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Public Service Dental Care Plan numbers are assigned based on the plan member's month of birth:
|
Plan member’s month of birth
|
Plan number |
|---|---|
| January, February, March |
72111 |
| April, May, June |
72112 |
| July, August, September |
72113 |
| October, November, December |
72114 |
Public Service Dental Care Plan Coverage
|
Overview |
|
|---|---|
|
Deductible |
$25 per person, up to $50 per family per calendar year. If the first dental expense in a calendar year is incurred in the last quarter of the year (October to December), and the applicable deductible has been paid, that deductible will be carried over to the following year. |
|
Reimbursement percentage |
|
|
Treatment plan |
A treatment plan, more commonly known as a predetermination, should be submitted to Canada Life before beginning treatment when the estimated cost is expected to be $300 or more. The predetermination can be submitted electronically using your practice management software or on a paper claim form. Approved services will be reimbursed upon completion of treatment (exception: orthodontic treatment). |
|
Maximum reinbursement |
Basic and major dental expenses:
Orthodontics:
|
| Dental fee guide | Previous year's dental fee guide for the province or territory where the services are rendered |
Frequency guidelines and plan limitations for select services
|
90% basic dental services
|
|
|---|---|
|
Complete exam |
Once every 3 years (36 months). |
|
Recall oral exam |
Once every 9 months, or once every 6 months in the case of eligible children only. |
|
Polishing |
Once every 9 months, or once every 6 months in the case of eligible children only. |
|
Fluoride treatment |
Once every 9 months, or once every 6 months in the case of eligible children only. |
|
Oral hygiene instruction |
Once per lifetime, or once per calendar year for eligible children. |
|
Scaling in combination with root planing |
6 units per calendar year. In the instance of documented cases and with the pre-approval of a treatment plan by the Plan Administrator, up to 6 additional units may be allowed in a given calendar year. Application for reimbursement for scaling and/or root planing may be made for up to 2 time units if such application is made within 3 months of the performance of the service. |
|
Panoramic radiographs |
Once every 3 years (36 months). |
|
Bitewing radiographs |
Once every 9 months, or once every 6 months in the case of eligible children only. |
|
Fillings |
Eligible member, eligible spouse or common-law partner: Replacement fillings once every 24 months. Eligible dependant child: Replacement fillings once every 12 months. |
|
50% major services |
|
|---|---|
|
Major restorative (e.g., crowns, implants) |
Replacement eligible after 60 months unless the appliance cannot be made serviceable. |
|
Major prosthodontic (e.g., dentures, bridges) |
Replacement eligible after 60 months unless the appliance cannot be made serviceable. |
|
50% orthodontics |
|
|---|---|
| Orthodontics |
Lifetime maximum of $2,500 per covered person. |
|
Other |
|
|---|---|
|
Alternative benefit clause |
An alternative benefit for a less expensive course of treatment may be reimbursed. Submitting a predetermination when costs exceed $300 provides an opportunity to discuss the best course of treatment with the plan member. Please note that accepting an alternate benefit may limit the eligibility for reimbursement for future treatments. |
This is intended to be a summary only. If a discrepancy occurs, the Rules of the Public Service Dental Care Plan (PSDCP) will govern. Please refer to the PSDCP Rules for a complete listing of services including limitations and exclusions.