Canada Life Dental Public Service: How Does Canada Life Dental Coverage Work
A survey shows more than 35% of Canadians don't have dental insurance.
Canada Life Dental Public Service is a great initiative by the government to make dental care services accessible for federal public service employees and their families.
Canada Life Dental Coverage offers financial assistance for several treatments, including basic cleaning and more specialized orthodontic treatments.
It also covers the cost of some services that are not a part of the provincial health care coverage.
To help you understand the Canada Life Dental Public Service, this blog covers the eligibility criteria and other necessary information that you must know.
Learn More: Guide to Dental Expenses Tax Deductible in Canada: Can I Claim Dental Expenses on my Taxes in Ontario?
PSCHCP Positive Enrolment: An Overview
Canada Life will complete positive enrolment on your behalf. That means you don't need to fill out an enrollment form if you are eligible for the Canada Life Dental Public Service coverage.
A requirement of the new Canada Life contract is mandatory positive enrolment.
Canada Life will ask you to update and validate your personal information between September and early October. You will receive this request via email or mail confirmation notification.
The message contains instructions on obtaining your new PSDCP benefit card and plan number.
In the Canada Life Dental Public Service message, you will receive a PSDCP benefit card as well.
If you haven't received a confirmation by early October, this implies that your positive enrolment is yet to be completed.
Moreover, if you fail to comprehend any terms related to the Canada Life Dental Public Service, you can check out the rules of the plan.
What Happens After You Become Eligible For Canada Life Dental Public Service Coverage
Membership and coverage under the PSDCP begin exactly three months after you become an eligible employee and work continuously for three months. Coverage includes the employee's qualified dependents on that same date.
New dependents' dental coverage will begin when they become eligible dependants.
If you were on leave, coverage will start on the first day of the month following the month you resumed your job.
Canada Life Dental Public Service Eligibility Under Various Situations
Here is what the Canada Life Dental Public Service coverage looks like in different employment conditions:
1.Temporary Employment
As soon as you become a member of the PSDCP, even if you are a seasonal employee, you will receive Canada Life Dental Public Service year-round coverage.
2.Unpaid Leave
If you want to maintain Canada Life Dental coverage, you will need to do the following:
Submit the reasons for your leave request to Compensation Services in your department or the Public Service Pay Center.
Make the quarterly payment of your monthly contributions in advance, if needed, before the expiration of your coverage.
Compensation Services in your department or the Public Service Pay Center will guide you on how to maintain dental coverage.
3.Suspension
Suppose you are a PSDCP member and you are suspended. In that case, you will remain eligible for benefits under the plan if you make the appropriate quarterly payments in advance.
Furthermore, it must be before the first of the month that follows the month that the suspension period starts.
The first of the month after the date of your return to duty will mark the continuation of your employer-paid coverage.
4.Terminations
If you make the required monthly payment amount and are laid off while covered by the PSDCP, you can keep your coverage for up to a full year.
Exemption for Terminated Employees
If you or your eligible dependent began dental treatment before your dental coverage expired and the procedure takes more than one session, an exception will be provided.
If the treatment is over within 31 calendar days after the day your coverage expires, you or your qualified dependant will qualify for the coverage.
Dentalcare Supplies and Services Covered by Canada Life Dental Public Service
The level of reimbursement for major dental services and supplies is equal to 50% of the lesser of the Dental Fee Guide or the invoiced cost of the major dental services and supplies.
The maximum benefit for major dental services and supplies is $750 per insured person per calendar year.
Here are the services that Canada Life Dental coverage includes:
1.Crown Replacement Procedures
Removal and recementation of crowns and onlays
Metal, plastic, and ceramic crowns
Onlays
Posts, cores, and pins related to covered crowns
Repairs of the crowns
To learn more about how the crown replacement procedure works, here is a comprehensive guide.
2.Dentures and Bridgework
During the duration of the Canada Life Dental Public Service policy, you can get dental treatments that you may need after a tooth extraction, such as dentures, bridges, and much more.
Replacement appliances.
When the present appliance is at least five years old and is out of use.
The existing appliance may be a temporary appliance that is covered.
If the current appliance is under five years old, replacement coverage is provided
The extraction of additional teeth renders the existing appliance unusable.
Coverage is restricted to replacing the extra teeth if more teeth are pulled, but the current appliance can still be used.
3.Surgical Treatments Related to Dentures
Canada Life Dental Public Service covers the following surgical services:
Extending the oral mucous folds
Remodeling the alveolar bone through excision
Removal, reduction, or augmentation
Remodeling the oral floor
Reconstruction of the thickened border of the jaw that has the teeth sockets
Procedures related to surgical grafts
Vestibuloplasty for improving the fit of the denture
4.Maintaining the Dental Work
Following the completion of the three-month post-insertion care period, Canada Life Dental coverage takes care of these services:
Remakes, adjustments, additions, and repairs of the denture
Resetting of denture teeth
Removal of the implant-retained prosthesis for repair
Reinsertion of implant-retained prostheses
Tissue conditioning, bridgework repairs, removal and recementation of bridgework
Related Blog: Caring for Dental Prosthetics: Maintenance Tips for Long-Term Durability
Restrictions of Canada Life Dental Coverage
Restrictions apply to the benefits payable for qualified major dental services and supplies, as detailed below:
The cost of crowns or onlays, provided when a tooth could have been adequately restored using other procedures, is limited to the cost of fillings.
