February 25, 2009
25.4.142
The employee grieved the department's denial of payment of excess dental costs, which surpass the costs which would have been incurred in Canada.
Bargaining Agent Presentation
The Bargaining Agent representative stated that the grievor had not been treated within the intent of FSD 39 – Health Care Expenses as although FSD 39.04 is silent with respect to limits and maximums, Instruction 6 following FSD 39.04 clarifies that an employee may claim for dental expenses to the extent which would place them in the same position as employees in Ontario. The bargaining agent further noted that this is supported by the Principle of Comparability as enunciated in the Introduction to the Foreign Service Directives.
The Bargaining Agent representative alleged that the claim would place the grievor in the same position as employees in Ontario who incur costs for orthodontic treatment which are in excess of the Public Service Dental Care Plan (PSDCP) ceiling. Although an employee residing in Ontario would be responsible for excess costs beyond the lifetime maximum under the PSDCP, this cost would not be as high as what the grievor was required to pay while at Post outside Canada. As such, the grievor is not looking for reimbursement for the full amount spent on orthodontia work at Post, but rather the difference between what he paid at Post, and what he would have paid had he continued to reside in Ontario. The Bargaining Agent representative suggested that through consultation with Great West Life, an assessment be made to determine the appropriate amount of reimbursement.
The Bargaining Agent representative further noted that the employee did not submit a pre-treatment plan to the Plan Administrator as he knew the maximum for orthodontic expenses had already been reached and nothing further could be claimed under the PSDCP. This however, should not preclude payment under FSD 39 – Health Care expenses.
The Bargaining Agent representative concluded by stating that the intent of the directive is to ensure that employees are placed in the same position as employees in Ontario and are not disadvantaged financially because of service outside Canada.
Departmental Presentation
The Departmental representative declared that although the PSDCP strongly recommends submitting a treatment plan before going ahead with dental services, the grievor did not do so. In addition, he did not submit a claim for dental expenses as he knew his lifetime limit for orthodontic services had been reached prior to posting and therefore the claim would have been rejected.
The Departmental representative indicated that despite FSD 39.04 Instruction 2 which indicates that where costs for medical and hospital care, drugs and/or dental treatment are excessive, and the treatment can be deferred, an employee should explore the possibility of obtaining treatment at an alternative location, the grievor did not seek approval from the employer beforehand, nor did he initiate discussions to explore different options in the circumstances prior to posting.
The Departmental representative concluded that when dental care claims are paid by the PSDCP, there can be no further compensation once the cost of treatment exceeds the lifetime limit. As the lifetime limit for orthodontic services had been reached prior to posting, there can be no reimbursement, nor would there have been for an employee living in Canada. As such, it was maintained that the grievor was treated within the intent of the directive.
Executive Committee Decision
The Executive Committee considered the report of the Foreign Service Directives Committee. The Executive Committee was unable to reach a consensus as to whether the grievor was treated within the intent of the Foreign Service Directives regarding the payment of excess dental costs. Therefore, the Committee reached an impasse.