Pensioners' Dental Services Plan enrolment information and plan summary

© Her Majesty the Queen in Right of Canada, represented by the President of the Treasury Board, 2011

Revised, September 2017

Table of Contents


Pensioners' Dental Services Plan

This booklet contains a summary of the Pensioners' Dental Services Plan (PDSP) Rules. If there are discrepancies or differences between this booklet and the PDSP Rules, the Rules will prevail.

You can access and download the complete PDSP Rules from the Treasury Board of Canada Secretariat website or obtain a printed copy from the Treasury Board of Canada Secretariat Distribution Centre. See Section E for contact information.

This booklet is intended for:

  • Retired persons and their dependants who meet the PDSP eligibility criteria and receive or will receive pensions under an Act of Parliament (see Question 2 in Section A of this booklet for a list of all eligible Acts).
  • Spouses, common-law partners, children, and students who meet the PDSP eligibility criteria and receive or will receive survivor pensions (see Question 2 in Section A of this booklet for a list of all eligible Acts).

Section A: Questions and Answers

  • What is the Pensioners' Dental Services Plan?

    The Pensioners' Dental Services Plan (PDSP) is a voluntary, contributory dental services plan established by the Government of Canada to provide eligible public service pensioners, and their eligible family members, with coverage for specific dental services and supplies that are not covered under a provincial or territorial health or dental care plan.

    The PDSP covers only reasonable and customary dental treatment necessary to prevent or correct a dental disease or defect, if the treatment is consistent with generally accepted dental practices. All entitlements are based on the PDSP Rules.

  • Who is eligible to apply?

    You are eligible to apply for membership in the Pensioners' Dental Services Plan (PDSP) under the following conditions:

    • You began receiving or will receive a pension (including a survivor's pension), annuity, or annual allowance under one of the following Acts of Parliament on or after :
      • Public Service Superannuation Act (except for limitations described in Question 3)
      • Canadian Forces Superannuation Act
      • Defence Services Pension Continuation Act
      • Royal Canadian Mounted Police Superannuation Act
      • Royal Canadian Mounted Police Pension Continuation Act
      • Members of Parliament Retiring Allowances Act
      • Judges Act
      • Governor General's Act
      • Lieutenant Governors Superannuation Act
      • Diplomatic Service (Special) Superannuation Act
      • Special Retirement Arrangements Act
    • You receive a pension (including a survivor's pension), annuity, or annual allowance or were entitled to a deferred annuity on , under one of the Acts listed above or under any other Act of the Parliament of Canada that provides for the payment of a pension or annuity as designated by the Treasury Board.
    • You are a former Member of Parliament who is eligible under section 71.2 of the Parliament of Canada Act, and you are considered eligible by the House of Commons or Senate Pension Offices.
    • You are an eligible survivor under one of the Acts listed above, even though you were not previously covered as a family member.

    Note: You do not have to be living in Canada to be eligible.

  • Which Public Service Superannuation Act pensioners are not eligible?

    Most Public Service Superannuation Act (PSSA) pensioners are eligible to apply for membership in the Pensioners' Dental Services Plan (PDSP). However, on or after , the following pensioners and their survivors are not eligible for membership:

    • Persons who defer their PSSA pension entitlement under the PSSA Divestiture Regulations upon transfer to an external employer; or
    • Persons who, on their pension entitlement date, received or will receive a PSSA immediate or deferred annuity as a result of retirement from an agency or entity not included in Schedule IV of Financial Administration Act or Schedule 1 of the PDSP Rules.

    For additional information, consult your pension office (see Section D for contact information).

  • When can I enrol?
    • You can enrol immediately, that is, when your pension entitlement begins; or
    • You can enrol at a future date.
  • When does coverage start?

    If you are eligible and apply within 60 days of the date you become entitled to your pension (including eligible survivors), coverage will begin on the effective date of your pension entitlement.

    Example: If your pension entitlement begins on , and you apply for Pensioners' Dental Services Plan (PDSP) coverage on (within the 60 days), your coverage begins on .

    If you apply more than 60 days after the date you become entitled to your pension (including eligible survivors), your coverage will begin on the first day of the second month following the date your pension office receives your completed and signed PDSP form.

    Example: If your pension entitlement begins on , and the pension office receives your completed and signed form on (after the 60-day period), your coverage will begin on .

  • What if I have coverage under another dental plan?

    You can enrol in the Pensioners' Dental Services Plan (PDSP) even if you and your family members have coverage under another (non-PDSP) dental plan. You may claim reimbursement under both plans. This is called coordination of benefits. The combined reimbursement from all plans cannot exceed 100 percent of the actual expenses.

