Oral and Maxillofacial Surgery Benefits Regulation (Alta. Reg. 86/2006)

Alta. Reg. 86/2006

Alberta — Regulations

© Published by Alberta King’s Printer Alberta King’s Printer Suite 700, Park Plaza 10611 - 98 Avenue Edmonton, AB T5K 2P7 Phone: 780-427-4952 E-mail: kings-printer@gov.ab.ca Shop on-line at kings-printer.alberta.ca Province of Alberta Office Consolidation Alberta Regulation 86/2006 With amendments up to and including Alberta Regulation 291/2025 Current as of December 18, 2025 ALBERTA HEALTH CARE INSURANCE ACT ORAL AND MAXILLOFACIAL SURGERY BENEFITS REGULATION

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Note All persons making use of this consolidation are reminded that it has no legislative sanction, that amendments have been embodied for convenience of reference only. The official Statutes and Regulations should be consulted for all purposes of interpreting and applying the law.

(Consolidated up to 291/2025) ALBERTA REGULATION 86/2006 Alberta Health Care Insurance Act ORAL AND MAXILLOFACIAL SURGERY BENEFITS REGULATION Table of Contents 1

Definitions 2 Eligibility 3 Benefits for services in Alberta 4 Benefits for services in Canada 5 Benefits for servic es outside Canada 6 Increased benefit 7 Included in amount of benefits 8 Repeal List of Oral and Maxillofacial Surgery Services

Definitions 1 In this Regulation, (a) “Act” means the Alberta Health Care Insurance Act; (b) “oral and maxillofacial surgery services” means the services in the List of Oral and Maxillofacial Surgery Services in this Regulation; (c) “Schedule of Oral and Maxillofacial Surgery Benefits” means the

Schedule of Oral and Maxillofacial Surgery Benefits prepared and published by the Department of Primary and Preventative Health Services and approved by the Minister. AR 86/2006 s1;170/2012;158/2025 Eligibility 2(1) Benefits are payable in accordance with the regulations under

Part 1 of the Act for oral and maxillofacial surgery services provided to a resident of Alberta by a dentist.

(2) Notwithstanding subsection (1), benefits are not payable for oral and maxillofacial surgery services if a declaration under

Section 3 AR 86/2006 ORAL AND MAXILLOFACIAL SURGERY BENEFITS REGULATION 2

section 25 of the Health Insurance Premiums Act is in effect in respect of the person who receives the services. AR 86/2006 s2;291/2025 Benefits for services in Alberta 3(1) The benefits payable for oral and maxillofacial surgery services provided to a resident of Alberta in Alberta and the descriptions of those services are set out in the

Schedule of Oral and Maxillofacial Surgery Benefits.

(2) Notwithstanding subsection (1), the benefits payable for oral and maxillofacial surgery services provided to a resident of Alberta in Alberta are limited to the lesser of (

a) the amount claimed, and (

b) the rates established i n the

Schedule of Oral and Maxillofacial Surgery Benefits. Benefits for services in Canada 4(1) The benefits payable for oral and maxillofacial surgery services provided to a resident of Alberta in another province or territory of Canada that are insured health services in Alberta are determined as follows: (

a) if the services are insured under the legislation in that province or territory, the benefits are payable according to the rules established for payment of benefits in that province or territory and the benefits payable are limited to the lesser of (

i) the amount claimed, and (ii) the rates established by that province or territory; (

b) if the services are not insured under the legislation in t hat province or territory, the benefits are payable according to

Part 1 of the Act and the regulations made under that Part and the benefits payable are limited to the lesser of (

i) the amount claimed, and (ii) the rates established i n the

Schedule of Oral and Maxillofacial Surgery Benefits.

(2) No benefits are payable for oral and maxillofacial surgery services provided to a resident of Alberta in another province or territory of Canada if the services provided are not insured health services in Alberta. AR 86/2006 s4;291/2025

Section 5 AR 86/2006 ORAL AND MAXILLOFACIAL SURGERY BENEFITS REGULATION 3 Benefits for services outside Canada 5(1) The benefits payable for oral and maxillofacial surgery services provided to a resident of Alberta outside Canada that are insured health services in Alberta are limited to the lesser of (

a) the amount claimed, and (

b) the rates established i n the

Schedule of Oral and Maxillofacial Surgery Benefits.

