A-29, r. 5 - Regulation respecting the application of the Health Insurance Act

Section 36 Disposition versions

2020-05-07

36. The services referred to in sections 31 and 35 are considered insured services where they are rendered by a dentist to an insured person 10 years of age or over who has held, for at least 12 consecutive months, a valid claim booklet issued in accordance with section 71.1 of the Act, excluding apexification on a permanent tooth by insertion of dentinogenic medium in order to close the apex and root canal treatment on a permanent tooth with guttapercha point, for which in both cases the insured person must be under 13 years of age.

Notwithstanding the foregoing, the period of 12 consecutive months referred to in the first paragraph is not required where the following services, are rendered as emergencies:

(a)  examination;

(b)  extraction of a tooth or root;

(c)  opening of the pulp cavity;

(d)  incision or drainage of an abscess;

(e)  alveolitis;

(f)  hemorrhage control;

(g)  repair of soft tissue laceration;

(h)  reduction of an alveolar bone fracture;

(i)  immobilization of a tooth loosened by traumatism;

(j)  re-implantation of an entirely exfoliated tooth.

Furthermore, once only per 12-month period with respect to an insured person referred to in the first paragraph, the following services are considered insured services where they are rendered by a dentist and where the person is the following age, depending on the service:

(a)  12 years of age or over for teaching and demonstration of oral hygiene procedures and cleaning of teeth;

(b)  16 years of age or over for scaling;

(c)  at least 12 years of age and less than 16 years of age for topical fluoride application.

Additionally, the fabrication, replacement, repair or relining of an acrylic prosthesis, or the addition of a device to such a prosthesis, when inserted, are considered insured services with respect to a person referred to in the first paragraph insofar as the person has held, for at least 24 consecutive months, a valid claim booklet. However, an insured person is entitled to only one complete or partial prosthesis with or without hooks or supports per maxilla, per 8-year period. Furthermore, the person is entitled to the replacement of a complete or partial prosthesis only where it has become necessary following oral surgery and on the written prescription of a dentist. As for relining, the person is entitled to this service 3 months after the date the prosthesis was initially inserted and, thereafter, every 5 years.

R.R.Q., 1981, c. A-29, r. 1, s. 36; O.C. 1712-82, s. 1; O.C. 1771-83, ss. 5 and 6; O.C. 1980-88, s. 3; O.C. 1027-90, s. 1; O.C. 1134-91, s. 3; O.C. 1192-92, s. 4; O.C. 69-94, s. 2; O.C. 1179-95, s. 8; O.C. 1287-96, s. 4; O.C. 1100-99, s. 1; O.C. 550-2004, s. 2; O.C. 840-2004, s. 1; O.C. 65-2014, s. 1; O.C. 21-2015, s. 1; O.C. 446-2020, s. 3.

2015-02-12

36. For the purposes of the second paragraph of section 3 of the Act, the dental services listed below are considered insured services for any insured person 10 years of age or over who holds a valid claim booklet issued in accordance with section 71.1 of the Act:

(A)  Diagnosis:

Examination

Consultation

(B)  Radiography:

Intraoral radiographs

External radiographs

Injection of contrast substance

(C)  Prophylaxis:

— teaching and demonstration of oral hygiene procedures

— cleaning of teeth

Notwithstanding the foregoing, the teaching and demonstration of oral hygiene procedures as well as the cleaning of teeth are considered insured services only for an insured person of 12 years of age or over.

— scaling

Notwithstanding the foregoing, scaling is considered an insured service only for an insured person of 16 years of age or over.

— tropical fluoride application

Notwithstanding the foregoing, topical fluoride application is considered an insured service only for insured persons of at least 12 years of age and of less than 16 years of age

(D)  Anaesthesia:

Local or regional

(E)  Restorations:

Obturation

— amalgam

— with aesthetic material (on anterior tooth or on buccal or mesial surface of upper premolar)

— complete reconstitution of one third of an incisor

— complete reconstitution of an anterior tooth in aesthetic material

Pivots

Prefabricated crown

— aesthetic material on anterior deciduous tooth

— matallic

Recementation of prefabricated crown

(F)  Endodontics:

Sedative dressing

Pulpotomy on deciduous tooth

Pulpotomy on permanent tooth under general anaesthesia

Pulpectomy on deciduous tooth

Emergency treatment

— emergency opening of pulp chamber

— apexification on a permanent tooth (insertion of dentinogenic medium in order to close the apex)

— root canal treatment on a permanent tooth with a guttapercha point or a silver point

Notwithstanding the foregoing, an apexification on a permanent tooth and a root canal treatment on a permanent tooth are considered insured services only for an insured person under 13 years of age.