  • Can my spouse and I cover each other as family members under the Pensioners' Dental Services Plan?

    No. An individual cannot be covered under the Pensioners' Dental Services Plan (PDSP) as both a member and a covered family member. There is no coordination of benefits between two (2) PDSP members

  • Which family members can be covered?

    If you are a member of the Pensioners' Dental Services Plan (PDSP), you can provide coverage for your eligible spouse or common-law partner and eligible children. Questions 9 and Question 10 explain who can be considered an eligible family member.

    There is no time limit within which you must apply to cover eligible family members. You can include them when you join the PDSP, or you can amend your coverage to add them at a later date.

    If you include your eligible family members on your PDSP form when you first join the Plan, their coverage will start the same date as yours. If you apply for coverage for eligible family members after you become a PDSP member, their coverage will be effective on the first day of the second month following the date your pension office receives your completed and signed PDSP form. (See the examples in Question 5.)

  • What do "spouse" and "common-law partner" mean?

    The term "spouse" means the person to whom you are married. Divorced spouses cannot be covered under the Plan.

    The term "common-law partner" means the person with whom you have been cohabiting in a conjugal relationship for a continuous period of at least one year and with whom you continue to cohabit.

    If you have both a spouse and a common-law partner, you can cover only one of them under the Pensioners' Dental Services Plan (PDSP).

  • What does "child" mean?

    A child means your unmarried child or your spouse or common-law partner's unmarried child, including:

    • an adopted child;
    • a stepchild; and
    • a child "adopted in fact" who is financially dependent primarily on you or your spouse or common-law partner for support and maintenance. The relationship must be like that of a parent and child, and must be expected to be permanent or of a lengthy duration. The relationship must have started before the child reached the age of majority of the province in which you live. If the child is under the age of majority, you or your spouse or common-law partner must have the care and control of the child. You will be asked to provide documentation to substantiate the relationship.

    A child must also be:

    • under 21 years of age or under 25 years of age and attending school full‑time; or
    • a dependant at 21 years of age or older incapable of engaging in self-sustaining employment because of a mental or physical impairment. A child who meets this definition can be covered only if he or she meets certain other conditions as set out in the Pensioners' Dental Services Plan (PDSP) Rules. Documentation to substantiate your child's condition will be required. Please contact your pension office for additional information.

    Notes on child eligibility:

    A child can be covered by only one (1) PDSP member at a time.

    You cannot cover a child who is already a PDSP member in his or her own right.

    Periodic audits are conducted for children aged 21 to 25 who are enrolled as students. You may be required to provide documentation to substantiate ongoing full-time attendance at school.

    A student's coverage is suspended but not terminated during vacation or other periods of non-attendance at school. Claims will be honoured once the student is again attending school full‑time, provided that he or she continues to meet the PDSP eligibility criteria.

  • When does coverage for my eligible family members start?

    Coverage for eligible family members begins on the same day as your coverage, if you apply to cover them when you initially enrol.

    In any other situation, coverage for your eligible family members will start on the first day of the second month following the date your designated pension office receives your completed Pensioners' Dental Services Plan (PDSP) form to enrol your eligible dependants.

  • When can I make a claim for dental services?

    You may submit a claim for eligible dental services for yourself and your eligible dependants from the date coverage begins.

  • When does membership and coverage end?

    Your coverage will end on the earliest of the following:

    • the date you die (eligible survivors will be given the opportunity to apply in their own right);
    • the first day of the second month following the month in which you cease to be an eligible pensioner; or
    • the first day of the second month following the date your pension office receives your written request to voluntarily terminate coverage, if you meet the eligibility criteria described below.

    Voluntary termination of coverage

    You may voluntarily request termination in writing provided you have met the mandatory enrolment period (see Question 14).

    Note: If you voluntarily terminate your coverage, it cannot be reinstated in the future.

  • What is the mandatory enrolment period?

    When you enrol, you agree to participate in the Pensioners' Dental Services Plan (PDSP) for a minimum of three (3) complete calendar years. In addition, you must also maintain coverage for each eligible family member for a minimum of three (3) complete calendar years before you can withdraw.

    Example 1:

    If you became a member (Category 1—Pensioner only) on , you cannot voluntarily withdraw until after .

    If you add an eligible dependant to your Plan, the three‑year mandatory enrolment period applies to the added dependant.

    Example 2:

    If you became a member on , and added a family member on , you cannot voluntarily withdraw until after .

