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Ontario Works - Lambton (Dental Plan)

This page was reviewed or revised on Tuesday, October 27, 2009 12:29 PM

Oral Health Fact Sheet

PDF of Fact Sheet

Overseeing the Plan

 The County of Lambton, Children’s Services Department, oversees the dental plan for Ontario Works-Lambton. All dental claims & pre-determination of services, except for dentures, must be sent to the Children’s Services Department, Oral Health Division.

Dental Eligibility Card

Each month with their cheque, every family is given a Dental Eligibility Card. This serves as I.D. to the dental office as proof of coverage. The up-to-date dental card must be shown at the dentist’s office to get care for that month.

If a client has lost or cannot find the dental card, they should contact Lambton County Social and Health Services for a new one.

What is Covered?

There are 3 dental services for Ontario Works clients. Two are based on age.
 

1) Mandatory (17 years and under)

Services and fees are detailed in the Ministry of Community and Social Services (MCSS) Schedule of Dental Services & Fees. Some services have a fixed number of visits and a maximum dollar total.
 

2) Discretionary (18 years and older)

Under this service only 2 teeth will be paid for in an emergency situation. Extra care must be pre-approved.

The plan covers up to $350 maximum for restorative care in a 12 month period. Root canal treatment may be approved, up to a maximum amount per tooth, if it prevents the use of a partial denture. Cleaning and pain control are not covered.

A list of services and fees are listed online: http://www.lambtonhealth.on.ca/dental/ontario.asp
 

3) Dentures

Requests for dentures must go straight to Ontario Works-Lambton at 150 Christina St. N. Sarnia, ON N7T 8H3.

Making Payments

Claims for dental care payments (except dentures) must be sent to:

Children's Services Department
Attention: Oral Health Division
160 Exmouth Street
Point Edward, ON N7T 7Z6

The Dental Eligibility Card, or a copy of the card, must be attached to the claim form for the month that treatment is given.

Payments will not be made unless the dental card is attached and all information is included.

Pre-Determination

OW Discretionary Program (18 years & older) requires pre-determination for all treatment beyond the 1-2 teeth covered by emergency care to stop pain.

The decision should be sent on a Pre-treatment Form. Do Not use a Standard Dental Claim Form.

Make sure you include the following information with your form:

• Copy of the Dental Eligibility Card
• Client/patient signature
• Cardholder’s name and case ID
• Patient’s name, date of birth and address
• Dentist’s name, address, unique ID number and signature
• List all services and fees

PDF Fact Sheet dated January 22, 2009