(G)  Surgery:

Package for complex surgery (cases of trauma, reconstruction or oncology where the duration of the anaesthesia is 6 hours or more)

Extraction of teeth

Excision of roots

Removal of foreign body from oral cavity or maxilla

Removal of teeth, dental fragments or foreign body by anthrostomy

Surgical exposure, for orthodontic purposes, of tooth whose crown is covered with bony tissue

Incision and drainage of abscess

Osteitis treatment

— alveolitis

— osteomyelitis

Excision and curettage of intraosteal cyst or granuloma

Marsupialization of intraosseous cyst

Evacuation of cervicofacial hematoma / seroma

Biopsy

Excision of tumor

Mandibulectomy

Maxillectomy

Complete lowering of the floor of the mouth

Extension of mucous folds

Excision of genial apophyses

Excision of mylohyoid ridge

Reinsertion of mylohyoid muscle

Alveolectomy

Tuberoplasty

Alveoplasty

Excision of hyperplastic tissue

Excision of excess mucous membrane

Excision of torus

Treatment of salivary glands

Closure of buccosinusal opening

Frenectomy

Gingivectomy in the case of hyperplastic gingivitis resulting from absorption of medicinal substance

Operculectomy

Haemorrhage control

Repair of laceration of soft tissue

Complete avulsion of inferior dental nerve

Avulsion of a branch of trigeminal nerve

Neural transposition and decompression

Alcoholization of a branch of trigeminal nerve

Infiltration of a branch of trigeminal nerve for diagnostic purposes

Anastomosis of a peripheral nerve under a microscope

Vascular anastomosis under a microscope

Implantation of alloplastic craniomaxillofacial prosthesis to correct congenital, developmental or post-traumatic defects

Craniomaxillofacial distractor

Stitching of a cut nerve (neurorraphy)

Emergency tracheotomy

Submandibular percutaneous intubation

Cleft palate

— closing of soft palate

— closing of hard palate

— additional lengthening of palate with intravelar myoplasty

— pharyngeal flap to cure velopharyngeal insufficiency

— cure of residual palatal fistula

— reconstruction of alveolar ridge

— primary rhinoplasty in the presence of cleft lip

— secondary rhinoplasty by open or endonasal approach

Cheiloplasty (reconstruction of lip)

Glossectomy

Bone graft

Taking of graft

Reduction of fractures

— bicoronal flap

— reduction of frontal bone

— occlusion of frontal sinus

— zygomatic arch

— zygomatic arch or malar bone, or both

— orbit

— nose

— maxilla

— mandible

— condyle

— alveolar bone

opened reduction of bucket handle mandibular fracture

Immobilization of tooth loosened by trauma

Reimplantation of completely exfoliated tooth

Mandibular reconstruction plate and bone fixation

— placement of reconstruction plate

— removal of bone fixation (pins, plate or screws) by surgical approach

Intermaxillary fixation and preprosthetic splint

Treatment of temporomandibular articulation

— luxation

— meniscectomy

— condylectomy

— high condylectomy (condyloplasty)

— temporomandibular arthroplasty

— coronoidectomy

— infiltration of temporomandibular articulation (intra-articular medication including substance)

— arthrocentesis

— arthroscopy

— injection of botulinum toxin for functional purposes

— implantation of glenoid fossa prosthesis

— implantation of condylar prosthesis

— cure of ankylosis

Osteotomy

— mandible

- vertical or horizontal branch by intra or extraoral approach

- segmental

— maxilla

- le Fort I

- total turbinectomy

- le Fort II

- le Fort III

- segmental

- zygomatic arch

- nasal pyramid

— interdental

Corticotomy

Repositioning or lessening of symphysis menti

Emergency opening of pulp chamber (emergency endodontia)

Oncology and reconstruction

— neck dissection

— lip repair with Abbé flap or cross lip flap

— correction of post-traumatic or surgical scars

— post-traumatic / cleft lip dermabrasion

— graft by transfer of local pedicled myocutaneous flap

— graft by transfer of regional pedicled flap

— free cutaneous graft, head and neck region

— graft by free microanastomosed flap

— intralesional injection of pharmaceutical agent for non-cosmetic purposes

(H)   Acrylic prosthesis:

— one complete prosthesis when inserted per 8-year period;

— one partial prosthesis with or without hooks or supports when inserted per 8-year period;

— one replacement prosthesis where it has become necessary following oral surgery and on the written prescription of a dentist;

— adding a device to a partial prosthesis;

— repair;

— one relining per 5-year period or 3 months after obtaining the prosthesis.

