 |
|||||
 |
 |
 |
 |
 |
 |
|
|
||||||||||||
               |
 |
2003 Annual Report of the Dental Care Plan Board of Management (NJC Component)
In accordance with the NJC By-Laws, the undersigned submit this annual report regarding the performance and the management of the Dental Care Plan (NJC Component) during the period of January 1 to December 31, 2003. GENERAL STATEMENT The Dental Care Plan Board of Management (NJC Component) is pleased to present this report for the period of January 1, 2003, to December 31, 2003. The Dental Care Plan completed 16 years of operation on March 1, 2003. The Plan covers reasonable and customary dental treatment necessary to prevent or correct dental disease or defect provided the treatment is consistent with generally accepted dental practices. The Dental Care Plan is private and its cost is fully paid by Treasury Board, the Employer. The Dental Care Plan Board of Management (NJC Component) is composed of management and union representatives. It is responsible for the overall administration of the Plan, balancing the overall needs of the members, within the allocated funding, resolving members' complaints regarding eligibility or claims disputes, monitoring the claims settlement performance of the Administrator, and recommending changes to the Plan. MEMBERSHIP The Board met six times during 2003, devoting its time to overseeing the administration and financial status of the Plan, resolving appeal cases and recommending improvements to the Plan. Germain Laporte completed his first year as Chairperson of the Board, after being appointed to replace Marie-Paule Scott. Ms Lynn Malette and Maryse Bernier, NJC Committee Advisors, served in the role of Secretary on behalf of Mr. Dan Butler, General Secretary of the NJC. The members of the Board as of the end of the 2003 reporting period are:
ADMINISTRATION The Board is satisfied that Great-West Life, the Administrator, adjudicated and paid claims in accordance with the Plan Document, which has been agreed to by the Treasury Board and the participating Public Service unions. The Board noted that the Administrator maintained a claim turn-around time of under five days for all claims, and at least a 70% rate of all calls answered within 30 seconds. ACTIVITIES The number of appeals may fluctuate from year to year, but remains within the same range. In 2003, the Board reviewed 67 appeals; 21 were upheld, and 46 were denied. The Board had reviewed 47 appeals in 2002 and 60 in 2001. The total cost of the Dental Care Plan (NJC Component) since 1999 is as follows:
The Plan's costs have risen steadily over the last five years. The increase appears to be due to an increase in membership, Plan utilization and the provincial fee guide. The total cost of $70.0 M for year 2003 includes $ 65.2 M or 93.1% for paid claims and $ 4.8 M or 6.9 % for expenses. The increases in costs over the previous year were 10.6% compared to 15.1% in 2002, 7.2% in 2001, and 8.0% in 2000. The number of covered employees increased during year 2003 by 3,275 or 3.1% from 106,421 at the beginning of year, to 109,696 at the end of the year (Fig. 1). A total of 92,134 employees (average of 84%) submitted at least one claim, either for themselves or an eligible dependant. A total of 540,826 claims were resolved, representing an increase of 10.2% from 2002; the average cost per claim increased by 0.5% to $120.49. The value of paid claims increased by almost the same percentage as the number of claims resolved, thus resulting in the same average cost per claim. The average benefit per member went up from $553.74 to $594.04, an increase of 7.3%[1]. The total amount charged by dentists to Plan members was $118,896,726[1] compared to $65,123,339 in net benefits paid to employees, for a reimbursement ratio of 54.8%. In general, variations between years 1999 and 2003, concerning paid claims by type of treatment, are as follows:The percentages have remained relatively stable for most services, with a few exceptions, over the past five years. Periodontic services have continued to rise, reaching 18.09% in 2003. In addition to an increase in utilization, this tendency is partially due to the unbundling of the preventive package in 2002 by the Ontario Dentists Association (ODA). Prior to 2002, the recall package was coded under preventive. In 2002, the ODA unbundled this package, which resulted in all scaling being charged under periodontic, recall exams and X-rays under diagnostics, and polishing and fluoride under preventive. The average amount paid by the Administrator to employees in 2003 has the age groups 40-44, 45-49 and 50-54 continued to form the bulk of the amount paid last year. In most categories, there has been an increase in the average paid amount from 2000 to 2003. However, the average amount paid for preventive services decreased in all age categories, thus supporting the theory that the unbundling of the preventive package in 2002 had some impact.DENTAL CARE PLAN In December 2003, an agreement was reached between the Treasury Board and the Bargaining Agent Side of the National Joint Council on changes to the Public Service Dental Care Plan effective January 1, 2004, until December 31, 2005. The maximum reimbursement amount for a calendar year per covered person for eligible dental expenses (excluding orthodontic services) increased from $1,400 to $1,500. When a temporary prosthodontic appliance is installed as part of major restorative services, Plan coverage for permanent prosthodontic appliances will be provided without regard to when the temporary appliances was first installed, provided that the person was under the Plan when the temporary appliance was installed. This removed the 12-month limitation on the replacement of temporary prosthodontic appliances. The necessary replacement of fillings (same tooth and surface) will be paid under this plan once every 24 months irrespective of the age of the filling. The necessary replacement of crowns will be paid under this Plan once every 60 months irrespective of the age of the crown. This assures coverage for fillings and replacement crowns on initial treatment under the Plan. The agreement reached responded to issues identified by the Board as a result of its review of appeals. COMMUNICATION At the same time as the announcement of changes to the Dental Care Plan, a series of practical reminders concerning the terms of the Plan were published on the NJC and the TBS Web sites. The Board has been reviewing the possibility of a GWL Web site for use by members and will be looking at on-line access once issues of privacy are addressed. TRAINING The Board recognized the importance of training for its members. Consequently, it covered the registration fees for the participation of members in educational or professional development activities. In particular, members of the Board attended conferences organized by the International Foundation of Employee Benefit Plans. CONCLUSION In closing, the Board wishes to take this opportunity to thank the Administrator's representatives, Peter Foley and Vida Kudzma, for their ongoing commitment and contribution to the successful administration of the Plan in year 2003. The Board on behalf of all members is pleased to oversee and provide advice on the management of this important employee benefit.[1] Amount does not include the exchange portion of claims in US dollars. / Le montant ne comprend pas la portion d'échange des réclamations en dollars US. [1] Average is based on membership at the end of the year. / La moyenne est fondée sur le nombre de participants à la fin de l'année. |
 |
||
| [ HOME | TOP | BACK ] | ||
| Last Modified: 2004-12-23 | [ Important Notices ] | |