Reserve Dental Care Plan - Frequently asked questions
Q1. What is the Public Service (PS) Dental Care Plan (DCP) and what is its relationship to the Reserve Dental Care Plan (RDCP).
The RDCP 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 is the Plan Administrator for the Reserve Dental Care Plan (RDCP)?
Great-West Life (GWL) is the Plan Administrator for the RDCP.
Q3. Can I participate in the Reserve Dental Care Plan (RDCP)?
Before becoming eligible to be a participant under the RDCP, you must have completed 3 months of continuous service in either the Regular Force (Reg F) or the Reserve Force (Res F). This is a one-time requirement.
Q4. What coverage do I have under the Reserve Dental Care Plan (RDCP)?
A member’s coverage depends upon the Reserve Force Class (Cl) of Service that they are performing. If the member is serving on Cl A or Cl B service less than 180 days, the member is only entitled to cover themselves under the plan, if they meet eligibility criteria as stated in Section 2 of the CF Reserve Dental Care Plan Administration Instructions Revision 1.0 . A member who is serving on Cl B over 180 days (181 days or more) is not entitled to coverage for himself/herself, as he/she is covered under the CF Dental Health Care Services, but is entitled to cover their eligible dependants (see CF Dependant Dental Care Plan Revision 1.3 )
Q5. Is there a fee or premium associated with the Reserve Dental Care Plan (RDCP)?
No. The Government, as the employer, pays the full cost of the Dental Care Plan. However, if the member lives in the Province of Quebec, the contribution made by the Employer on behalf of the member is a taxable benefit.
Q6. What is the Plan number for the Reserve Dental Care Plan (RDCP)?
The Plan Policy number for the RDCP is 55999.
Q7. Where do I get my individualized certificate number?
Following enrolment in the Reserve Dental Care Plan (RDCP), members who are eligible to participate will be assigned a unique dental care certificate number from their Unit Orderly Room (UOR). Each certificate number will be assigned only once and will be retained for the duration of the member’s Reserve career.
Q8. When will I be issued with a Dental Plan Participation Card?
A dental plan participation card will not be issued until the member submits an initial claim. Once the initial claim is processed, Great-West Life (GWL) will issue a card.
Q9. When do I get a new certificate number?
Once you are a participant in the Reserve Dental Care Plan (RDCP) and have been assigned a certificate number by your Unit Orderly Room (UOR), this certificate number shall be retained by you for the duration of your Reserve service, regardless of class/length of employment, transfers or release.
Q10. How is my participation recorded?
Your participation in the Reserve Dental Care Plan (RDCP) must be recorded in the Human Resources Management System (HRMS). Although coverage for the plan is entirely paid for by the Treasury Board (TB), there is a clear requirement to identify participating members and the level of their coverage. It is in your best interest to make certain your Orderly Room has updated your dental information within HRMS.
Information on how to input dental participation into HRMS can be found at the following link HRMS 7.5 Guide - Res Dental Plan Participation .
Q11. Can a member authorized Exempt Drill and Training (ED&T) for maternity or parental reasons submit a claim for dental services for themselves?
Yes. Under the provisions of the RDCP, a Cl A member, while on authorized ED&T for maternity or parental leave purposes, is entitled to continue their coverage for the total period of their absence.
Q12. What types of Leave Without Pay (LWOP)/Exempt Drill and Training (ED&T) are covered under the Reserve Dental Care Plan?
Employer-paid coverage will be extended to you for the total period of absence if LWOP or ED&T has been authorized for any of the following reasons:
- maternity purposes;
- parental purposes (within the 52-week period following the birth or adoption of a child);
If you proceed on any other type of approved LWOP/ED&T, employer-paid coverage will continue during the first three consecutive calendar months of leave. If you would like to maintain your RDCP coverage after this period, you must pay contributions (including applicable provincial sales tax) quarterly and in advance. Contributions will start with the fourth (4th) month of your LWOP/ED&T and will continue up to and including the month you return to work. An example of this is as follows:
e.g. You are approved ED&T from 1 August 2013 until 31 July 2016, and return to work 1 August 2016.
You have employer-paid RDCP coverage through the first three full months of ED&T (August, September and October 2013). This employer-paid coverage will cease on 31 October 2013.
If you wish to have continued RDCP coverage, you must remit contributions in advance on a quarterly basis for the period beginning 1 November 2013. Contributions would be required for November 2013 through August 2016 (inclusively) as employer-paid coverage would not be reinstated until September 1, 2016 (the first of the month following your return to work).
Q13. What is the process for submitting a dental claim?
Plan participants, once enrolled into the RDCP, must submit claims for reimbursement of reasonable and customary dental services and expenses, as outlined in the Public Service Dental Care Plan (PSDCP) Member Booklet, through their Unit Orderly Room (UOR).
Q14. Why must my claim be stamped by the Unit Orderly Room (UOR) prior to being sent to Great-West Life (GWL) for reimbursement under the Reserve Dental Care Plan (RDCP)?
