Note: Only available for dependants 18 and under.
- Enhanced Option 1: 50% of the Dental Benefit List fees for examinations, diagnostics, and all other treatments (e.g. appliances, banding, etc.) up to $3,000 per person per lifetime
- Enhanced Option 2: Not available
- Core: Not available
Except for diagnostic tests, ASEBP requires an orthodontic predetermination (treatment plan) to be in place and the patient is under the direct care of a licensed dental provider before reimbursing orthodontic services. Note that the treatment plan should also include payment arrangements.
For an orthodontic predetermination to be complete, your orthodontist must include the following information:
- A description of the condition requiring treatment, including the classification and malocclusion (misalignment)
- Length of time per course of treatment
- Total cost of treatment and payment details, including:
- if treatment will be paid as a one-time full payment, or
- if payment will be broken down into an initial fee and instalment payments (include down payment and instalment—monthly or quarterly—amounts)
Here are some important things for you to know:
- You can find your orthodontic predeterminations online on My ASEBP under Documents.
- Receiving a predetermination isn’t a pre-approval for the reimbursement of your expenses. It’s a confirmation that the prescribed treatment you’re considering is included as part of your ASEBP coverage.
- Predeterminations only take into account the costs that have been accumulated against your maximum at the time of the authorization—they don’t include any costs that haven’t yet been billed to ASEBP or coordination of benefit rules, etc.
- To be reimbursed for the amounts confirmed, treatment must begin within 12 months of your orthodontist submitting the predetermination to ASEBP. If your orthodontic treatment began prior to you being enrolled in ASEBP dental coverage, a predetermination for any remaining work will need to be submitted and approved by ASEBP before any portion of the work will be paid.
- If your approved treatment plan indicated you would pay an initial fee (down payment) plus instalment payments but the claim you submitted shows the treatment has been paid in one payment, your claim will be processed for the full amount you paid (up to plan limitations).
- If your treatment plan has a specified payment plan (e.g. monthly, quarterly, etc.), the initial down payment or fee can’t exceed 1/3 of the overall cost of the treatment.
- Please contact us if you’re currently making instalment payments for a treatment plan and would like to make more than one scheduled payment but less than the full balance.
- If you’re currently making instalment payments for a treatment plan but decide you want to pay the remaining balance in full, you’ll need to submit a receipt indicating the full balance has been paid with your claim.
