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: Eden.Bedard@njc-cnm.gc.ca
Quarterly Report to the National Joint Council (June 2022)
Regular activities:
- The Board has met once (1) since the last Council meeting and examined four (4) appeals.
- The four (4) appeals reviewed by the Board were regarding requests for coverage, crowns, and a periodontal exam. Of the four (4) appeals, two (2) were upheld and two (2) were denied.
- Regarding the Board’s request to receive the Administrator’s adjudication guidelines for assessing claims to help the Board better understand Canada Life’s reasons for approval or denial of claims, Canada Life has agreed to share the relevant sections of the guidelines when reviewing appeals as needed during meetings.
- TBS provided the Board with an update regarding the claims audit of the Administrator, stating that there are significant problems from a legal perspective and the Department of Justice is now involved. However, TBS remains optimistic that an audit will start in 2022.
- The Board contributed to the creation and finalization of the 2021 Annual PSDCP Report.
- The Board provided feedback on a draft checklist created by TBS, that will be posted publicly to help Plan members better understand what is needed when submitting appeals to the Board.
- The Board has agreed to include “2022 Plan Review” as a standing item for future meetings, as they are hopeful TBS will soon issue a mandate to begin negotiations.
Outstanding item(s):
- The Board has four (4) outstanding appeals.
Next meeting: October 4, 2022