sunlife.com/us Dental Insurance
Frequently asked questions
How does a PPO work?
PPO stands for Participating Provider Organization. With a
dental PPO plan, dental providers agree to participate in a
dental network by offering discounted fees on most
dental procedures. When you visit a provider in the
network, you could see lower out-of-pocket costs
because providers in the network agree to these pre-
negotiated discounted fees on eligible claims.
How do I find a dentist?
Simply visit www.sunlife.com/sunlifedentalnetwork. Follow
the prompts to find a dentist in your area who participates
in the PPO network. You do not need to select a dentist in
advance. The PPO network for your plan is the Sun Life
Dental Network® with 130,000+ unique dentists
3
.
How can using a network dentist help lower my costs?
You are free to use the dentist or specialist of your choice.
However, this plan allows you to have access to the Sunlife
Dental Network® PPO dentists and to take advantage of
their fee discounts. Treatment is available from out-of-
network dentists, but their fees are subject to an allowable
charge. The allowable amount for out-of-network dentists
is based on 45% off the 80th percentile of the amount
charged by other dentists in the same geographic area.
Patients are responsible for fees in excess of the allowable
charge. There can be significant out-of-pocket expenses if
an out-of-network dentist is chosen.
Are my dependents eligible for coverage?
Yes. Your plan offers coverage for your spouse
4
and
dependent children. An eligible child is defined as a child to
age 26.
5
Do I have to file the claim?
Many dentists will file claims for you. If a dentist will not file
your claim, simply ask your dentist to complete a standard
American Dental Association (ADA) claim form and mail it
to Sun Life. The address will be provided on your dental ID
card.
What value added benefits does my plan include?
Your plan includes our Lifetime of Smiles® program, with
benefits many people prefer, such as brush biopsies for
the early detection of oral cancer.
CONSIDER A
PRE-DETERMINATION
OF BENEFITS
They allow us to review your
provider’s treatment plan to let
you know before treatment is
started how much of the work
should be covered by the plan,
and how much you may need to
cover. We recommend them for
any dental treatment expected
to exceed $500.
1. American Academy of Periodontology https://www.perio.org/consumer/gum-disease-and-other-diseases (accessed 07/21).
2. American Academy of Periodontology https://www.perio.org/newsroom/periodontal-disease-fact-sheet (accessed 07/21).
3. Zelis Network Analytics data as of January 2022 and based on unique dentist count. Sun Life's dental networks include its affiliate, Dental
Health Alliance, L.L.C.® (DHA), and dentists under access arrangements with other dental networks. Nationwide counts are state level totals.
4. If permitted by the Employer’s employee benefit plan and not prohibited by state law, the term “spouse” in this benefit includes any
individual who is either recognized as a spouse, a registered domestic partner, or a partner in a civil union, or otherwise accorded the same
rights as a spouse.
5. Please see your employer for more specific information.
Read the Important information section for more details including limitations and exclusions