Group Benefits Unlimited employs Specific strategies to decrease dental care costs by identifying cost drivers and measuring the quality of care and the outcome.

Dental Care Solutions

National On-line, real-time dental claims connected to over 70% of licensed dentists in Canada.  Each claim is exposed to exacting checks prior to acceptance, adjustment or rejection.

Flexible plan designs

• Frequency limitations
• Treatment limitations
• Oral hygiene instruction limitations
• Periodontal scaling limitations
• Amalgam bonding specifications
• Wisdom teeth extraction specifications
• Replacement fillings specifications
• Missing tooth provisions
• General practitioner and specialist fee guide adjudication
• Pay member or pay provider claims payment
• Standard plan designs or totally customized dental programs
• Reference based pricing-specified amount of a distinct procedure
• Tiered coinsurance per benefit class
• Coinsurance plus calendar maximum per benefit class
• Front end deductibles
• Maximums:
  • Per annum
  • Per certificate
  • Per individual 
  • Per benefit class
• Coordination of benefits, private and provincial

Your card is recognized and accepted throughout Canada. 

Our Dental Ajudicators are partnered with the Canadian Dental Association (CDA) and the Quebec Dental Association (ACDQ) offering the most advanced communication protocol available in real-time claims management services.

Dental claims that are submitted by providers and members on a reimbursement (paper) basis are also subjected to the same exacting standards of checks and audits applied to electronically transmitted claims.

Systems are designed to ensure member/dependent eligibility and procedure code eligibility. Cost containment measures are strictly adhered to.

A member/dependent simply presents their Pay Direct Health Card at the dental office after services have been rendered. The dental provider keys data directly into their practice management software and electronically submits the claim detail for adjudication. Within seconds, the dental provider is sent:

• Acknowledgment of claim receipt
• Confirmation of the eligibility of the procedure(s)
• Acknowledgment that the claim is being paid or adjusted (with explanation)
• Required data to enable the dentist to produce an Explanation of Benefit (EOB) for the patient
• Customer out-of-pocket expenses are limited to deductible or co-payment