The Dental Care Board of Management (NJC Part) is responsible for the overall administration of the Plan, resolving members' complaints regarding eligibility or claims disputes with the Administrator, monitoring the claims settlement performance of the Administrator, and recommending changes to the Plan.
Committee Advisor: Michelle.Clément@njc-cnm.gc.ca
Quarterly Report to the National Joint Council (March 2018)
- The Committee has met three (3) times since the last Council meeting. Thirty one (31) appeals were reviewed. Ten (10) upheld, twenty (20) denied, and one (1) deferred for request of additional information. The Board was able to eliminate the backlog in the appeals during the last months.
- One of the appeals concerned a request from the Administrator for reimbursement for an event that occurred 25 years prior. The Board upheld the appeal and allowed the reimbursement of the filling noting that it would be unreasonable to seek reimbursement of an overpayment after 25 years without any evidence of the claim and the dentist who performed the treatment in 1992.
- Among all the appeals, we can observe the following trends late claim of orthodontic treatment, recall exam before the timeframe, and confusion concerning the alternate benefit clause. The Board discussed about the possibility of having a better communication with the Plan participants to remind them of and explain the Dental Care Plan provisions.
Plan negotiation activities:
- The Board has received an update on the status of the Plan negotiations by W. Leffler from TBS at the last meeting. There were concerns about the delay the arbitration will cause to the negotiations. The NJC Bargaining Agents asked if there is a possibility to negotiate their own plan. W. Leffler will be able to come back at the Board in March and discuss further about this matter.
- Two (2) appeals
Next meeting: June 20, 2018