Pensioners’ Dental Services Plan (PDSP) Appeal Checklist

An appeal may be submitted when a plan member disagrees with the decision of the Plan Administrator (Sun Life) or the Government of Canada Pension Centre (Pension Centre). When coverage for a benefit has been denied, an appeal may be submitted for further review by the PDSP Board^{Footnote i}. 

Types of appeals

There are three appeal categories:

• Coverage^{Footnote ii}
• Enrolment^{Footnote iii}
• Other^{Footnote iv}

Who can submit an appeal

• A PDSP member^{Footnote v}
• A dentist or a family member on behalf of a PDSP member
• A legal guardian or a Power of Attorney on behalf of a PDSP member
• A compensation advisor (Pension Centre representative) on behalf of the PDSP member
• A PDSP member on behalf of their dependant(s), a spouse or dependant child(ren)

How to submit an appeal

To submit an appeal, a letter clearly outlining the reason for the appeal must be submitted along with the following information:

1. The member’s name, address, telephone number and email address, if available.
2. The member’s PDSP certificate number.
3. If the member is a retired member of the Federal public service, the Canadian Armed Forces or the Royal Canadian Mounted Police.
4. If the appeal concerns the member or the member’s dependant(s). For dependant appeals, include their full name and date of birth.
5. The appeal category: coverage, enrolment, or other (please specify).
6. A copy of the explanation of benefits denying coverage from Sun Life or any correspondence from the Pension Centre.
7. All correspondence with Sun Life or the Pension Centre related to the item(s) in the appeal.
8. Any supporting documentation from the dental provider.

Note: Appeal documentation must be sent by mail. Medical and dental records as well as information on dependant children and child custody are considered Protected B.

To avoid delays, as much detail as possible should be provided to support the appeal. Additional information may be requested by the PDSP Board upon review of the appeal, which could delay the final decision.

The appeal letter must be mailed to the Treasury Board of Canada Secretariat (TBS). All appeals containing sensitive information (Protected) are not accepted by email or fax.