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

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 Great-West Life (GWL). When an issue cannot be resolved with GWL, the matter should be referred to the Board of Management for reconsideration.

What should be included in the appeal:

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:

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 Great-West 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:

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:

Secretary to the Dental Care Plan Board of Management
National Joint Council
C.D. Howe Building, West Tower
7th Floor, 240 Sparks Street
PO Box 1525, Station "B"
Ottawa, ON K1P 5V2