    Exception: There is an exception to the mandatory enrolment period. You may voluntarily withdraw from the PDSP at any time if you become employed in the federal public service and become covered under the Public Service Dental Care Plan, or if you become entitled to dental services as a member of the Canadian Forces (including the Reserve Force), the Royal Canadian Mounted Police, or through the Veterans Affairs Canada Dental Services Program. If you withdraw under this provision, you will be able to reinstate your coverage at a later date. Contact your pension office for more details (see Section D).

  • What do I do if there is a change in my family circumstances?

    There may be circumstances that change your coverage needs. Such circumstances could include:

    • the death of a spouse, common-law partner or covered child;
    • a divorce or legal separation;
    • a new marriage or common-law partnership;
    • the birth or adoption of a child;
    • a covered child reaching age 21, or a full-time student reaching age 25.

    To ensure your coverage is kept up-to-date, it is important to communicate with your pension office to report these changes. You must complete, sign and mail a Pensioners' Dental Services Plan (PDSP) form to your pension office to effect any changes to your coverage. These forms are multi-purpose and are used to start, amend or terminate PDSP coverage. You can obtain a form by calling your pension office (see Section D).

    In general, any change in coverage will take effect on the first day of the second month following the date the pension office receives your completed PDSP form.

    Please note that an original signature is always required; therefore, a facsimile or a photocopy of your PDSP form cannot be accepted.

  • When does my spouse or common-law partner's coverage end?

    Your spouse or common-law partner's coverage will end on the earliest of the following:

    • the date your coverage ends;
    • the date your spouse or common-law partner dies or ceases to be your spouse or common-law partner (see Question 9); or
    • the date your spouse or common-law partner becomes a Pensioners' Dental Services Plan (PDSP) member in his or her own right.

    It is your responsibility to ensure that your coverage meets your needs and to contact your pension office should an amendment be required (see Section D).

    Voluntary termination: You can voluntarily request termination of your eligible spouse or common-law partner's coverage provided that he or she has been covered for the mandatory period of three (3) complete calendar years. In this case, coverage ends on the first day of the second month following the date your pension office receives a completed PDSP form to voluntarily terminate coverage.

    Note: If you voluntarily terminate an eligible family member's coverage, you cannot reinstate coverage for this person in the future.

    Exception: If you and your spouse have entered into a formal separation agreement and your spouse consents in writing to the termination of his or her PDSP coverage, termination will be granted before the mandatory period of three (3) complete calendar years.

  • When does my child's coverage end?

    Your child's coverage will end on the earliest of the following:

    • the date your coverage ends;
    • the date your child marries, dies or ceases to meet the definition of child (see Question 10);
    • the date your child ceases to be your legal responsibility through adoption; or
    • the date your child becomes a Pensioners' Dental Services Plan (PDSP) member in his or her own right.

    It is your responsibility to ensure that your coverage meets your needs and to contact your pension office should an amendment be required.

    Voluntary termination: You can voluntarily request termination of your eligible child's coverage provided that he or she has been covered for the mandatory period of three (3) complete calendar years. In this case, the coverage ends on the first day of the second month following the date your pension office receives a completed PDSP form.

    Note: If you voluntarily terminate an eligible family member's coverage, you cannot reinstate coverage for this person in the future.

  • How much does coverage cost?

    The Pensioners' Dental Services Plan (PDSP) costs are equally shared between the plan member and the Government of Canada.

    The contribution rates depend on the "category of coverage" selected. Only one category of coverage can be chosen. Amendments to coverage can increase or decrease the monthly contribution (e.g., enrolling a new spouse, a covered child reaching the age of 21 and no longer in school, etc.).

    The following table contains the monthly PDSP contribution rates effective .

    Category of Coverage Member's Monthly Contribution Ratestable note 1 *

    Table 1 Notes

    Table Note 1

    Contribution rates are subject to change.

    Return to table note 1 * referrer

    Category I - Pensioner only $17.46
    Category II - Pensioner and one eligible family member $36.85
    Category III - Pensioner and more than one eligible family member $44.38
  • Is tax added to the cost?

    Pensioners' Dental Services Plan (PDSP) contributions are not subject to GST.

    In Ontario and Quebec, sales tax is added to the plan member's contribution rate and will be deducted from your pension. These taxes are in addition to the contribution rates shown in the previous tables. If you live in Ontario, 8 percent Ontario provincial sales tax is added; if you live in Quebec, 9 percent Quebec sales tax is added.

    Tax rates may change subject to provincial and federal regulations.

