Links - Dental

Q: What kind of award do teeth never want to get? (answer below)

teeth

 

Dental Claim form

POLICY # = 55777

PPIN = Service Number

Bad jokes aside, here is everything you need to know to care for your teeth!


Dental plan changes - 1 Jan 2020:

  • The current yearly maximum reimbursement for dental services of $1,700 will gradually be increased over a three year period as follows:
    • $2,000 per year starting on January 1, 2019
    • $2,250 per year starting on January 1, 2020
    • $2,500 per year starting on January 1, 2021
  • Eligible dental implants will be covered.
  • Replacement fillings for the same tooth and surface will be covered for eligible children only every 12 months after the initial filling was done, instead of once every 24 months.
  • Services and supplies needed to treat congenital or developmental malformation will be covered for children until age 21, instead of age 19.
  • The allowable break in service to become eligible for the plan is extended to 7 days, instead of 5 days.
  • Reimbursement for up to two units of extra scaling and/or root planning may be approved retroactively, if the application is made within 3 months of the service.
  • Oral hygiene instructions will be eligible for reimbursement once per calendar year for children and remains eligible once per lifetime for an adult.
  • Participants under suspension can keep their coverage if they pay the required contributions quarterly in advance.
  • To reduce unnecessary costs while ensuring plan participants do not experience a reduction in services, duplicative charging (i.e. charging twice) for the following services will no longer be allowed:
    • Trauma control when it is done during a treatment for caries or pain control (note: traumatic dental injury remains covered);
    • Enlargement of the canal or pulp chamber billed separately from a root canal treatment;
    • Dental professional peer consultation costs as these are already included in the original examination fee covered by the Public Service Dental Care Plan;
    • The assistance of a second oral surgeon invoiced in surplus of the charges already billed for a procedure.

Snapshot of coverage as outlined in the Coverage Booklet

  • Annex B - covers all Eligible Dental Services

  • Annex C - outlines Exclusions and Limitations

  • NEW Reimbursement limit of $2,000 per calendar year per covered person for all eligible dental services (except for orthodontic services)
  • Maximum reimbursement amount of $850 per person for that year, if you, your eligible spouse or common-law partner and/or children join the DCP on or after July 1 of any given year (excluding orthodontic services)
  • Orthodontic services are subject to a separate lifetime limit of $2,500 for each covered person for all eligible orthodontic services
  • The annual deductible amount is $25 per covered person. However, where eligible expenses are incurred for more than one person in a family in a calendar year, the deductible amount will be limited to $50
  • Claims must be submitted to the Plan Administrator within 15 months of the date on which the expense is incurred
  • If you are posted OUTCAN you cannot submit electronic claims; you must use snail-mail

To learn more about the Public Service Dental Care Plan, visit this link


answer:  A Plaque!