The cost of complicated crowns is limited to the cost of standard crowns.
Replacement crowns and onlays are reimbursed when the current restoration is at least five years old and cannot be functional.
The cost of tooth-colored onlays on molars is limited to the cost of metal onlays.
Denture remakes are only allowed once every three years.
Inlays are restricted to the cost of fillings.
Benefits will not cover the following services and supplies:
Congenital defects on developmental malformations in individuals in the age bracket of 19 and above with insurance
Treatments related to myofascial discomfort
Crowns and onlays if the tooth's structural loss is such that alternative procedures can sufficiently restore it. Secondly, if appliances are not necessary to replace an existing crown or one that cannot be restored to a functional state.
Maximum Limit For Treatments
For each individual who qualifies for Canada Life Dental Public Service, a lifetime maximum of $2,500 applies to orthodontic services.
How to Start the Canada Life Dental Public Service Coverage Plan
You must provide Canada Life with an estimate of the intended work before starting any procedure or treatment that is anticipated to cost more than $300.
By doing this, you will get information on:
The amount of work the plan covers
Dental work will be covered in the absence of benefit coordination
With a predetermination of benefits statement, you get details of the services you are eligible for.
Those who have availed of the Canada Life Dental coverage once a year must confirm that they have not exceeded the annual limit.
Apart from that, for some treatments, such as pit and fissure sealants, the individual needs to have a certain age limit.
How To Claim Canada Life Dental Coverage
1.Through the Website
With the PSDCP Member Services website, claiming Canada Life Dental Public service benefits is hassle-free.
You have to submit your claims within 15 months of the day you become responsible for paying for the orthodontic treatment cost. And within 15 months of the date of each monthly appointment for the duration of the treatment.
You will only get reimbursement for the payment you make after the 15-month window if you can provide proof that you could not file your claim in that time frame.
To access the site, you will require your plan and certificate numbers (found on the PSDCP benefit card), the service number (for dependents of CAF members), or the regimental number (for RCMP members and their dependents).
The PSDCP Member Services website also provides details on your benefits and helps with these:
Register for direct deposit to enable Canada Life to make payments straight into your bank account and view Canada Life Dental Public service coverage details.
Fill out the customized dental claim forms and print them out.
When you file a claim for dental costs not covered by the plan, you can read and print your claim summaries to keep track of your claim history and use them for income tax purposes.
Check your benefit statements' explanation and the status of your claims over the previous 24 months.
Verify the balance of your dental coverage and the eligibility dates for your upcoming appointment with your dependents.
Upload a direct photo, scanned copy, or document of your claim.
Regarding claims that the dentist's office submits, you must:
Give your dentist permission to file claims.
Ensure that all of your personal information, including your address, plan number, and certificate number, is accurate and up to date.
2.Claims Via Mail
If you don't do it online, fill out and send in an approved claim form along with the necessary details, such as:
Your complete address, including the postal code and name
The numbers on your plan and certificate
The dental plan and certificate number of your spouse or common-law partner, if applicable, and your signature on the relevant portion of the claim form that your dentist has filled out
If any information in the form is missing, Canada Life will send it back to you. Also, send any invoices or receipts you possess, ensuring they contain complete information about the products or services.
To send claims to Canada Life. you can mail them to these addresses:
For citizens of Canada, excluding those who live in Quebec:
Winnipeg Benefit Payments
P.O. Box 6025 Station Main
Winnipeg MB
Canada
R3C 3C7
For citizens of Quebec living outside of the National Capital Region:
Montreal Benefit Payments
800 de la Gauchetière Street West
Suite 5800
Montreal QC
Canada
H5A 1B9
For workers who don't live in Canada:
Health and Dental Benefits
Canada Life Payments Foreign Benefits
Post Office Box 6000
Winnipeg MB
Canada
R3C 3A5
You have to file your claim with the provincial authorities first if you reside in a jurisdiction that covers dental care. You can then file a claim under the PSDCP for any further qualified expenses once that claim has been handled.
FAQs
How do I verify my Canada Life Dental Public Service coverage?
By logging into your Canada Life plan member portal, you can evaluate your plan's specifics, such as your limits, claims history, and coverage.
Is Canada Life Dental Public Service coverage for all orthodontic treatment?
Plans differ in their partial coverage of orthodontic services. It's crucial to review the precise terms of your plan to determine the requirements and coverage limits for orthodontics.
Who can receive Canada Life Dental Public Service coverage?
The Canada Life Dental Public Service plan normally covers federal public service employees who work full-time or part-time, as well as their qualified dependents (spouse and children under a particular age or enrolled full-time in school).
Summary
This is all the information you need to benefit from the Canada Life Dental Public Service.
The plan covers some of the orthodontic services in full and other services partially, while some may not even be included.
To know all these services, you should visit the Canada Life website. If you have any problem using the website, you can check out this PDF.
To get the best dental treatment with flexible financing plans, you can also contact KWC Dental.
We can help you make the most out of your insurance plans and give you insights on how you can get the desired treatments.