    If you reside in Quebec, unless you are receiving a survivor pension, the Government of Canada's share of your PDSP contribution is a taxable benefit.

  • How do I pay my contributions?

    The monthly contribution and any applicable tax will be deducted from your monthly pension to provide coverage for the following month.

    No contribution is required for the month your coverage begins, unless it begins on the first day of the month.

    Contributions will begin or change as soon as your pension office can process your completed and signed Pensioners' Dental Services Plan (PDSP) form. Additional contributions may be required for one or more months when starting or amending coverage to recover or refund arrears as required.

    If your net pension is too small for a deduction to be made, you must pay your contributions to your pension office regularly in advance. If you do not make the required contributions, no benefits will be paid until the contributions are paid. Should contributions not be paid after the mandatory membership period ends, coverage will terminate, and you will not be able to become a member again.

  • Which is my designated pension office for Pensioners' Dental Services Plan enrolment purposes?

    Your pension office in most cases is your pension administrator. For enrolment, eligibility and contribution inquiries, contact your pension office (see the contact list in Section D.)

    For benefit coverage or claim inquiries, contact Sun Life Assurance Company of Canada (Sun Life) toll-free at 1-888-757-7427 in North America or 613-247-5100 in the National Capital Region.

Section B: Overview of Benefits

To be eligible for coverage, dental services must meet generally accepted industry standards, the guidelines developed for the purposes of the Pensioners' Dental Services Plan (PDSP), and the adjudication practices agreed on between the Administrator of the PDSP and the Treasury Board of Canada Secretariat.

Services must be performed by a dentist, dental specialist, dental mechanic, or dental hygienist (under the direct supervision of a dentist unless licensed to provide such services without direct supervision in the province or territory where the services are performed).

It is strongly recommended that you send Sun Life an estimate, before the work begins, for any treatment or procedure that will cost more than $300.

What benefits will be paid?

If you live in Canada, eligible expenses are generally reimbursed based on the maximum amounts listed in the Dental Association fee guides from the previous year, specifically as follows:

  • for services received in Canada (except in Alberta), the fee guide in the province or territory where the treatment is received;
  • for services rendered in Alberta, the annual Dental Reimbursement Guide Sun Life establishes in accordance with Canadian Life and Health Insurance Association (CLHIA) guidelines; and
  • for services received outside Canada, the fee guide in the province or territory where you normally live.

If you are living outside Canada, reimbursement is based on reasonable and customary charges in the area where the services were performed.

Maximum reimbursement and deductible amounts

Annual Deductible

The annual deductible is a specific dollar amount that you must satisfy each calendar year before you receive reimbursement on your first claim. The annual deductible amount is $25 for one covered person or $50 for more than one covered person.

Maximum Reimbursement

Once the annual deductible has been satisfied, the Pensioners' Dental Services Plan (PDSP) will reimburse 90 percent of eligible preventive and basic dental services and 50 percent of eligible major dental services up to a yearly total combined maximum of $1,500 (or $750 if coverage began after July 1st). This maximum amount applies to each covered person per calendar year.

Orthodontic services have a separate lifetime limit of $2,500.

Limitations

There are limits on how often certain dental services will be covered. The following examples do not include all limitations; please see the Member Booklet and Plan Rules for more details:

  • Dental polishing—once every nine months;
  • Relining or rebasing of removable dentures—once every 36 months;
  • Scaling and root planing services—generally not more than six 15-minute time units each calendar year;
  • Expenses for crowns will be reimbursed only when the structure of the tooth cannot be adequately restored by a filling and, in the case of the replacement of a crown, when the original crown is at least five years old;
  • Generally, denture replacement is an eligible service only when the existing denture is at least five years old and cannot be made serviceable; and
  • Dental implants are not covered under the Pensioners' Dental Services Plan (PDSP); however, a benefit may be paid based on the reasonable and customary charges for a less expensive alternative course of treatment that is eligible under the Plan.

Benefits reimbursed at 90 percent

The following list provides examples and is not complete; please see the Member Booklet and Plan Rules for more details:

  • Diagnostic—examinations, x-rays, laboratory examinations (excluding services related to major prosthodontic and orthodontic).
  • Preventive—dental cleaning and polishing, topical application of fluoride, space maintainers.
  • Minor restorative—amalgam, silicate, acrylic, or composite.
  • Endodontics—root canal therapy.
  • Periodontics—treatment of gums.
  • Minor prosthodontic (services for removable dentures)— repairs and adjustments, relining and rebasing.
  • Surgery—extractions of teeth, other surgical procedures.
  • Adjunctive services—emergency services not otherwise specified, anaesthesia.

