Public Service Dental Care Plan Appeal Checklist

Types of appeals

When submitting an appeal, your request should fall under one of the following three appeal categories:

• Coverage: This relates to an appeal about the adjudication of a PSDCP claim relating to specific dental services outlined in the PSDCP Rules.
• Enrolment: This relates to enrolment issues such as denied eligibility and that of a dependant child; amendments to coverage; disputed effective date of coverage for a dependant or spouse/common-law partner or administrative error.
• Other: This relates to situations that do not pertain to either the Coverage or Enrolment categories. An example would be a complaint about the services provided in processing a request (either by the Pay Centre or Canada Life).

Who can submit an appeal

• A PSDCP member^{Footnote 2}
• A dentist or a family member on behalf of a PSDCP member
• A legal guardian or a Power of Attorney on behalf of a PSDCP member
• A compensation advisor (Pay Centre representative) on behalf of a PSDCP member
• A PSDCP member on behalf of their eligible dependant(s), a spouse / common law partner or eligible dependant child(ren)

What to include in an appeal

To expedite an appeal, a letter clearly detailing the reason for the appeal should include:

1.  The member’s name, address, telephone number and email address.
   • If the appeal is for an eligible dependant, include their full name and date of birth, medical certificate if referring to a medical condition and any original documents (if applicable)
   • Upon assumption of guardianship or custody of a child that does not meet the definition under Rule 1 of the PSDCP Rules , please mail the original legal documents or court order as indicated in the PSDCP Member Booklet.
2. The member’s PSDCP certificate number.
3. The appeal category: coverage, enrolment, or other (please specify). 
4. If the appeal is related to coverage, include the member’s employment status such as, indeterminate, term, leave without page (LWOP), parental leave and relevant dates as appropriate.
5. A copy of:
   • The explanation of benefits from Canada Life that denies coverage.
   • All correspondence with Canada Life, the Pay Centre, departmental compensation advisor related to the appeal.
   • Any supporting documentation from the dental provider such as a treatment plan or a rationale for treatment.

Consult the PSDCP Member Booklet for additional information. To avoid delays, as much detail as possible should be provided to support the appeal. Additional information may be requested by the PSDCP Board of Management upon review of the appeal.

Where to send an appeal:

Appeal documentation must be sent by mail. Medical and dental records as well as information on dependant child(ren) custody are considered Protected B and cannot be emailed. 

If you are represented by the Public Service Alliance of Canada (PSAC): 

Board of Management
Dental Care Plan (PSAC) Component
90 Elgin Street
3rd Floor, Suite 3026
Ottawa, Ontario
K1A 0R5

If you are a member of the Canadian Armed Forces (CAF) or the Reserves:

Canadian Armed Forces 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, Ontario
K1A 0K2

If you are a member of the Royal Canadian Mounted Police (RCMP):

RCMP Dental Care Plan Board of Management
National Compensation Services: Insurance
73 Leikin Drive, M5-4-101
Mail stop 31
Ottawa, Ontario
K1A 0R2

For all other members:

Board of Management
Dental Care Plan (NJC)
P.O. Box 1525, Station B
240 Sparks Street West
7th floor
Ottawa, Ontario
K1P 5V2