DATE: February 15, 2001
TO: Compensation Managers
Directors of Personnel
Heads of Personnel of Participating Separate Employers
Heads of Bargaining Agents
SUBJECT: Public Service Dental Care Plan
This is to inform you that the revised version of the Dental Care Plan (DCP) booklet intended for employees is now
available in electronic format. Arrangements are being made to provide a printed version of the booklet in the near future.
We also want to take this opportunity to provide employees, who are members of the Dental Care Plan, with helpful reminders concerning the terms of the plan.
Please find attached a Notice to Employees on this subject. We would ask that you distribute it as quickly as possible, to all employees in your
department or agency, including those employees on leave of absence without pay.
Compensation Managers may call Lise Gendron at (613) 952-3260 if there are any questions about the notice.
Public Service Dental Care Plan - Helpful Information and Reminders
This is to advise you that the revised version of the Dental Care Plan (DCP) information booklet is now available in
electronic format.
Practical reminders regarding your Plan
- The annual maximum reimbursement limit in 2001, excluding orthodontic services, has been increased to $1300 (from $1250) per
person. If you or your dependants become eligible on or after July 1, the maximum reimbursement will be $650 (from $625) for that year. It would be to
your advantage to keep track of your reimbursements, and to know how much is remaining in the current calendar year when planning your dental appointments.
- Recall exams, cleaning and polishing, topical application of fluoride and bitewing X-rays are limited to once every 9 months exactly. For example, if you are
reimbursed for an exam and cleaning rendered on January 15, 2001, you will not be eligible for reimbursement of another exam or cleaning until on or after
October 15, 2001. If your exam and cleaning is rendered on October 14, 2001 or earlier, the services will not be eligible.
- Diagnostic services associated with orthodontic treatment are paid at 90% while the actual orthodontic treatment is paid at 50%. The lifetime limit for all
orthodontic services is $2,500 per covered person.
- Scaling and root planing are limited to a combined total of 6 time units per calendar year. In cases of documented periodontitis, up to an additional 6 units can
be allowed in a given calendar year, with the pre-approval of a treatment plan. Consequently, if you have such a condition, you must obtain pre-approval of the
required treatment for that calendar year. If additional treatment is needed in a new calendar year, a new treatment plan must be submitted. Updated documentation will
be required with each request.
- Treatment plans are strongly recommended when a treatment is expected to cost more than $300. Please note that the remarks included on the Pre-determination of
Benefits statement provided by the administrator are part of the Treatment Plan assessment and must be read in conjunction with any amounts approved. For example, if
other claims were paid after the approval date, it would affect the anticipated benefit payment.
- Claims, including those for co-ordination of benefits, must be submitted within fifteen (15) months of the date the service was incurred in order for reimbursement
to be made. Each claim for monthly orthodontic services must also be submitted within fifteen (15) months of the date of the visit.
- Dental claims submitted electronically by your dental office with respect to routine services will be adjudicated electronically by the administrator, if the
required information is on their file. The dental office will provide you with a copy of the Explanation of Benefits during your visit. It is your responsibility to
ensure that personal information such as address, certificate number and co-ordination of benefits details, if applicable, is up to date. If the claim is for a
student, ensure that the information regarding student status is updated.
- Membership in the Plan ends automatically on the date a person ceases to be employed or the date a person ceases to qualify as an eligible employee or dependant.
ln cases where a given dental treatment requiring more than one sitting began while the person was in the Plan, coverage for that treatment will continue if it is
completed within 31 calendar days of the date of termination. Examples include root canal treatment (pulp chamber opened), a crown (tooth prepared and impressions
taken), or ongoing active orthodontic treatment (initial appliance inserted).
As a member of the plan, it is your responsibility to be aware of the terms of your plan prior to treatment. You should refer to the Dental Care Plan
booklet or call the administrator at one of the toll free numbers shown below if you have questions concerning your dental treatment. Be sure to have your plan and ID
number ready when calling.
For employees residing outside Canada
Toll free (English): 1-800-957-9777
Toll free (French): 1-800-704-4007
For Quebec residents, other than the National Capital Region
Toll free (French and English): 1-800-663-2817
For all other Canadian residents
Toll free (English): 1-800-957-9777
Toll free (French): 1-800-704-4007
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