Each year the various provincial dental associations set the suggested dental fee guide for the coming year.  Most dentists follow this guide to charge for the regular work they perform (there are also specialists guides and orthodontics are different again).  Most insurers also use them as a guide for ensuring a fair amount is paid (like a reasonable and customary (R&C) table) for the reimbursement of dental claims.

2023 is looking to be the highest increase I’ve seen in my 26 years in the business.  This is likely in response to the higher costs incurred during the pandemic and the recent jumps in the inflation rate.  So far, we’ve heard from Ontario with an increase of 8.5%, Quebec at 9.8%, Manitoba 5.25%, PEI 5.77%, Saskatchewan 5.62%, and Alberta with 6.0%.

On top of the fee guide adjustment, which increases the cost for the service, we are also seeing increases in trend (coming back more often) and utilization (sitting in the chair for longer).  Together these will mean dental costs will increase by about 10% if you are an AVERAGE user.  Plans facing their first year renewal (with a new plan) will often see much higher increases as employees get work done that had been put off until the plan was put in place.

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The ODA Suggested Fee Guide

Ontario dental fees may also be influenced by the ODA’s annual Suggested Fee Guide. The Guide lists every dental service that dentists may perform. It also outlines dental codes and suggested fees for each specific service. Both dentists and dental plan providers may use the Guide as a reference point to help inform service fees.

Dentists are not required to follow the Guide or any fee schedule. They set their own fees based on the factors influencing their individual practice. This means that your dentist’s fees may vary both above and below the Guide. 

Many dental plan carriers will base their plan coverage on fees and codes within the Guide. In some cases, the coverage may be based on previous years’ Guides (going back a year or more). Dental plan providers do not work with the ODA to develop the Guide.

Dental Costs Explained

The Globe and Mail has reported that Ontario is prepared to implement a biologic and biosimilar mandatory switching policy following leaders like British Columbia, New Brunswick, Alberta, Saskatchewan and PEI.  The new strategy is expected to take place on March 31, 2023 and phase in over the year. 

So what does this mean to you and your employees?  Biosimilars are similar (but not the same) as generic drugs and have a reduced cost compared to the Biologic drug they replace.  The costs of the drugs themselves are in the tens of thousands of dollars a year, so the savings can be significant and anywhere from 17 to 50% off the comparator drug.   

Once this program goes into place, those that use the Ontario Drug Benefit plan (ODB), such as; seniors, those on Ontario Works, or the Trillium Drug Benefit will be made to switch to the cheaper biosimilar drug (unless there is a medical reason not to). Most employee benefit plans will mirror that change (Green Shields has been for years already), requiring the employee to change.  This will help control the costs paid by the employer (and often shared with the employee).  Expect to see more on this in the coming year.

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“Under the new policy, there will be a nine-month transition period that is set to start March 31. That will allow patients time to have discussions with their care providers about what the changes mean, as well as their options. Certain patients will be exempt from mandatory switching, such as those who are pregnant and people with certain types of cancer, the government official said.”

https://www.theglobeandmail.com/canada/article-ontario-mandatory-drug-swap-generic/

I got this article (below) that acted as a reminder of Ontario employer obligations under the updated OHSA regulations  I’ve include the article and the provincial site providing more detail and locations where you can get your free kit (most pharmacies).

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Does your workplace have a naloxone kit? Are you legally required to have one?

In light of the opioid crisis, the Ontario government passed Bill 88, Working for Workers Act, 2022 ( Act ), which amended, among other things, the OHSA to prescribe the inclusion of naloxone kits in select workplaces.

The OHSA now requires an employer who becomes aware, or ought reasonably to be aware, that there may be a risk of a worker having an opioid overdose at the workplace to provide and maintain a naloxone kit in the workplace.

READ ARTICLE

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Naloxone can temporarily reverse an opioid overdose. Learn how to recognize an opioid overdose and use naloxone to reverse it.

https://www.ontario.ca/page/get-naloxone-kits-free