(2) No benefits are payable for oral and maxillofacial surgery services provided to a resident of Alberta outside Canada if the services provided are not insured health services in Alberta. AR 86/2006 s2;291/2025 Increased benefit 6(1) Notwithstanding sections 3 and 4, a benefit that is higher than the rate set out in the

Schedule of Oral and Maxillofacial Surgery Benefits may be payable for oral and maxillofacial surgery services provided to a resident of Alberta in Canada if unusual complications occur or unusual care is required.

(2) A request for an increased benefit must be accompanied by supporting evidence satisfactory to the Minister. Included in amount of benefits 7 The benefits payable for oral and maxillofacial surgery services provided to a resident of Alberta by a dentist include an amount for the following: (

a) performing the oral or ma xillofacial surgery service; (

b) administration; (

c) recording of information regarding the services provided unless if the recording of the information is for the purposes of a third party; (

d) completing and submitting claims; (

e) discussion or co rrespondence with a referring health care professional regarding treatment or a service to be provided to a patient directly related to managing the patient’s care, unless otherwise provided in this Regulation or the Alberta Health Care Insurance Regulation.

Section 8 AR 86/2006 ORAL AND MAXILLOFACIAL SURGERY BENEFITS REGULATION 4 Repeal 8 The Oral and Maxillofacial Surgery Benefits Regulation (AR 123/95) is repealed. 9 Repealed AR 15/2016 s3. List of Oral and Maxillofacial Surgery Services (

a) non-operative endoscopy of respiratory tract; (

b) other non-operative endoscopy; (

c) diagnostic interview and evaluation or consultation; (

d) injection or infusion of other therapeutic or prophylactic substance; (

e) other injection or infusion of other therapeutic or prophylactic substance; (

f) other miscellaneous diagnostic and therapeutic procedures; (

g) cranioplasty; (

h) incision, division and exci sion of cranial and peripheral nerves; (

i) destruction of cranial and peripheral nerves; (

j) suture of cranial and peripheral nerves; (

k) freeing of adhesions and decompression of cranial and peripheral nerves; (

l) transposition of cranial and peripheral nerves; (

m) injection into peripheral nerve; (

n) control of epistaxis; (

o) submucous resecti on of nasal septum; (

p) reduction of nasal fracture; (

q) repair and plastic operations on the nose; (

r) intranasal antrotomy; (

s) repair and plastic operation of nasal sinus;

List AR 86/2006 ORAL AND MAXILLOFACIAL SURGERY BENEFITS REGULATION 5 (

t) excision of dental lesion of jaw; (

u) other orthodontic operations; (

v) other dental operations; (

w) partial glossectomy; (

x) complete glossectomy; (

y) repair and plastic operations on tongue; (

z) invasive diagnostic procedures on tongue; (aa) other operations on tongue; (bb) incision of salivary gland or duct; (cc) excision of lesion of salivary gland; (dd) sialoadenectomy; (ee) other operations on salivary gland or duct; (ff) drainage of face or floor of mouth; (gg) incision of palate; (hh) excision of lesion or tissue of palate; (ii) plastic repair of mouth (internal); (jj) palatoplasty; (kk) invasive diagnostic procedures on oral cavity; (ll) other operations on mouth and face; (mm) plastic operation on pharynx; (nn) temporary tracheostomy; (oo) incision of chest wall and pleura; (pp) other operations on vessels; (qq) closed reduction of facial fractures; (rr) open reduction of facial fractures; (ss) incision of facial bone without division; (tt) partial ostectomy of faci al bone, except mandible;

List AR 86/2006 ORAL AND MAXILLOFACIAL SURGERY BENEFITS REGULATION 6 (uu) temporomandibular arthroplasty; (vv) other facial bone repair and osteoplasty; (ww) invasive diagnostic p rocedures on facial bones; (xx) other operations on facial bones and joints; (yy) sequestrectomy; (zz) synovectomy; (aaa) other operations on joints; (bbb) incision of muscle, t endon, fascia and bursa; (ccc) excision of skin and subcutaneous tissue; (ddd) relaxation of scar or contracture of skin; (eee) flap or pedicle graft; (fff) plastic operations on lip and external mouth; (ggg) ill-defined operations.

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Document details

Collection	Alberta — Regulations
Citation	Alta. Reg. 86/2006
Type	regulation
Volume / chapter	2006 086
Language	en
Format	pdf
Source	PROVINCIAL
Identifier	d93eb45c63daf6042c1a93d3725c53887d521152

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