How to File a Dental Appeal at the National Joint Council

If you disagree with a decision made by the plan administrator, you may submit an appeal to the appropriate Public Service Dental Care Plan Board of Management Component. Here are the following Boards of Management and where to send an appeal to:

If you are represented by the Public Service Alliance of Canada (PSAC): 

Board of Management
Dental Care Plan (PSAC) Component
90 Elgin Street
3rd Floor, Suite 3026
Ottawa, Ontario   K1A 0R5

If you are a member of the Canadian Armed Forces (CAF) or the Primary Reserve:

Canadian Armed Forces Dental Care Plan Board
Director General Compensation and Benefits
Directorate of Pensions and Social Programs
MGen George R. Pearkes Building
101 Colonel By Drive
Ottawa, Ontario   K1A 0K2

If you are a member of the Royal Canadian Mounted Police (RCMP):

RCMP Dental Care Plan Board of Management
National Compensation Services: Insurance
73 Leikin Drive, M5-4-101
Mail Stop 31
Ottawa, Ontario   K1A 0R2

For all other members of Public Service Departments and Eligible Agencies (NJC Plan):

Board of Management
Dental Care Plan National Joint Council (NJC)
P.O. Box 1525, Station B
240 Sparks Street West
7th floor
Ottawa, Ontario   K1P 5V2

APPEAL PROCEDURE FOR THE NJC DENTAL CARE PLAN BOARD OF MANAGEMENT 

If your plan number is 072111, 072112, 072113, or 072114 then please follow these procedures:

Appeals typically fall into three categories:

• Claims
  • You disagree with the reason Canada Life gave for denying a dental claim or you believe that an error was made.
• Enrolment
  • Enrolment issues such as:
    • denied eligibility for yourself or a dependant;
    • amendments to coverage;
    • disputed effective date of coverage;
    • leave without pay coverage;
    • administrative error.
• Other Issues
  • Issues not related to claims or coverage, such as a complaint about services provided by Canada Life or errors by the Pay Centre or the departmental pay office.

Your appeal should include why you disagree with the claim or coverage decision and the following information:

• The plan member’s name, address, telephone number and email address:
  • If the appeal is for an eligible dependant, include their full name and date of birth, medical certificate, if referring to a medical condition, and any relevant documentation.
• The plan member’s PSDCP certificate number and plan ID number
• The category of the appeal: coverage, enrolment or other
• Copies of supporting documents such as:
  • The explanation of benefits statement from Canada Life;
  • Correspondences with Canada Life or your departmental compensation office or Pay Centre related to the appeal;
  • Documentation from the dental provider including a treatment plan, additional medical information or a rationale for the dental services;
  • Additional information may be requested by the applicable PSDCP Board of Management before an appeal decision is final;
  • if applicable, the latest decision from the Canada Life process outlining their rationale for denial (which could include the explanation of benefits).

The Boards of Management may meet bi-monthly, quarterly or less frequently depending on the volume of appeals. The response to an appeal may take a few months.

The decision of the Board of Management is final unless an appellant can provide new information not previously considered.

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.

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