Public Service Dental Care Plan FAQ’s

The Public Service Dental Care Plan (DCP) is a private health service plan for federal Public Service employees and their eligible dependants. It covers you for specific dental services and supplies that are not covered under your provincial health care or dental care plan. The purpose of the Dental Care Plan is to provide members and their dependants with coverage, up to certain limits, for expenses for required services and supplies.

The Public Service Dental Care Plan has 5 components:

• Plan 55666 – Members of the Public Service Alliance of Canada
• Plan 55555 – Employees of Public Service Departments and Eligible Agencies (referred to as the NJC Plan)
• Plan 55777 – Dependents of Members of the Canadian Forces
• Plan 55888 – Dependents of Members of the RCMP
• Plan 55999 – Eligible Members and Dependents of the Canadian Forces Reserves

The complete terms and conditions of your Public Service Dental Care Plan are set out in the Dental Care Plan Rules.

The employee booklet Dental Care Plan (DCP) Public Service of Canada describes your benefits as a plan member. The Great West Life Assurance Company of Canada administers the DCP. Plan members, who do not have access to the Internet, should contact their departmental compensation advisor.

Some examples of eligible dental services are: diagnostic services such as examinations and x-rays; preventive services such as cleaning and polishing; restorative services such as fillings; endodontics such as root canal therapy; prosthodontic services such as dentures and bridges; and, oral surgery. As well, the plan covers orthodontic services, within limits.

There are some limitations on the frequency for which the costs of dental services will be covered: for example, once every 9 months for recall examinations.

You can find a complete description of what is covered and the limitations under the Plan in Appendices B and C of the Dental Care Plan booklet located on the Public Service Employees Dental Care Plan - Policies and Publications page of the TBS web site.

In addition, members should consult the Dental Care Information Notices for practical reminders and revisions to the Plan..

Some benefits will be reimbursed at 90% of the Plan member’s costs based on the previous year’s provincial/territorial dental fee schedule (or its equivalent). Services such as x-rays, cleaning, fillings, treatment of gums, surgical extractions and repairs and adjustments to dentures are reimbursed at 90%.

Other services are reimbursed at 50% of the Plan Member’s costs, based on the previous year’s provincial or territorial fee schedule. Examples of these services are crowns, dentures, fixed bridges and orthodontics.

Each calendar year, there is an annual deductible amount per person or per family which members must pay. Expenses in excess of this amount are eligible for reimbursement from the Plan. The current annual deductibles are $25.00 per person and $50.00 per family.

In addition, there are annual maximum reimbursement limits of $1700 per calendar year per covered person (or $850 if you or your eligible dependant join the DCP on or after July 1 of any year).

Orthodontic Services are subject to a separate lifetime limit of $2500 for each covered person.

Please consult the Dental Care Plan Booklet or the Public Service Employees Dental Care Plan - Policies and Publications for other information on Plan limits.

When the estimated cost of treatment suggested by your dentist exceeds $300, you are strongly urged to submit a treatment plan to the Plan Administrator before going ahead with the treatment. The Administrator will then tell you the benefits payable under the DCP for the services proposed. See the section Treatment Plans in the Plan Member Booklet on the TBS Web Site for further details.

The Government as the employer pays the full cost of the Public Service Dental Care Plan (PSDCP).

For some types of leave without pay, you may be required to pay the full cost of your coverage. Your departmental Compensation services or the Public Service Pay Centre can provide you with further information.

Membership in the DCP is automatic if you have been appointed for more than 6 months and you are a full time employee or a part time employee working more than 1/3 of the normal work week. Benefits can be paid after a waiting period of 3 months of coverage.

Members can also apply to cover their eligible dependants. Dependants’ coverage is effective immediately.

If you are in doubt about your membership, contact your compensation advisor.

Plan members receive an identity card showing their certificate number and the effective date of their coverage.

As a plan member, you can apply for coverage for the person to whom you are legally married alternatively, you may apply for coverage for the person with whom you have lived for a continuous period of at least one year and with whom you continue to live in a conjugal relationship.

You may apply for coverage for your dependant child or the dependant child of your spouse or common law partner. To be eligible as a dependant child, the person must be unmarried and either under the age of 21 OR under the age of 25 and a full time student OR be primarily dependent upon you for support because he or she is incapable of engaging in sustainable employment by reason of mental or physical impairment.

NOTE: If your child is a member of the DCP in his or her own right, that child cannot also be covered as your dependant.

Generally speaking, you can continue to be covered under the DCP. However, depending upon the length of your leave and the type of leave, you may be required to pay the full cost of your coverage.

If you are required to submit your contributions during the period of your leave and you do not do so within the time required, your membership will be suspended until the 1st of the month following your return to duty.

Before proceeding on leave, you should arrange with your compensation advisor to continue your DCP coverage.

When you and your spouse or common-law partner are covered under two different plans, or if you are each members in your own right under the DCP (including the Canadian Forces/RCMP Dependants Components of the Dental Care Plan), you can claim reimbursement from both plans. In all cases, the combined reimbursement from all plans cannot exceed the expenses incurred.

See the Duplicate Protection Section of the Plan Member booklet for further information.

Claims are made on the Public Service Dental Care Plan Claim Form (PDF Document – 126 KB) (The Great-West Life Assurance Company). Both you and your dentist must complete the appropriate sections of the form. Claims should be forwarded to the DCP Administrator, the Great-West Life Assurance Company of Canada to the Payment Office described in Appendix D of the Dental Care Plan member booklet.

Claims may be submitted electronically by your dentist. It is your responsibility to authorize your dentist to submit the claims and to ensure that your dentist has your current personal information.

Claims must be submitted within 15 months of the date the expenses have been incurred.

Questions about DCP claims should be directed to the Great-West Life Assurance Company at:

• 1-800-957-9777
• For Quebec residents, other than in the National Capital Region: 1-800-663-2817

Your coverage under the DCP ends automatically when you retire.

If you begin receiving an immediate on-going pension under the Public Service Pension Plan, you may apply for coverage for yourself and your eligible dependants under the Pensioners’ Dental Services Plan (PDSP). The PDSP is a voluntary, contributory dental care plan for federal Public Service pensioners.

The Pensioners Dental Services Plan is completely separate from the DCP. It is administered by a different company, the Sun Life Assurance Company.

Yes. Reimbursement of your dental care expenses will be based on the actual incurred expenses provided they are "reasonable and customary" in the region where they were incurred. Annual and Lifetime limits will be determined by reference to the amounts that would have been incurred in Ontario for the dental procedure involved.