Public Service Dental Care Plan (Revisions 2002-2003)

January 22, 2003

Public Service Dental Care Plan (Revisions 2002-2003)

This is to inform you that an agreement has now been reached among the Treasury Board, the Public Service Alliance of Canada and the Bargaining Agent Side of the National Joint Council on changes to the Public Service Dental Care Plan for 2002 and 2003.

Effective January 1, 2002.

• The maximum reimbursement amount for a calendar year per covered person for eligible dental expenses ( excluding orthodontic services) shall be $1400.(increased from $1300)
• The maximum reimbursement amount for a calendar year per covered person for eligible expenses for employees who join the Plan on or after July 1 of any year shall be $700. (increased from $650)

All other provisions of the amended plan agreement will remain in effect until December 31, 2003.

Please note that the plan administrator, Great-West Life, will automatically review and adjust the claims of all plan members, both employees and their dependants who are eligible for further reimbursement as a result of the increase in the maximum reimbursable amount. It is not necessary for plan members to contact the administrator to receive reimbursement up to the new maximum on claims filed earlier in 2002.

Practical reminders regarding your Plan

• Recall exams, cleaning and polishing, topical application of fluoride and bitewing X-rays are limited to once every 9 months exactly.
• The Plan pays for replacement filings when the existing filings are over 2 years old and replacement crowns and dentures when the existing crowns and dentures are over 5 years old. This applies whether or not the Plan covered the original filing or crown. Premature replacement of fillings, crowns and dentures is the responsibility of the dentist or the patient as a well-placed filling, crown or denture should last longer than the 2 or 5-year period. Exceptions may be permitted in the limited circumstances when the replacement was not as a result of the failure of the original dental treatment.
• When temporary dentures are installed, a permanent denture must replace them within 12 months of the installation of the temporary denture, unless there are documented dental health reasons preventing the completion of the treatment within 12 months.
• 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.
• The annual maximum reimbursement limit for this calendar year, excluding orthodontic services, is $1400 per person. If you or your dependants become eligible for coverage on or after July 1^st, the maximum reimbursement will be $700 for the year. It would be to your advantage to keep track of your reimbursements, and to know how much is remaining in the current year when planning your dental appointments.
• Claims 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.
• Please note that the administrator will adjudicate dental claims submitted electronically by your dental office with respect to routine services electronically, if the required information is on file. The dental office will provide you with a copy of the Explanation of Benefits during your visit.

As a member of the plan, it is your responsibility to be aware of the terms of your plan prior to treatment. Be sure to have your plan and ID number ready when calling the administrator at one of the toll-free numbers shown below.

Dental claims should be sent to Great-West Life, at one of the following addresses: