How to Get Dental Implants Covered by Insurance in Toronto

Factors Influencing Dental Insurance Coverage

Several factors determine whether insurance will cover dental implants:

• Insurance Policy Terms: Review your policy for exclusions related to cosmetic procedures or specific clauses regarding implants. Some plans may offer partial coverage, while others exclude implants altogether.
• Pre-Existing Conditions: Some insurance plans impose waiting periods or exclude coverage for pre-existing conditions, such as missing teeth. If you lose a tooth, seek replacement as soon as possible to increase the likelihood of coverage.
• Medical Necessity Clauses: If tooth loss results from trauma, injury, or medical conditions, some insurance plans cover implants as a necessary restorative treatment rather than a cosmetic procedure. Examples include a car accident, sports injury, or workplace incident.
• Alternative Benefit Provision: Many plans apply a Least Expensive Alternative Treatment (LEAT) clause, meaning they will cover only the cost of a lower-priced alternative, such as a dental bridge, rather than a full implant. If a bridge costs $2,000 but an implant costs $4,000, insurance may only cover the $2,000, leaving you responsible for the remaining amount.
• Coordination with Medical Insurance: In cases involving severe trauma (jaw fractures, facial injuries), medical insurance (rather than dental insurance) may cover part of the cost. Extended health benefits or disability insurance may also contribute.
• Workers’ Compensation (WSIB in Ontario) – If tooth loss occurs due to a workplace accident, Workers’ Compensation may cover the cost instead of private dental insurance.