R.R.Q., 1981, c. A-29, r. 1, s. 36; O.C. 1712-82, s. 1; O.C. 1771-83, ss. 5 and 6; O.C. 1980-88, s. 3; O.C. 1027-90, s. 1; O.C. 1134-91, s. 3; O.C. 1192-92, s. 4; O.C. 69-94, s. 2; O.C. 1179-95, s. 8; O.C. 1287-96, s. 4; O.C. 1100-99, s. 1; O.C. 550-2004, s. 2; O.C. 840-2004, s. 1; O.C. 65-2014, s. 1; O.C. 21-2015, s. 1.

2014-02-27

36. For the purposes of the second paragraph of section 3 of the Act, the dental services listed below are considered insured services for any insured person 10 years of age or over who holds a valid claim booklet issued in accordance with section 71.1 of the Act:

(A)  Diagnosis:

Examination

Consultation

(B)  Radiography:

Intraoral radiographs

External radiographs

Injection of contrast substance

(C)  Prophylaxis:

— teaching and demonstration of oral hygiene procedures

— cleaning of teeth

Notwithstanding the foregoing, the teaching and demonstration of oral hygiene procedures as well as the cleaning of teeth are considered insured services only for an insured person of 12 years of age or over.

— scaling

Notwithstanding the foregoing, scaling is considered an insured service only for an insured person of 16 years of age or over.

— tropical fluoride application

Notwithstanding the foregoing, topical fluoride application is considered an insured service only for insured persons of at least 12 years of age and of less than 16 years of age

(D)  Anaesthesia:

Local or regional

(E)  Restorations:

Obturation

— amalgam

— with aesthetic material (on anterior tooth or on buccal or mesial surface of upper premolar)

— complete reconstitution of one third of an incisor

— complete reconstitution of an anterior tooth in aesthetic material

Pivots

Prefabricated crown

— aesthetic material on anterior deciduous tooth

— matallic

Recementation of prefabricated crown

(F)  Endodontics:

Sedative dressing

Pulpotomy on deciduous tooth

Pulpotomy on permanent tooth under general anaesthesia

Pulpectomy on deciduous tooth

Emergency treatment

— emergency opening of pulp chamber

— apexification on a permanent tooth (insertion of dentinogenic medium in order to close the apex)

— root canal treatment on a permanent tooth with a guttapercha point or a silver point

Notwithstanding the foregoing, an apexification on a permanent tooth and a root canal treatment on a permanent tooth are considered insured services only for an insured person under 13 years of age.

(G)  Surgery:

Package for complex surgery (cases of trauma, reconstruction or oncology where the duration of the anaesthesia is 6 hours or more)

Extraction of teeth

Excision of roots

Removal of foreign body from oral cavity or maxilla

Removal of teeth, dental fragments or foreign body by anthrostomy

Surgical exposure, for orthodontic purposes, of tooth whose crown is covered with bony tissue

Incision and drainage of abscess

Osteitis treatment

— alveolitis

— osteomyelitis

Excision and curettage of intraosteal cyst or granuloma

Biopsy

Excision of tumor

Mandibulectomy

Maxillectomy

Complete lowering of the floor of the mouth

Extension of mucous folds

Excision of genial apophyses

Excision of mylohyoid ridge

Reinsertion of mylohyoid muscle

Alveolectomy

Tuberoplasty

Alveoplasty

Excision of hyperplastic tissue

Excision of excess mucous membrane

Excision of torus

Treatment of salivary glands

Closure of buccosinusal opening

Frenectomy

Gingivectomy in the case of hyperplastic gingivitis resulting from absorption of medicinal substance

Operculectomy

Haemorrhage control

Repair of laceration of soft tissue

Complete avulsion of inferior dental nerve

Avulsion of a branch of trigeminal nerve

Neural transposition and decompression

Alcoholization of a branch of trigeminal nerve

Infiltration of a branch of trigeminal nerve for diagnostic purposes

Anastomosis of a peripheral nerve under a microscope

Stitching of a cut nerve (neurorraphy)

