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