Dental and Optical Assistance for Seniors

Eligibility

To be eligible for the Dental and Optical Assistance for Seniors programs you must:

• be 65 years of age or older
• be an Alberta resident and must have resided in Alberta for three months immediately prior to applying
• be a Canadian citizen, or admitted to Canada for permanent residence (landed immigrants),
• have submitted a completed Seniors Financial Assistance programs application form,
• meet financial eligibility criteria.

For more information on program eligibility, read the Dental and Optical Assistance for Seniors brochure.

Income

Your eligibility for the Dental and Optical Assistance for Seniors programs is determined using prior year's total income (line 15000 of the personal tax form) as reported to Canada Revenue Agency.

How to apply

You must complete and submit the Seniors Financial Assistance application form (PDF, 124 KB) before accessing Dental and Optical Assistance benefits. If you have already submitted the Seniors Financial Assistance application form for another program, there is no need to apply again.

Once you are enrolled, your service provider can confirm your eligibility and coverage levels before proceeding with your treatment or claim(s):

• Dental service: contact the Alberta Dental Service Corporation
• Optical service: contact Alberta Blue Cross

Dental coverage

Eligible seniors are covered for select dental services up to a maximum of $5,000 every 5 years.

Maximum coverage

There is a maximum amount of coverage for each dental procedure and a specific number of times you can receive assistance for procedures within certain time periods. If you are eligible for the maximum amount (100%), then you are eligible for up to the maximum coverage allowed under the schedule of dental procedures for this program.

Partial coverage

Minimum dental coverage of 10% to 99% is allowed under the schedule of dental procedures for this program. The percentage of coverage increases as annual income decreases.

Services covered

• Diagnostic services (examinations and x-rays)
• Preventative services (polishing and scaling)
• Restorative services (fillings, trauma/pain control)
• Extractions (simple and complicated)
• Root canals (endodontics)
• Procedures relating to gum disease (periodontics, root planing)
• Dentures (prosthodontics, full and partial basic dentures)

Services not covered

• Bridges
• Crowns
• Braces
• Implants
• Fluoride treatment
• Teeth bleaching
• Inlays (gold or gems)

Frequency limitation

A senior may receive the maximum dental benefit once every 5 years. The 5-year period begins from the date of the first dental service that is funded.

Frequency limitations may apply for covered services.

Dental coverage under this program is based on a pre-determined schedule of fees, which establishes both the maximum fee amount and the frequency of coverage for eligible procedures. Dental providers may choose to charge more than the maximum fee allowed for each procedure and/or perform procedures more frequently than allowed under the schedule. The senior would then be responsible for the payment of these additional amounts.

The Dental Assistance for Seniors program's schedule of dental procedures and fees includes basic dental procedures and services in order to maintain good dental health.

It is important to ask your service provider to submit a predetermination (cost estimate) to the Alberta Dental Service Corporation previous to you receiving your dental service. Your dental provider can quickly check how much, if anything, you will have to pay. Your plan may not cover the full cost of the dental service or your provider may charge more than the maximum fee allowed by your plan.

Optical coverage

Eligible seniors are covered for select optical services up to $230 every 3 years.

Services covered

Prescription eyeglasses, including lenses and frames from a recognized optical provider. The maximum amount covered is based on your eligibility at the time of purchase.

Services not covered

• Eye surgery
• Eye exams
• Accessories
• Magnifying devices
• Eye medication
• Non-prescription sunglasses
• Reading glasses not dispensed by optical provider

Frequency limitation

A senior may receive the maximum optical benefit once every 3 years. The 3-year period begins from the date of the first optical service that is funded.

If you purchase prescription eyeglasses and you do not use the maximum benefit at that time, you can submit additional expenses before the 3-year period ends.

Assistance with an additional set of eyeglasses within the same 3-year period can be funded to an eligible senior when they have had cataract surgery, leading to a change in prescription. A medical note confirming the cataract surgery must be submitted to the benefit administrator or optical provider previous to the additional funding being provided.

Submit a claim

To submit a claim you must first be enrolled in the Seniors Financial Assistance programs.

The Ministry of Health has partnered with the Alberta Dental Service Corporation to administer dental claims and Alberta Blue Cross to administer optical claims.

Each benefit administrator provides information regarding procedures, answers questions regarding claims and issues payments to the service provider or the senior if a reimbursement is required.

Step 1: Talk to your health service provider when visiting

When visiting a dental or optical office, show your Alberta personal health number and tell the service provider that you are a senior.

The service provider can confirm your coverage level and eligibility at the time of your appointment.

Step 2: Pay for services

If direct bill is available, pay amounts not covered by your plan

Dental or optical offices may bill the benefit administrator directly for services provided to you. If your service provider accepts this method, you will only be required to pay any outstanding amounts not covered by your plan.

In these cases, skip step 3.

If direct bill is not available, pay the full amount and fill out a reimbursement claim

Dental or optical offices may not direct bill the benefit administrator directly. You will be required to pay the balance and submit for reimbursement. Your or your service provider must also complete a section of the reimbursement form.

Step 3: Submit a reimbursement claim

If direct bill was available, you can skip this step.

Forms are available from:

• Alberta Dental Service Corporation
• Alberta Blue Cross
• your service provider

Completed forms can be mailed to the address on the form.

Please include your personal health number on your claim.

Exceptions and reviews

You can request a review if you were denied funding or funded less than expected for a dental or optical claim.

Dental claim reviews and exceptions

To request an explanation of the income information used to determine your eligibility for the Dental Assistance for Seniors Program:

Call the Alberta Supports Contact Centre
Toll free: 1-877-644-9992

If you have any questions regarding the outcome of a dental claim or the amount of a payment:

Step 1: Contact the Alberta Dental Service Corporation (ADSC)

Phone: 1-800-232-1997, select option 1, then option 1 again
Email is available by visiting the Alberta Dental Service Corporation website.

Step 2: Write to the Alberta Dental Service Corporation

If you were unable to resolve the issue over the phone, request a review in writing:

Alberta Dental Service Corporation
17010 103 Avenue NW
200 Quikcard Centre
Edmonton, Alberta  T5S 1K7

Your dental provider may also submit a request on your behalf. The dental provider will need to submit a treatment plan and all supporting documents for review and consideration.

Optical claim reviews and exceptions

To request an explanation of the income information used to determine your eligibility for the Optical Assistance for Seniors Program:

Call the Alberta Supports Contact Centre
Toll free: 1-877-644-9992

If you have any questions regarding the outcome of an optical claim or the amount of a payment:

Write to the Optical Assistance for Seniors Program

PO Box 3100 Stn Main
Edmonton, Alberta  T5J 4W3

The program advisor will review your written request, compare it to policies and make a decision.

Contact

To connect with the Alberta Supports Contact Centre:

Hours: 7:30 am to 8:00 pm (open Monday to Friday, closed statutory holidays)
Toll free: 1-877-644-9992