburse these costs or coordinate insurance with the CNESST.

    Following an automobile accident

    The reimbursement of medical care and medications related to an automobile accident must be claimed from the Société de l'assurance automobile du Québec (SAAQ).

    MÉDIC Construction does not reimburse these costs or coordinate insurance with the SAAQ.

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