AISH Dental Coverage - What's Covered & What's Not

Maintaining good oral health is essential for overall well-being, but dental care can be expensive. Thankfully, if you’re an Assured Income for the Severely Handicapped (AISH) recipient in Alberta, you have access to dental coverage as part of your health benefits.

What is AISH Dental Coverage?

The AISH program provides financial and health support to adults with permanent medical conditions that severely limit their ability to earn a living. Among its many benefits, AISH offers dental coverage for recipients, their spouses or partners, and dependent children. This ensures that essential oral health care is accessible without financial strain.

1. What’s Covered in AISH Dental Coverage?

AISH dental coverage focuses on providing basic and essential oral care services. Here’s an overview:

Regular dental check-ups:
Adults: Every 24 months.
Children: Every 12 months.
Teeth cleaning (scaling and polishing).
X-rays for diagnostic purposes.
Fillings for cavities.
Tooth extractions when necessary.
Emergency dental treatments for pain or oral infections.
Full or partial dentures.
Repairs or replacements for dentures as needed.

Dental care services sequence infographic showing six steps: check-ups, teeth cleaning, X-rays, fillings, tooth extractions, and dentures

Specialized Procedures

Certain specialized treatments may be covered but require prior approval. For example:

Crowns for anterior (front) teeth (with pre-approval).
Difficult cases involving severe handicapping conditions may qualify for special fee adjustments through Alberta Blue Cross.

Utilizing AISH dental coverage ensures that essential oral health services are accessible and affordable.

Tip: Always schedule appointments in advance and confirm with your dentist about the procedures covered to avoid unexpected expenses.

2. What’s Not Covered?

While AISH dental benefits are generous, there are limitations:

Orthodontics: Braces and other orthodontic treatments are not covered for adults unless pre-approved before the recipient turned 18.
Crowns: Crowns for posterior (back) teeth are not covered; anterior crowns require pre-approval.
Cosmetic Procedures: Treatments like teeth whitening or implants are excluded.
Scaling and Root Planing: Additional units beyond standard limits are not covered.

Additionally, recall exams and cleaning frequency are limited:

Adults: Routine cleaning every six months; complete oral exams every 24 months.
Children: Routine cleaning every six months; complete oral exams every 12 months.

How to Get AISH Dental Benefits?

Navigating health benefits can feel overwhelming, but accessing your AISH dental coverage is straightforward if you follow these steps:

Step 1: Confirm Your Eligibility

Ensure you, your spouse/partner, or dependent children are listed as eligible beneficiaries under the AISH program. Your AISH Health Benefits Card serves as proof of eligibility.

Step 2: Present Your Health Benefits Card

When visiting a dentist, denturist, or dental hygienist, present your AISH Health Benefits Card at the time of your appointment. This card allows the dental provider to bill Alberta Blue Cross directly for covered services.

Step 3: Choose a Participating Dentist

Not all dentists accept AISH benefits. Before booking an appointment, confirm with the dental office that they accept patients under the AISH program.

Step 4: Understand Coverage Limits

Discuss with your dentist which procedures are covered under AISH. For treatments requiring prior approval (e.g., anterior crowns or dentures), ensure your dentist submits the necessary paperwork to Alberta Blue Cross before proceeding with treatment.

Step 5: Coordinate with Other Insurance (if applicable)

Remember that If you have additional dental insurance, inform your dentist so they can bill that plan first. AISH will cover any remaining eligible costs after your primary insurance has been applied.

Step 6: Seek Pre-Approval for Complex Procedures

For specialized treatments like anterior crowns or denture replacements, pre-approval is required. Your dentist will need to submit a request to Alberta Blue Cross outlining the necessity of the procedure.

Step 7: Appeal Denied Claims (if necessary)

If a claim is denied, consult your AISH worker about appealing the decision or requesting an exception through the Health Benefits Exception process.

By following these steps, you can effectively utilize your AISH dental benefits and ensure that essential oral health services remain accessible and stress-free.

Tips and Suggestions

Here are some practical tips to help you make the most of your AISH dental coverage:

Plan Your Appointments: Schedule regular check-ups within the allowed frequency limits to stay proactive about your oral health.
Communicate Clearly: Always discuss treatment plans with your dentist beforehand to avoid surprises about what’s covered.
Ask Questions: Don’t hesitate to ask your dentist or Alberta Blue Cross about specific procedures if you’re unsure whether they’re covered.
Keep Records: Maintain copies of all dental bills and correspondence with Alberta Blue Cross in case you need them for appeals or clarifications.
Choose Wisely: Look for dentists experienced in working with government benefit programs like AISH—they’ll better understand how to handle claims efficiently.
Stay Within Alberta: Remember that your AISH Health Benefits Card is only valid within Alberta—services outside the province aren’t covered.

Oral health isn’t just about having a great smile—it’s deeply connected to overall well-being. Poor oral hygiene can lead to serious health issues like heart disease, diabetes complications, and infections. By utilizing your AISH dental benefits effectively, you can prevent these problems while maintaining a healthy lifestyle.

Personal Thoughts on AISH Dental Coverage

As someone who has seen firsthand how financial barriers can prevent people from accessing basic healthcare, I believe programs like AISH play a critical role in providing equity and well-being in our communities. The inclusion of dental coverage is particularly commendable because it addresses an often-overlooked aspect of health care.

However, I would suggest that recipients take full advantage of these benefits by staying informed about what’s covered and maintaining open communication with their healthcare providers. Prevention is always better than cure—and regular check-ups can save you from more extensive (and painful) procedures down the line.