Emergency tracheotomy

Submandibular percutaneous intubation

Palatine fissure

Cheiloplasty (reconstruction of lip)

Glossectomy

Bone graft

Taking of graft

Reduction of fractures

— bicoronal flap

— reduction of frontal bone

— occlusion of frontal sinus

— zygomatic arch

— zygomatic arch or malar bone, or both

— orbit

— nose

— maxilla

— mandible

— condyle

— alveolar bone

Immobilization of tooth loosened by trauma

Reimplantation of completely exfoliated tooth

Insertion of splints

— intra- or periosteal (stem or wire for pericranial suspension)

— placement of a reconstruction plate

— acrylic prosthesis or cap splint attached to maxilla or teeth

— arch

— pericranial device

Removal of splints

— intra- or periosteal: stem, wire or screw for pericranial suspension or pericranial device, or both

— acrylic prosthesis or cap splint attached to maxilla or teeth

— arch

— pins, plates or screws requiring a surgical approach

Treatment of temporomandibular articulation

— luxation

— meniscectomy

— condylectomy

— high condylectomy (condyloplasty)

— temporomandibular arthroplasty

— coronoidectomy

— infiltration of temporomandibular articulation (intra-articular medication including substance)

— arthrocentesis

— arthroscopy

Osteotomy

— mandible

- vertical or horizontal branch by intra or extraoral approach

- segmental

— maxilla

- le Fort I

- total turbinectomy

- le Fort II

- le Fort III

- segmental

- zygomatic arch

- nasal pyramid

— interdental

Corticotomy

Repositioning or lessening of symphysis menti

Emergency opening of pulp chamber (emergency endodontia)

(H)   Acrylic prosthesis:

— one complete prosthesis when inserted per 8-year period;

— one partial prosthesis with or without hooks or supports when inserted per 8-year period;

— one replacement prosthesis where it has become necessary following oral surgery and on the written prescription of a dentist;

— adding a device to a partial prosthesis;

— repair;

— one relining per 5-year period or 3 months after obtaining the prosthesis.

R.R.Q., 1981, c. A-29, r. 1, s. 36; O.C. 1712-82, s. 1; O.C. 1771-83, ss. 5 and 6; O.C. 1980-88, s. 3; O.C. 1027-90, s. 1; O.C. 1134-91, s. 3; O.C. 1192-92, s. 4; O.C. 69-94, s. 2; O.C. 1179-95, s. 8; O.C. 1287-96, s. 4; O.C. 1100-99, s. 1; O.C. 550-2004, s. 2; O.C. 840-2004, s. 1; O.C. 65-2014, s. 1.

2012-09-01

36. For the purposes of the second paragraph of section 3 of the Act, the dental services listed below are considered insured services for any insured person 10 years of age or over who holds a valid claim booklet issued in accordance with section 71.1 of the Act:

(A)  Diagnosis:

Examination

Consultation

(B)  Radiography:

Intraoral radiographs

External radiographs

Injection of contrast substance

(C)  Prophylaxis:

— teaching and demonstration of oral hygiene procedures

— cleaning of teeth

Notwithstanding the foregoing, the teaching and demonstration of oral hygiene procedures as well as the cleaning of teeth are considered insured services only for an insured person of 12 years of age or over.

— scaling

Notwithstanding the foregoing, scaling is considered an insured service only for an insured person of 16 years of age or over.

— tropical fluoride application

Notwithstanding the foregoing, topical fluoride application is considered an insured service only for insured persons of at least 12 years of age and of less than 16 years of age

(D)  Anaesthesia:

Local or regional

(E)  Restorations:

Obturation

— amalgam

— with aesthetic material (on anterior tooth or on buccal or mesial surface of upper premolar)

— complete reconstitution of one third of an incisor

— complete reconstitution of an anterior tooth in aesthetic material

Pivots

Prefabricated crown

— aesthetic material on anterior deciduous tooth

— matallic

Recementation of prefabricated crown

(F)  Endodontics:

Sedative dressing

Pulpotomy on deciduous tooth

Pulpectomy on deciduous tooth

Emergency treatment

— emergency opening of pulp chamber

— apexification on a permanent tooth (insertion of dentinogenic medium in order to close the apex)

— root canal treatment on a permanent tooth with a guttapercha point or a silver point

Notwithstanding the foregoing, an apexification on a permanent tooth and a root canal treatment on a permanent tooth are considered insured services only for an insured person under 13 years of age.