Benefits reimbursed at 50 percent

The following list provides examples and is not complete; please see the Member Booklet and Plan Rules for more details:

  • Major restorative—gold and porcelain restorations (inlays), crowns.
  • Major prosthodontic—repairs of fixed dentures (bridges), complete dentures, partial dentures, fixed bridges (abutments, pontics), replacements subject to five‑year limitations.
  • Orthodontic—surgical services, observation and adjustments, fixed appliances, removable appliances.

Section C: Enrolment Instructions

How do I enrol in the Pensioners' Dental Services Plan?

If you are about to retire, you can obtain the Pensioners' Dental Services Plan (PDSP) form from the Government of Canada Pension Centre. Part A of the form will be pre-filled. You must complete Part B carefully, following the instructions provided with the form.

If you are already retired or become entitled to a survivor pension, you can obtain the PDSP form from your pension office. Part A of the form will be pre‑filled by your pension office. You must complete Part B carefully, following the instructions provided with the form.

The PDSP form is multi-purpose and is used to enrol, amend or terminate PDSP coverage. If you have questions, contact your pension office (see Section D).

Note: Incomplete forms can cause delays to coverage start and stop dates.

Section D: Contact Information

Public Service Superannuation Act Pensioners

Address
Public Works and Government Services Canada
Government of Canada Pension Centre
PO Box 5244
Shediac NB E4P 8T8

In Canada and US—Toll-free
1-800-561-7930

Outside Canada and US
506-533-5800
(collect calls accepted)

Telephone Teletype (TTY): 506-533-5990
(collect calls accepted)

RCMP Pensioners (for Pensioners' Dental Services Plan purposes only)

Address
Public Works and Government Services Canada
Government of Canada Pension Centre
PO Box 5244
Shediac NB E4P 8T8

In Canada and US—Toll-free
1-800-561-7930

Outside Canada and US
506-533-5800
(collect calls accepted)

Telephone Teletype (TTY): 506-533-5990
(collect calls accepted)

Canadian Forces Pensioners

Address
Canadian Forces Pensions
1451 Coldrey Avenue
Ottawa ON K1A 0S5

Local telephone number
613-952-9933—Bilingual Service

In Canada—Toll-free
1-800-267-0350—Bilingual service

Outside Canada—Call collect
613-952-9933—Bilingual service

Members of Parliament Pensioners

Address
House of Commons Pension Office
1451 Coldrey Avenue
Ottawa ON K1A 0S5

Local telephone number
613-957-0440—Bilingual service

In Canada and US—Toll-free
1-800-883-2456—Bilingual service

Outside Canada and US—Call collect
613-957-0440—Bilingual service

Senate of Canada Pensioners

Address
Senate of Canada Pension Office
40 Elgin Street
Ottawa ON K1A 0A4

Local telephone number
613-995-3990—Bilingual service

In Canada and US—Toll-free
1-800-267-7362—Bilingual service

Outside Canada and US—Call collect
613-995-3990—Bilingual service

Judges Act Pensioners

Address
Office of the Commissioner for Federal Judicial Affairs
99 Metcalfe Street, 8th Floor
Ottawa ON K1A 1E3

Local telephone number
613-995-5140– Bilingual service

In Canada and US—Toll-free
1-877-583-4266—Bilingual service

Outside Canada and US—Call collect
613-995-5140—Bilingual service

Section E: Plan Administrator

For information about your Pensioners' Dental Services Plan (PDSP) benefits, contact Sun Life Assurance Company of Canada:

  • 1-888-757-7427 toll-free in North America
  • 613-247-5100 in the National Capital Region

Call Centre Representatives are available to take your calls from Monday to Friday, 7:00 a.m. to 8:00 p.m., Eastern Standard Time.

Booklet and Rules Distribution

The Enrolment Information and Plan Summary is also available in alternative formats and on the Treasury Board of Canada Secretariat website.

Copies of this booklet and the Pensioners' Dental Services Plan (PDSP) Rules may be obtained by contacting:

Distribution Centre
Treasury Board of Canada Secretariat
300 Laurier Avenue West
Ottawa ON K1A 0R5
Tel: 613-995-2855
Fax: 613-996-0518
Email: Contact Distribution Centre by E-mail : Services-Publications@tbs-sct.gc.ca

TBS Distribution Centre Stock Numbers:
PDSP Rules—TBS 006779
Enrolment Information and Plan Summary—TBS 006796

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