How to File a Dental Appeal at the National Joint Council

The Public Service Dental Care Plan consists of five (5) Boards of Management.

• Plan 55555 – Employees of Public Service Departments and Eligible Agencies (NJC Plan)
• Plan 55666 – Members of the Public Service Alliance of Canada
• Plan 55777 – Dependants of members of the Canadian Forces
• Plan 55888 – Dependants of members of the RCMP
• Plan 55999 – Eligible members and dependants of the Canadian Forces reserves

Appeal procedure for the NJC Dental Care Plan Board of Management (Plan 55555)

If your plan number is 55555, then please follow these procedures:

Appeals typically fall into three categories:

1)  Benefit Coverage
2)  Leave Without Pay (LWOP) Coverage
3)  Dependant Coverage

Please consult the correct section below to determine the appropriate appeal procedure for your claim.

1) Benefit Coverage

The Public Service Dental Care Plan (PSDCP) provides coverage for specific services and supplies that are not covered under a provincial health or dental care plan. Further, the PSDCP covers only reasonable and customary dental treatment, necessary to prevent or correct dental disease or defect, provided the treatment is consistent with generally accepted dental practices. Occasionally a disagreement may arise with an assessment made by Canada Life (CL). When an issue cannot be resolved with CL, the matter should be referred to the Board of Management for reconsideration.

What should be included in the appeal:

• The plan member's certificate number and plan ID number
• A letter signed by the plan member providing background information and the reason for the appeal
• Supporting documentation (i.e. claim forms, pre-treatment plans, responses from CL, etc.)

2) Leave Without Pay (LWOP) Coverage

In general, plan members continue to be covered under the PSDCP when on LWOP. However, depending upon the length and type of leave, plan members may be required to pay the full cost of their coverage. If a plan member is required to submit contributions during the period of leave and it is not done so within the time required, plan membership will be suspended until the 1st of the month following the return to duty. Before proceeding on leave, plan members should arrange with their compensation advisor to continue their PSDCP coverage. If there are issues with premium payments, the matter should be referred to the Board of Management for consideration.

What should be included in the appeal:

• The plan member's certificate number and plan ID number
• A letter signed by the Compensation Advisor providing background information and the reason for the appeal

3) Dependant Coverage

The Boards' of Management approve the addition of dependants in certain situations. A child who does not meet the definition of Eligible Child but is a child for whom the member stands in place of a parent, may be considered for coverage with the approval of the Board of Management, which decides eligibility in such instances. Should Canada Life indicate that the plan member needs to contact the Board of Management to add a dependant, one of the following documents must accompany the request:

What should be included in the appeal:

• The plan member's certificate number and plan ID number
• A copy of a provincial court custody order; or
• A notarized affidavit recognizing that the member is the sole person who is financially and physically responsible for the child; or
• A copy of child tax benefit or provincial tax benefit approval; or
• Confirmation of coverage under the Public Service Health Care Plan

Requests for appeals under the NJC Plan 55555

Appeals are scheduled in sequential order based on the date which they arrive at the NJC. Should documentation for the appeal be incomplete, the review of the file will be delayed.

Once the appeal file is complete, it is prepared for the Board of Management's review, and heard at its regular bimonthly meeting. Once the Board of Management has rendered a decision, a letter will be mailed to the plan member indicating the outcome. This decision is final.

For further information, please refer to the Dental Care Plan (DCP) Public Service of Canada employee booklet, which describes benefits for plan member.

Requests for independent review by the NJC Dental Care Plan Board of Management should be sent to:

As a result of the COVID-19 Pandemic, it is acknowledged that it may be more difficult for plan members to contact the NJC Secretariat in order to request an appeal of their claim under the NJC Dental Care Plan (Plan #55555). In order to facilitate this occurrence, you may prefer to send your request via electronic mail to the following: email.courrier@njc-cnm.gc.ca.

Do not send any personal information such as X-rays or other medical information. This type of information should be shared directly with the provider – Canada Life.