The UOR uses the PRes Health Benefits Stamp to:
- substantiate that you meet the eligibility criteria;
- verify that you qualify to participate in the plan;
- verify that the claim is complete and that you have signed the claim; and
- authorize the claim form prior to sending to GWL.
Q15. What should I do when a claim is sent back from Great-West Life (GWL) stating they have two or more certificate numbers for me?
When you submit a claim and GWL locates two or more certificate numbers assigned to you, GWL will return the claim to you. You shall complete the claim form again, confirming with your UOR the first certificate number assigned to you under the RDCP.
Q16. Can a dentist submit electronic claims on my behalf?
No. Without the stamp of the member’s UOR, dental claims for the RDCP will not be processed by GWL and will be returned to the member.
Q17. How long do I have to submit a claim to Great-West Life (GWL)?
GWL must receive claims within fifteen (15) months of the date on which the service is rendered. Claims received after the fifteen-month period shall not be paid unless it was impossible to submit the claim within that time. However, except in the case of legal incapacity, no claim will be paid if it is submitted more than twenty-four (24) months after the service was rendered. For orthodontic treatment, a claim must be received within 15 months of each monthly visit throughout the treatment period. Provisions of the plan can be found in the CF Reserve Dental Care Plan Administration Instructions Revision 1.0
Q18. I have two dental plans in my name; one with the Reserves as a Cl A or B member under 180 days (RDCP), and the other through my civilian position. Once I have exhausted my benefits under my civilian plan, can I claim under the RDCP?
No. Members may not coordinate benefits for themselves. Members cannot hold coverage under two plans for themselves, regardless of Plan Administrator. Before determining a member’s eligibility, the UOR must ensure that the member meets the criteria of not having other dental insurance coverage where he/she is listed as the member/employee of another dental insurance plan.
Please Note: It is the member’s responsibility to advise their UOR whether or not they are a member of another plan before having their claim stamped and submitting the claim for reimbursement.
Q19. If I do not agree with a decision made by Great-West Life (GWL), what recourse do I have?
The member may not agree with how a claim was processed by GWL or with a decision concerning the eligibility of either themselves or a family member under the RDCP. Any disagreements on eligibility should first be discussed with the member’s UOR. Disagreement on how a claim was processed by GWL should first be discussed with GWL. Should these discussions with either the UOR or GWL fail to provide a solution, the member can request a review of the disputed issue by sending an appeal 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
Q20. What needs to be included when submitting a claim for dental services?
In addition to a completed claim form, you must ensure that you attach the bills/receipts, giving full details for services rendered, prior to sending to your UOR for verification.
Q21. What is a predetermination of benefits and when should I get one?
Before incurring actual expenses, you are encouraged to get a pre-determination of benefits where the cost is expected to exceed $300.00. It is in your best interest to determine what will be paid before treatment begins. A pre-determination of benefits is handled in the same manner as submitting a claim except that you do not sign section 1 of the claim form. Further information is provided under Section3: Dental Claims\Stamping the Claim in the CF Reserve Dental Care Plan Administrative Instructions Revision 1.0
Q22. What happens if my Cl B (181 days or more) employment is extended or shortened?
Extended period of service (beyond 181 days) - The member becomes entitled to dental coverage from CF Dental Services, effective the same date that the amended Statement of Understanding (SOU) authorizes the new period of service extending them over 181 days. They are also eligible to participate in the Dependants' Dental Care Plan effective that date if they have eligible dependants.
Shortened period of service (less than 180 days) - A member's coverage is affected when the member's period of Cl B service (181 days or more) has been shortened to a period of less than 180 days. The member becomes entitled to coverage for himself or herself only under the Reserve Dental Care Plan (RDCP), as the member ceases to be entitled to dental coverage from CF Dental Services, effective the date of the amended Statement of Understanding (SOU), which authorizes the new period of service. This also affects the eligibility for coverage of his eligible dependants. The dependants are no longer covered under the dental plan.
Q23. Is a member, who is covered under their parent’s component of the Public Service Dental Plan, entitled to be covered under the RDCP?
Once a Res F member is eligible in his/her own right to participate in the RDCP, they are no longer eligible for coverage through a parent who is a participant in any component of the Public Service Dental Care Plan (PSDCP).
Q24. Does dental coverage continue after I release from the CF?
A member’s membership in the RDCP ends automatically on the date of their release from the Canadian Armed Forces. If you are in receipt of a pension under the Canadian Forces Superannuation Act (CFSA), 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.
Q25. How can Great-West Life (GWL) be reached?
Toll Free Inquiries:
Members posted outside Canada:
Foreign Benefits Payments
PO Box 6000
Winnipeg MB R3C 3A5
Quebec residents other than National Capital Region:
800 de la Gauchietière St. W
Montréal QC H5A 1B9
Other Canadian resdents:
P.O. Box 6025, Station Main
Winnipeg, MB R3C 3C7
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