Dependants' Dental Care Plan - Frequently asked questions

Q1. What is the Public Service (PS) Dental Care Plan (DCP)? How is it related to the Dependants’ Dental Care Plan (DDCP)?

The DDCP is one of the five components under the Public Service DCP. The DCP reimburses plan participants for reasonable and customary dental treatment necessary to prevent or correct dental disease or defect, provided the treatment is consistent with accepted dental practices. The DCP is for public service employees and their eligible dependants, eligible dependants of Regular Force (Reg F) members, eligible members of the Reserve Force (Res F) and/or their eligible dependants, and the eligible dependants of RCMP members.

Q2. Who administers the Dependants’ Dental Care Plan (DDCP)?

Great-West Life (GWL) is the Plan Administrator for the DDCP.

Q3. Can I participate in the Dependants’ Dental Care Plan (DDCP)?

As a member of the Reg F or Res F on Class C service you can only cover your eligible dependants under the DDCP. Dependants are defined as:

(a) Eligible spouse: a person legally married to you or a person who is living with you in a common-law relationship which has been recognized in accordance with the provisions of Queen’s Regulations and Orders (QR&O’s) 1.075.

(b) Eligible children

• your unmarried child(ren), including an adopted child, a step-child or a foster-child, provided he or she is not a member of the Plan as an employee: and
• under 21 years of age; or
• between 21 and 25 years of age and in full-time attendance at an educational institution; or
• 21 years of age and over with a mental or physical impairment who is incapable of engaging in self-sustaining employment and is primarily dependent upon you for support

Note: Your child must meet this definition on the date you join the Plan; otherwise, the child has to have been covered under the Plan immediately before his or her 21st birthday. If the child becomes impaired after reaching the age of 21, the child must have been covered as a student at the time the impairment began.

Q4. Can I get coverage for a child if I am the permanent guardian or have a custodial order or a notarized private guardianship agreement?

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 CF Dental Care Board, which determines eligibility in such instances. Supporting documentation must be submitted to the CF Dental Care Board. Examples of supporting documents include:

• a permanent guardianship (court) order;
• a custodial (court) order;
• a notarized private guardianship/care-giving agreement or a notarized voluntary surrender of custody and guardianship, indicating the parent(s) relinquish parental responsibility to you.

The Board will also consider the extent to which you, as the plan member, are financially responsible for the child; whether your relationship is that of parent and child, and the expected duration of the relationship.

You may write or send correspondence to the Board at:

CF 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 ON K1A 0K2

Q5. Can I get dental coverage for myself under the Plan?

No. IAW QR&O 35.04(1), a member of the Reg F is provided comprehensive dental treatment from CAF Dental Services except beyond the 21st day of a period of absence without authority, or beyond the date of the member’s release.

Res F members should consult the Reserve Dental Care Plan for coverage options.

Q6. What is the DDCP Plan Policy Number?

The DDCP Plan Policy number is 55777. This number must appear on any claim sent to GWL.

Q7. What is a Plan Participant Identification Number? How do I get one?

Once enrolled in the DDCP, you use your Service Number (SN) as your PPIN.

Q8. What does the Dependants’ Dental Care Plan (DDCP) cost me?

The Government as the Employer pays the full cost of the DDCP. However, if you live in the Province of Quebec, the contribution made by the Employer on behalf of the member is a taxable benefit and is recorded on your Relevé 1.

Q9. How is my participation recorded?

Your participation in the DDCP must be recorded by your unit into the Human Resources Management System (HRMS). The information is used to notify Great-West Life of a member’s participation in the plan. A list of changes is sent to them at the end of every month. In order to alleviate any possible delay in processing dental claims, it is in your best interest to make certain your Orderly Room has updated your dental information within HRMS.

Please note that the following form is available on DHRIM/HRIC's intranet website. If you do not have access to the intranet website, send an email to: Healthanddental-Santeetdentaire@forces.gc.ca and we will provide you with the required form(s).

• HRMS 7.5 Guide - Dental Care Plan

Q10. Can I submit a claim if I am on approved leave without pay (LWOP) for maternity or parental reasons?

Yes. If you are on authorized leave without pay for maternity or parental reasons, you are entitled to continue coverage of your eligible dependants for the total period of your absence.

Q11. What types of leave without pay (LWOP) are covered under the Dependants' Dental Care Plan (DDCP)?

If you go on authorized LWOP for any of the following reasons, employer-paid coverage will be extended to you for the total period of absence:

• maternity leave;
• parental leave (within the 52-week period following the birth or adoption of a child);
• academic or technical training; when it is in the interests of the CF and the LWOP is authorized.

If you proceed on any other type of LWOP, employer-paid coverage will continue during the first three consecutive calendar months of leave. Following this period, if you would like to maintain your DDSP coverage, you must pay contributions (including applicable provincial sales tax) quarterly in advance, starting with the fourth month of your leave of absence and continuing for the duration of the LWOP, including the month you return to work. An example of this type of LWOP is as follows:

You take LWOP for Spousal Accompaniment from 1 August 2013 until 31 July 2016, and return to work 1 August 2016. You have employer-paid DDCP coverage through the first three full months of LWOP (August, September and October 2013). This employer-paid coverage will cease on 31 October 2013. You must remit contributions in advance on a quarterly basis for the period beginning 1 November 2013 if you wish to have continued DDCP coverage throughout the remaining period of LWOP. Contributions would be required for November 2013 through August 2016 (inclusively) as employer-paid coverage would not be reinstated until December 1, 2012 (the first of the month following your return to work.