(G)  Surgery:

Package for complex surgery (cases of trauma, reconstruction or oncology where the duration of the anaesthesia is 6 hours or more)

Extraction of teeth

Excision of roots

Removal of foreign body from oral cavity or maxilla

Removal of teeth, dental fragments or foreign body by anthrostomy

Surgical exposure, for orthodontic purposes, of tooth whose crown is covered with bony tissue

Incision and drainage of abscess

Osteitis treatment

— alveolitis

— osteomyelitis

Excision and curettage of intraosteal cyst or granuloma

Biopsy

Excision of tumor

Mandibulectomy

Maxillectomy

Complete lowering of the floor of the mouth

Extension of mucous folds

Excision of genial apophyses

Excision of mylohyoid ridge

Reinsertion of mylohyoid muscle

Alveolectomy

Tuberoplasty

Alveoplasty

Excision of hyperplastic tissue

Excision of excess mucous membrane

Excision of torus

Treatment of salivary glands

Closure of buccosinusal opening

Frenectomy

Gingivectomy in the case of hyperplastic gingivitis resulting from absorption of medicinal substance

Operculectomy

Haemorrhage control

Repair of laceration of soft tissue

Complete avulsion of inferior dental nerve

Avulsion of a branch of trigeminal nerve

Neural transposition and decompression

Alcoholization of a branch of trigeminal nerve

Infiltration of a branch of trigeminal nerve for diagnostic purposes

Anastomosis of a peripheral nerve under a microscope

Stitching of a cut nerve (neurorraphy)

Emergency tracheotomy

Submandibular percutaneous intubation

Palatine fissure

Cheiloplasty (reconstruction of lip)

Glossectomy

Bone graft

Taking of graft

Reduction of fractures

— bicoronal flap

— reduction of frontal bone

— occlusion of frontal sinus

— zygomatic arch

— zygomatic arch or malar bone, or both

— orbit

— nose

— maxilla

— mandible

— condyle

— alveolar bone

Immobilization of tooth loosened by trauma

Reimplantation of completely exfoliated tooth

Insertion of splints

— intra- or periosteal (stem or wire for pericranial suspension)

— placement of a reconstruction plate

— acrylic prosthesis or cap splint attached to maxilla or teeth

— arch

— pericranial device

Removal of splints

— intra- or periosteal: stem, wire or screw for pericranial suspension or pericranial device, or both

— acrylic prosthesis or cap splint attached to maxilla or teeth

— arch

— pins, plates or screws requiring a surgical approach

Treatment of temporomandibular articulation

— luxation

— meniscectomy

— condylectomy

— high condylectomy (condyloplasty)

— temporomandibular arthroplasty

— coronoidectomy

— infiltration of temporomandibular articulation (intra-articular medication including substance)

— arthrocentesis

— arthroscopy

Osteotomy

— mandible

- vertical or horizontal branch by intra or extraoral approach

- segmental

— maxilla

- le Fort I

- total turbinectomy

- le Fort II

- le Fort III

- segmental

- zygomatic arch

- nasal pyramid

— interdental

Corticotomy

Repositioning or lessening of symphysis menti

Emergency opening of pulp chamber (emergency endodontia)

(H)   Acrylic prosthesis:

— one complete prosthesis when inserted per 8-year period;

— one partial prosthesis with or without hooks or supports when inserted per 8-year period;

— one replacement prosthesis where it has become necessary following oral surgery and on the written prescription of a dentist;

— adding a device to a partial prosthesis;

— repair;

— one relining per 5-year period or 3 months after obtaining the prosthesis.

R.R.Q., 1981, c. A-29, r. 1, s. 36; O.C. 1712-82, s. 1; O.C. 1771-83, ss. 5 and 6; O.C. 1980-88, s. 3; O.C. 1027-90, s. 1; O.C. 1134-91, s. 3; O.C. 1192-92, s. 4; O.C. 69-94, s. 2; O.C. 1179-95, s. 8; O.C. 1287-96, s. 4; O.C. 1100-99, s. 1; O.C. 550-2004, s. 2; O.C. 840-2004, s. 1.