To: Executive Council
Re: Dental Care Plan – Dental Claims
Dear Sisters, Dear Brothers:
Previously, Bulletin 2007-07 was issued to explain the benefit coverage available to UTE members as well as when they would become members of each respective plan. It has recently come to our attention that although the members now have an understanding of when they become eligible to receive benefits under the respective benefit plans, many have not been provided with the proper information regarding questioning a claim or the actual filing of a complaint and/or appeal related to a dental claim. This has resulted in a number of our members having claims denied and subsequently finding themselves out of pocket for claims, as they did not understand the appeal process.
This Bulletin is designed to provide members with accurate information on when and how to file an appeal when their dental claims have been denied.
Dental Care Plan
Membership is automatic if you have been appointed for more than six (6) months and are a full-time employee or a part-time employee working more than one-third of the normal workweek. Benefits can be paid after a three-month waiting period. In addition, members can apply to cover their eligible dependants and the coverage is in effect immediately.
Every member is assigned a Plan Number. Please note that the PSAC Plan Number is 55666 and the other bargaining agents in the Federal Government have plan number 55555. Although the plan number does not, at this time, make a difference in terms of the benefits you receive, it does affect who hears any appeal that you might make.
Policy Inquiries – Inquiries about the interpretation of the policy relating to the Public Service Dental Care Plan (DCP) should be sent to the CRA Corporate Compensation Centre, who may in turn contact the Insurance Benefits Program Group at The Treasury Board Secretariat, if required.
Administrative Inquiries – Inquiries of an administrative nature (issues such as employee coverage stopped in error or effective date of coverage errors) should be sent to the Public Service Dental Care Plan Inquiry Section by e-mail at email@example.com or by mail at the following address:
Public Service Dental Care Plan Inquiry Section
Pay Policies and Training Services Directorate
10A2, Phase III
Place du Portage
Gatineau (Hull) QC K1A 0S5
Claims/Benefits Inquiries – Any inquiry related to claims and dental expenses covered under the Public Service Dental Care Plan (DCP) must be addressed to the Plan Administrator. This includes:
- Inquiries regarding estimates
- Queries regarding what is covered, limitations and exclusions
- Inquiries regarding reimbursement.
Members can find the addresses of the claims offices in the DCP Booklet or on the actual claim form.
Appealing a denial of your Claim
An appeal is any inquiry related to where a member contests the validity of the decision of the Administrator to decline a claim or where an employee or their dependent’s eligibility and/or effective coverage date is disputed. The procedures for filing an appeal are relatively straightforward:
- The particulars of the case outlined in a letter and
- Any background documentation which would help the board to resolve the case.
Appeals of this nature must be addressed to:
Board of Management
Dental Care Plan (PSAC)
300 Laurier Ave West, 5th Floor
Ottawa ON K1A 0R5
If you have any questions or require further clarifications, you are requested to contact a member of your Local Executive.
Labour Relations Officer.