Q12. How do I claim dental expenses?

To claim reimbursement for your dependant’s eligible dental expenses (as provided in the Public Service Dental Care Plan (DCP) Member Booklet), you may either send a paper claim to GWL, or, if the service is available and your file has been created with GWL, your dentist may submit your claim electronically on your behalf.

On an authorized claim form, provide your full name and address (including your postal code), your plan number and your service number. You must ensure that your dentist has completed his or her section on the claim form and you must sign the claim form. Incomplete claims will be returned to you. Attach your bills/receipts which give full details for services rendered or purchases made.

Q13. How long do I have to submit a claim to Great-West Life (GWL)?

You have 15 months from the date on which the expense was incurred to submit your claim. Claims received after the 15 month period will not be paid unless you can demonstrate that it was impossible to submit the claim within that time. No claim will be paid if it is submitted more than twenty-four (24) months after the service was rendered except for cases of legal incapacity. For orthodontic treatment, a claim must be received within 15 months of each monthly visit throughout the treatment period.

Q14. How do I appeal a decision made by Great-West Life (GWL)?

Generally speaking, a disagreement about claims should be handled through GWL. Occasionally, a dispute may occur about the validity of a declined claim. When all other remedies have been exhausted, the matter should be referred to:

CF 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 ON K1A 0K2

Q15. What is a pre-determination of benefits and when should I get one?

If the cost for dental services for an eligible dependant is expected to exceed $300.00, you should get a predetermination of benefits statement from Great-West Life (GWL) before beginning a treatment or procedure. The predetermination of benefits statement will tell you in advance if the treatment or procedure is covered by the Plan and if so, the portion of the estimated cost that will be reimbursed to you.

To obtain a predetermination of benefits statement, you and/or the dentist should submit a claim for the estimated cost of the dental services to be rendered – do not sign section 1 of the claim form. For more information, refer to the Public Service Dental Care Plan (DCP) Member Booklet

Q16. Can I submit a claim for an ex-spouse?

No. See question # 3. Coverage ceases when the member's spouse ceases to be an eligible spouse.

A spouse from whom you are separated can still be covered under the plan until such time as they no longer meet the definition of an eligible spouse. It should be noted that dental coverage for other eligible dependants would remain in effect.

Q17. How do I end dental coverage for an ex-spouse or ineligible dependant?

To end dental coverage for an ineligible dependant you:

1. should contact your Unit Records Section (URS) or Unit Orderly Room (UOR) to ensure your personal record is accurate; and
2. must write to Great-West Life (GWL) indicating your plan number, ID number (service number), ex-spouse’ s name and their relationship to you (legal or common-law partner), their date of birth, the date of divorce, or, for those who are in a common-law relationship, the date the relationship ended. No legal documents are required. Great-West Life will also accept the request for termination electronically if it is sent by email or a scanned electronic letter. Faxed copies will not be accepted. If the member has other eligible dependants, their dental coverage would remain in effect.

Q18. Do I need to contact Great-West Life (GWL) to add a spouse or dependant?

There is no requirement to advise GWL in writing of the addition of an eligible dependant, however, to avoid any delays in claims processing, you may wish to advise GWL of your new dependant information. If this is the case, you can write to GWL indicating the plan number, your ID number (service number), name of the dependant, relationship to you, date of birth, adoption, marriage, or recognition of common-law relationship. No legal documents are required. GWL will also accept the request electronically, if sent by email or a scanned electronic letter. Faxed copies will not be accepted.

Q19. Who may contact Great-West Life (GWL) to make changes to make any changes to coverage?

Only you as the plan participant may add, delete or end coverage. Your information will be shared with no one.

Q20. Why would Great-West Life (GWL) reject a claim for dental work done during summer months for an eligible dependant who is in full-time post secondary school?

IAW the plan and the definition of an eligible child, dental coverage can be provided to children who are between twenty-one (21) and twenty-five (25) years of age and in full-time attendance at an educational institution. Consequently, claims for dental services rendered during the summer will not be processed until the fall when the child has enrolled in and has returned to their post secondary education. This protects the member from claims overpayment and overpayment recovery. To avoid possible rejection of claims for dental services performed over the summer months for your eligible dependant in full-time post secondary school, you should not submit the claims until the child has returned to their post secondary education.

Q21. Does my dental coverage continue after I release from the Canadian Armed Forces (CAF)?

Your coverage under the DDCP ends automatically on the date of your release from the CAF.

Q22. What dental coverage is available after I release?

If you are receiving a Canadian Forces Superannuation Act (CFSA) pension, you may choose to have dental coverage for yourself and/or your eligible dependants under a separate premium-based plan. This plan is called the Pensioners Dental Services Plan (PDSP) and it is administered by the Sun Life Assurance Company. The necessary application forms are provided by your Release Office. Coverage under the PDSP is not automatic. You should be aware that the costs and coverage under the PDSP are not necessarily the same as under the CF Dental Care Plans.

Note: To ensure a smooth transition into the new plan and to avoid any delay in coverage, you have to complete and submit the correct forms within 60 days of the date you become entitled to your pension.

Further information on the PDSP can be found in the PDSP Rules and in the Enrolment Information and Plan Summary booklet.

Q23. How can I contact Great-West Life (GWL)

Members may call Great-West Life (GWL) toll free at:

Great-West Life Assurance Company

English 1-800-957-9777
French 1-800-957-9777

Or by mail: