Public Service Dental Care Plan Rules

General provision

3.(1) Subject to this Rule, every eligible employee shall become covered as a member under the Plan:

• as of the date the Plan came into effect, if employed on such date, otherwise
• as of the day following the date of completion of three (3) months of continuous eligible service, provided they qualify as an eligible employee on that date.

3.(2) Eligible employees who are on rehabilitation leave from the Canadian Forces will not be covered under the Plan until the later of:

• the day following the expiration of the rehabilitation leave, or
• the day following the completion of three (3) months of continuous employment from the employee’s date of eligibility.

3.(3) Effective June 1, 1988, all eligible employees and their eligible dependants are automatically enrolled in the Plan without having to complete an enrolment form.

Person on leave of absence without pay

3.(4) Where a person is on leave of absence without pay on the day they would under the terms of paragraph (1) become a member of the Plan, the date of coverage of such person shall be deferred to the first day of the month following the date the person resumes duty with pay as an eligible employee.

Coverage during leave without pay

3.(5)

• Subject to this Rule, a person to whom a leave of absence without pay is granted while they are a member of this Plan may continue to be a member of the Plan during such leave.
• Where a person to whom subparagraph (a) applies has been on a leave of absence without pay for a period of more than three (3) consecutive months, such person shall remit contributions in the manner and in the amount prescribed in Rule 7, except for leave of absence without pay described in subparagraph (b) of paragraph 1 of Rule 7.
• Notwithstanding subparagraph (a), where the contributions required to be made pursuant to subparagraph (b) and Rule 7 are not made, the person in respect of whom the contributions should have been made shall, subject to subparagraph (d), cease to be a member of the Plan on the last day of the month in respect of which the required contribution was last made.
• Where coverage has been discontinued in the circumstances described in subparagraph (c), it may only be reinstated on the first day of the month following the date the person resumes duty with pay as an eligible employee.

Member deemed eligible for coverage after layoff

3.(6)

• Subject to this Rule, an eligible employee who is laid off under the terms of the Public Service Employment Act or such other employment policy, while they are a member of this Plan, may continue to be a member of the Plan for a period of one (1) year from the date they were laid off.
• A person to whom subparagraph (a) applies shall remit contributions in the manner and in the amount prescribed in subparagraph (4) of Rule 7.
• Notwithstanding subparagraph (a), where the contributions required to be made pursuant to subparagraph (b) and Rule 7(4) are not made, the person in respect of whom the contributions should have been made shall, subject to subparagraph (d), cease to be a member of the Plan on the last day of the month in respect of which the required contribution was made.
• Where membership has been discontinued in the circumstances described in sub¬paragraph (c), it may only be reinstated on:
  • the first day of the month following the date the person resumes duty with pay as an eligible employee, provided they’ll enter the Public Service within one (1) year of layoff.

Termination of coverage

3.(7) Notwithstanding any other provisions, no person shall be covered as a member of this Plan:

• after the date the person ceases to be an employee, if this person resigned or retired from the Public Service, or
• after the date the person no longer qualifies as an eligible employee

whichever date comes first.

Re-employment

3.(8) Where an employee who was a member of the Plan ceases to be employed and again becomes employed in an eligible position three (3) months or less after termination of employment, coverage under the Plan shall resume the first day of the month following the date of re-employment.

Reinstatement as eligible employee

3.(9) An employee who ceased to be eligible for coverage under the Plan, as a result of changes to working hours or a transfer to a non-participating employer, and who subsequently becomes eligible again by starting to work more than one-third (1/3) of the standard full-time hours or with an organization participating in the Plan, shall have coverage under the Plan reinstated the first day of the month following the new date of eligibility provided that there is no break in service of more than five (5) working days immediately prior to this date.

Transfer to a position for a determinate period

3.(10) A person who was a member of the Plan immediately prior to an appointment to a position for a determinate period of less than six (6) months does not have to complete another period of three (3) months of continuous employment, as this person shall remain a member of the Plan for as long as employment continues without interruption.

Suspension

3.(11)

• A member under suspension may maintain coverage provided that the member pays the required contributions quarterly in advance, in the manner and in the amount prescribed in subparagraph (4) of Rule 7.
• Employer-paid coverage shall resume on the first of the month following the date the member returns to duty.

General provision

4.(1) Subject to paragraph (2) a member becomes eligible to cover a spouse or a common-law partner under this Plan on the later of:

• the date the employee becomes covered as a member of this Plan, and
• the first date the member acquires an eligible spouse or common-law partner.

In the case of a member who ceases to have an eligible spouse or common-law partner, the member shall again become eligible for coverage on such later date, if applicable, that they again acquire an eligible spouse or common-law partner.

Effective date of coverage

4.(2) The coverage of the spouse or of the common-law partner of a member shall be effective on the date the coverage for the spouse or the common-law partner of the member is effective.

Termination of coverage

4.(3) The coverage of the spouse or the common-law partner of a member shall terminate on the earlier of:

• the date the coverage of the member terminates, or
• the date the member no longer has an eligible spouse or common-law partner.

Termination of coverage as a spouse or common-law partner

4.(4) Notwithstanding any other provision of this Rule, no spouse or common-law partner of a member shall be covered under this Plan:

• after the date they no longer qualify as an eligible spouse or common-law partner under this Plan, or
• after the date the coverage of the member ceases,

whichever date comes first.

General provision

5.(1) A member shall be eligible for children’s coverage under this Plan on the later of:

• the first date the person acquires an eligible child, and
• the date the employee becomes a member of this Plan.

In the case of a member who ceases to have eligible children, the member shall again become eligible for children’s coverage on such later date, if applicable, that they again acquire eligible children.

Effective date of a child’s coverage

5.(2) The coverage of a child of a member shall be effective on the later of:

• the date they qualify as an eligible child, and
• the date the children’s coverage of the member is effective.

Notwithstanding the above provision, where coverage is on behalf of children who are covered under this Plan by the member’s spouse or common-law partner, the children’s coverage of such member shall be effective on the day the member submits a claim for a child’s coverage to the administrator.

Termination of children’s coverage

5.(3) The coverage of a member’s child shall terminate on the earlier of:

• the date the member’s coverage terminates, and
• the date the member’s child is no longer eligible.

Termination of a child’s coverage

5.(4) Notwithstanding any other provision of this Rule, no child of a member shall be covered under this Plan:

• after the day they no longer qualify as an eligible child under this Plan, or
• after the date the coverage of the member ceases,

whichever date comes first.

Definition of benefits

6.(1) Subject to the other provisions of the Plan, in this Rule,

• “covered expenses” means, where permitted by law, reasonable and customary charges for the eligible dental services provided to the member, their eligible spouse or common-law partner and their eligible children but, with respect to members residing in Canada, up to, but not exceeding, the amount shown in the previous year fee guide for dental practitioners and specialist fee guide where available, or such other fee guide or pricing methodology as may be adopted from time to time for the purposes of the Plan;
  • of the province or territory where services are rendered, where such services are rendered in Canada;
  • of the province or territory of residence of the member, where such services are rendered outside Canada.
• “co-insurance percentage” means that portion of covered expenses, for the applicable eligible dental services in excess of the calendar year deductible, which represents the amount of the benefit to which a member is entitled;
• “calendar year deductible” means the initial deduction on the first claim of each calendar year. Where there is a combined deductible, the amount will apply against the covered expenses of a member and their eligible dependants.

  It is provided that, if the first dental expenses in a calendar year is incurred in the last quarter of the year (October to December), and the applicable deductible has been paid, that deductible will be carried over to the following year.

Eligible dental services

6.(2) Subject to the other provisions of the Plan, “eligible dental services” means the dental services listed hereafter when rendered by a dentist or dental specialist, or rendered by a registered dental hygienist or a dental hygienist under the direct supervision of one of the above mentioned professionals or rendered by a denturist.

Where any province, state or country employs a coding of procedures for individual dental treatment which is different from that of the Canadian Dental Association, the appropriate codes of the guide of such province, state or country for the equivalent procedure shall apply. Where it cannot be ascertained that dental services rendered are eligible services, eligible services shall be such alternative services which are defined below as eligible dental services, as determined by the administrator. The PSDCP’s alternative benefit clause allows coverage of a less expensive, reasonable and customary alternative dental service.

• Diagnostic Services
  • examination and diagnostic
    • complete oral examination, once every three (3) years (36 months) (this limitation does not apply to limited new patient examinations)
    • recall oral examination, once every nine (9) months, or once every six (6) months in the case of eligible children only
    • specific oral examination
    • emergency oral examination
    • treatment planning
  • radiographs
    • complete series of periapical radiographs where required to support a proper course of treatment, but in no event more frequently than once every three (3) years (thirty-six (36) months)
    • occlusal films
    • bitewings where required to support a proper course of treatment, but in no event more frequently than once every nine (9) months, or once every six (6) months in the case of eligible children only
    • extra oral films
    • sialography, use of dyes
    • panoramic film, where required to support a proper course of treatment, but in no event more frequently than once every three (3) years (36 months)
    • interpretation of radiographs from another source
    • tomography, including but not limited to, cone beam computed tomography
  • tests, laboratory examinations
    • biopsy of oral tissue
    • pulp vitality tests
• Preventive Services
  • routine services
    • dental cleaning and polishing, but in no event more frequently than once every nine (9) months, or once every six (6) months in the case of eligible children only. Frequency limitations are waived for patients undergoing chemotherapy.
    • topical application of fluoride where required to support a proper course of treatment, but in no event more frequently than once every nine (9) months, or once every six (6) months in the case of eligible children only, Frequency limitations are waived for patients undergoing chemotherapy.
    • pit and fissure sealants
    • caries control
    • enameloplasty
    • oral hygiene instructions once per calendar year for eligible children only and once per lifetime for any other person
    • Prefabricated crowns for primary teeth
  • space maintainers (not involving movement of teeth); however adjustments within the first thirty-one (31) days of application shall not be covered.
• Direct to consumer devices
  • direct to consumer devices with the documented professional responsibility of a specific dentist duly licensed in the province or territory where the treatment took place
  • direct to consumer devices delivered and monitored in the dental clinic of a specific dentist duly licensed in the province or territory where the treatment took place
• Restorative
  • minor restorations
    • amalgam
    • acrylic or composite
    • pin reinforcements for these restorations

    Note: Replacement fillings for the same tooth and surface are covered no more than once every twenty-four (24) months for adults, and no more than once every twelve (12) months for eligible children.

  • major restorations
    • gold foil
    • inlays (gold and porcelain)
    • retention pins, posts and cores
    • crowns
    • implants
    • other restorative services
• Endodontics
  • pulp capping
  • pulpectomy or pulpotomy
  • root canal therapy
  • periapical services
  • other endodontic procedures
• Periodontics
  • non-surgical services
  • surgical services
  • post-surgical treatment
  • occlusal equilibration, not exceeding eight (8) time units every year (twelve (12) months)
  • scaling and root planing, limited to six (6) times units per calendar year. In cases of documented periodontitis, up to six (6) additional time units shall be allowed in a given calendar year with the pre-approval of a treatment plan by the administrator

    Note: Application for reimbursement for scaling and/or root planing may be made for up to two (2) time units if such application is made within three (3) months of the date the treatment was rendered.

  • other periodontic services
• Prosthodontics
  • minor services for removable dentures
    • repairs
    • adjustment
    • relining and rebasing, limited to once every three (3) years (thirty-six (36) months)
  • major
    • exams, films and diagnostic casts
    • addition of a tooth to a removable denture
    • complete dentures
    • partial dentures
    • fixed bridges (abutments retainers, pontics)
    • retentive pins in abutments
    • repairs of fixed appliances
    • other prosthodontic services
• Oral surgery
  • uncomplicated removal
  • surgical removal
  • tooth repositioning
  • alveoloplasty, gingivoplasty, stomatoplasty, osteoplasty, tuberoplasty
  • removal of excess mucosa
  • surgical excision
  • removal of cyst
  • surgical incision
  • removal of impacted teeth
  • repair of soft tissue
  • frenectomy, dislocations
  • miscellaneous surgical services
• Orthodontic Services
  • diagnostic services
    • orthodontic exam
    • films
    • orthodontic diagnostic casts
  • observation and adjustment
    • surgical services
    • observation and adjustment
    • repairs, alterations
  • appliances
    • removable appliances
    • fixed appliances
    • retention appliances
    • appliances to control harmful habits
• Adjunctive general services
  • emergency services not otherwise specified
  • anaesthesia in connection with oral surgery and drug injections or for any eligible services where a covered person has a documented mental illness or developmental disorder where the administration of such drugs is necessary for the safety of the patient and/or dental professional(s)
  • consultation
  • house call, hospital call and special office visit
• Services related to temporo-mandibular joint disorders
  • injections
  • appliances
  • assessments

Specific limitations with respect to major services

6.(3) Services listed in paragraph (2):

• with respect to insertion of prosthodontic appliances (e.g. fixed bridges, implants, partial or complete dentures, temporary or permanent), constitute eligible dental services only if they are rendered for:
  • an initial prosthodontic appliance, or
  • the replacement of an existing prosthodontic appliance, including the addition of teeth to an existing appliance, if
    • the replacement, or the addition of teeth is required because at least one additional natural tooth was extracted after the insertion of the existing appliance, and the appliance could not have been made serviceable. If the existing appliance could have been made serviceable, only the expense for that portion of the replacement appliance, which replaces the teeth extracted, shall be covered;
    • a period of sixty (60) months has passed since the previous replacement covered under the Plan, or
      • if no such coverage was provided, on initial replacement under the Plan, and once every sixty (60) months thereafter;
    • the existing appliance was temporarily inserted, provided the person was covered under the Plan when the temporary appliance and that such replacement appliance will thereafter be deemed permanent for the purposes of this provision;
    • the replacement appliance is required as a result of the installation of an initial opposing denture after the date they become covered under the Plan; or
    • the replacement appliance is required as a result of accidental dental injury to a natural tooth that occurred after the date they became covered under the Plan.
• with respect to crowns, the services for the replacement of a crown are eligible once every sixty (60) months from the date coverage was last provided, or, if no such coverage was provided, on initial replacement under the Plan, and once from the date of the previous placement every sixty (60) months thereafter.
  Notwithstanding the above, the 60-month period may be waived in cases where it is deemed necessary by the current treating dental practitioner. Such an exception shall normally be understood not to include failure of the appliance as a result of error in installation by a dental practitioner.
• A claim for major coverage shall not be denied where it is determined at a given point in time that there is insufficient structural damage to a tooth to be eligible for major services, but it is further determined that such damage is likely to worsen within a reasonable time period, resulting in eligibility for major coverage.

Amount of benefit

6.(4) Subject to the other provisions of this Rule, where an eligible member or dependant incurs covered expenses under the Plan, while covered by the Plan in respect of the person for whom such expenses are incurred, they shall be entitled to a benefit equal to the co-insurance percentage of those covered expenses excluding the calendar year deductible, not exceeding the maximum reimbursement amounts for the applicable covered expenses.

Table of benefits

6.(5) For the purpose of calculating the member’s benefit under paragraph 6.(4), the co-insurance percentages, deductibles and maximum reimbursement amounts shall be as follows:

• Co-insurance percentages effective January 1, 2025:
  • Sixty-five per cent (65%) for the following services effective January 1, 2025
  • major restorative services (listed under provision (d)(ii) of paragraph (2))
  • major prosthodontic services (listed under provision (g)(ii) of paragraph (2)), and
  • Fifty per cent (50%) for the following services
    • orthodontic services (listed under paragraph (I), subparagraphs (ii) and (iii) of paragraph (2));
  • Ninety per cent (90%) for all other services listed under paragraph (2).
• Calendar year deductibles:
  • individual deductible: twenty-five dollars ($25);
  • combined deductible: fifty dollars ($50).
• Maximum reimbursement amounts:
  • Two thousand five hundred dollars ($2,500); three thousand dollars ($3,000) effective January 1, 2025; three thousand two hundred fifty dollars ($3,250) effective January 1, 2027 for all benefits payable with respect to eligible orthodontic services (listed under subparagraph (h) of paragraph (2)) rendered to a covered person for the whole period while covered under the Plan;
  • Two thousand five hundred dollars ($2,500); three thousand dollars ($3,000) effective January 1, 2025; three thousand two hundred fifty dollars ($3,250) effective January 1, 2027 for benefits payable with respect to eligible dental services, other than orthodontic services (referred to in the preceding provision (i)), rendered to a covered person in a given calendar year.

Notwithstanding the above provision, the maximum reimbursement amount for dental expenses, excluding orthodontic services, shall not exceed one thousand two hundred fifty dollars ($1,250); one thousand five hundred dollars ($1,500) effective January 1, 2025; one thousand six hundred twenty five dollars ($1,625) effective January 1, 2027 in a given calendar year, if the member, their eligible spouse or common-law partner and eligible children became covered under the plan on or after July 1 of that given year.

Treatment Plan Provision

6.(6)

• The member should submit a treatment plan to the administrator for benefit determination when the estimated cost of a course of treatment is three hundred dollars ($300) or more.
• It is further provided that such treatment plan will not be considered valid if treatment does not commence within one hundred eighty (180) days of the date the treatment plan was submitted.
• Notwithstanding the above provision, if the treatment plan is for the purpose of allowing an additional six (6) time units of scaling and root planning in a given year in cases of documented periodontitis, the approved treatment plan for additional units will be valid for three (3) consecutive calendar years before another pre-approval is required.

Upon receipt of a treatment plan, the administrator shall advise the member of the estimated amount payable on the basis of the treatment plan estimate at the time of benefit determination.

Date an expense is incurred

6.(7) As a general rule, a covered expense shall be deemed to be incurred on the date the particular service is rendered or the supply purchased. Where multiple appointments are required for a single service, the covered expenses shall be deemed to be incurred on the date such service is complete.

Where applicable, a procedure involving the installation of an appliance shall be deemed to be completed on the date the appliance is installed. However, in the case of orthodontic services, covered expenses shall be deemed to be incurred monthly, starting with the first date the appliance is installed, and at the same date of each subsequent month falling during the treatment period.

Where the cost estimates given in the orthodontic treatment plan do not provide for specific fees with respect to the placement of the initial appliance (hereinafter referred to as “initial fee”) the amount of covered expenses incurred for each month shall be equal to the total amount of covered charges for the treatment divided by the number of months in the treatment period.

Where the cost estimates given in the orthodontic treatment plan contain fees with respect to the initial fee, the amount of covered charges incurred for each month shall be equal to:

• with respect to the first month of treatment, the lesser of thirty-five per cent (35%) of the total amount of covered charges for the treatment and the fees shown for the initial fee;
• with respect to subsequent months, the difference between the total amount of covered charges for the treatment and the covered charges for the first month divided by the number of subsequent months in the treatment period.

Method of Payment

6.(8) Reimbursement under this Plan shall be made in a single payment for each claim. However, in the case of orthodontic services, payments shall be made monthly, the amount of each reimbursement being equal to the benefit payable with respect to covered expenses incurred during such month, as determined under paragraph 6.(7).

Extension of benefits

6.(9) Notwithstanding any other provision of the Plan,

• where a person’s coverage terminates because the member has terminated services with the employer or because the member or the member’s dependant is no longer eligible under the Plan, the person’s coverage for the following services shall be extended for a period of thirty one (31) days after the termination date, provided the services commenced as defined below, before such date.
  • endodontic services, where the pulp chamber is opened before the termination date:
    services listed under subparagraph (2)(e) for “root canal therapy”;
  • prosthodontic services involving an appliance for which an impression was taken before the termination date:
    services listed under subparagraph (2)(g) for “relining” and “addition of tooth to a removable denture”, “complete dentures” and “partial dentures”,
  • major restorative and prosthodontic services for which a tooth was prepared before the termination date:
    • major restorative services listed under paragraph (2)(d) for “gold inlays”, “crowns”, “implants” and “other restorative services”;
    • prosthodontic services listed under subparagraph (2)(g) for “fixed bridges”, “retentive pins in abutments” and “repairs of fixed appliances”.
  • ongoing orthodontic treatment where the initial appliance was placed before the termination date.

Conditions for benefit payment

6.(10)

• A member entitled to a benefit under the Plan must submit to the administrator notice and proof of claim satisfactory to the administrator within the time period indicated in subparagraph (b).
• Written notice and proof of claim must be provided to the administrator within fifteen (15) months of the date the expense is incurred or deemed to be incurred under the Plan.
• Claims for orthodontic treatments are an exception where ongoing treatments are reimbursed based on a pre-approved monthly payment plan. Each monthly payment must be submitted within fifteen (15) months of the payment date.
• Failure to provide the written notice and proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is provided in writing as soon as reasonably possible and in no event, except in the case of legal incapacity or unavoidable circumstances, later than twenty-four (24) months after the expense was incurred.

Coordination of benefits

6.(11)

• All covered expenses shall be subject to coordination of benefits as defined in this paragraph.
• For the application of this paragraph, “allowable expense” means any reasonable and customary item of expense at least a portion of which is covered under at least one of the Plans covering the person for whom claim is made.
• This paragraph shall apply in determining the benefits as to a person covered under this Plan for any calendar year if, for the allowable expenses incurred as to such person during such year, the sum of the benefits that would be payable under this Plan in the absence of this paragraph, and the benefits that would be payable under all plans, including this Plan in the absence therein of provisions of similar purpose to this paragraph, would exceed such allowable expenses.
• As to any calendar year with respect to which this paragraph is applicable, the benefits that would be payable under this Plan in the absence of this paragraph for the allowable expenses incurred as to such person during such calendar year shall be reduced to the extent necessary so that the sum of such reduced benefits and all the benefits payable for such allowable expenses under all plans, including this Plan except as provided under subparagraph (e) below, shall not exceed the total of such allowable expenses. Benefits payable under another plan include the benefits that would have been payable had claim been duly made therefor.
• If
  • another plan which is involved in subparagraph (d) of this paragraph and which contains a provision coordinating its benefits with those of this Plan would, according to its rules, determine its benefits after the benefits of this Plan have been determined, and
  • the Rules set forth in subparagraph (f) of this paragraph would require this Plan to determine its benefits before such other plan,

  then the benefits of such other plan shall be ignored for the purpose of determining the benefits under this Plan.

• For the purpose of subparagraph (e) of this paragraph, the Rules establishing the order of benefit determination are:
  • benefits shall be determined first under the plan which covers the person for whom expenses have been incurred
    • other than as a spouse, common-law partner or child, or
    • as a child of the person whose date of birth, excluding year of birth, is earlier in the calendar year;
  • subject to provision (iii) below, where rules specified in (i) do not establish an order of benefit determination, or another plan contains different rules, benefits will be pro-rated between or amongst the plans in proportion to the amounts that would have been paid under each plan in the absence of other coverage;
  • notwithstanding (ii), where the other Plan is the Public Service Health Care Plan (PSHCP), benefits shall be determined first under the PSHCP for allowable expenses on account of accidental dental injury and first under this Plan for allowable expenses with respect to oral surgery.
• When this provision operates to reduce the total amount of benefits otherwise payable as to a person covered under this Plan during any calendar year, each benefit that would be payable in the absence of this paragraph shall be reduced proportionately, and such reduced amount shall be charged against any applicable maximum reimbursement amount of this Plan.
• For the purpose of determining the applicability of, and implementing the terms of this paragraph or of any provision of similar purpose of any other plan, the administrator may without the consent of, or notice to any person, release to or obtain from any other insurance company or other organisation or person any information, with respect to any person, which the administrator deems to be necessary for such purposes. Any person claiming benefits under this Plan shall provide to the administrator such information as may be necessary to implement this provision.

Covered expenses limitations

6.(12) Expenses incurred for the following shall in no event be covered expenses:

• services and supplies, or any portion thereof, which are covered under any provincial, territorial or other public dental, hospital or health plan to which the person is eligible;
• services and supplies, or portion thereof, which are the legal liability of any other party;
• services and supplies, rendered or provided to which a person is entitled without charge pursuant to any law including, but not limited to Workers’ Compensation or similar law, or for which there is no cost to the person except for the existence of insurance against such cost;
• services and supplies received in a hospital owned or operated by a government, unless the person is required to pay for such services or supplies regardless of the existence of insurance;
• services and supplies rendered outside Canada to persons residing in Canada or to children of a member residing in Canada, which would be payable under a provincial health, dental or hospital plan if the services had been rendered in Canada;
• dental treatment involving the use of precious metals, if such treatment could have been rendered at lower cost by means of a reasonable substitute consistent with generally accepted dental practice, except for that portion of expenses which would have been incurred for treatment by means of a reasonable substitute;
• user fees, co-insurance charges or similar charges which are in excess of charges payable by a governmental dental, hospital or health plan;
• dental treatment which is not yet approved by the Canadian Dental Association or which, in the opinion of the administrator, is clearly experimental in nature;
• services and supplies which, in the opinion of the administrator, are rendered principally for cosmetic purposes including, but not limited to, porcelain or composite facings on crowns or bridges on molar teeth;
• services and supplies related to the purchase, repair, modification or replacement of a duplicate prosthodontic appliance, for any reasons;
• services rendered and supplies purchased prior to the date the person became covered under this Plan;
• charges for an appliance or a modification of one where an impression is made for such appliance or modification before the person became covered under this Plan; charges for crowns, bridges and gold restorations for which a tooth was prepared before the person became covered under this Plan; charges for root canal therapy where the pulp chamber was opened before the person became covered under this Plan;
• services and supplies rendered as a result of a congenital or developmental malformation which is not a Class I, II or III malocclusion, except for a child under twenty-two (22) years of age;
• charges for an orthodontic treatment, in respect of a member or their eligible spouse or common-law partner, where the initial appliance was inserted before the person became covered for such service under this Plan;
• charges for trauma control if done at the same time as a treatment for caries or pain control;
• charges for the enlargement of the canal or pulp chamber as part of a dental treatment;
• charges for a dental professional peer consultation;
• charges for the assistance of a second oral surgeon;
• charges for the analysis of mixed dentition (if a complete oral examination was performed in the same year);
• charges for tooth isolation as part of a dental treatment. However, coverage shall not be denied if a substantiated medical condition justifies treatment.

Appeals

6.(13)

• When a member is seeking to appeal the decision of the administrator to decline a claim, the member shall appeal that decision with the administrator as a first resort.
• If there is no resolution between the member and the administrator at first resort, a member may then submit an appeal case to the appropriate Board of Management.
• The Board of Management shall endeavour to hear the case in as expeditious a manner as possible.

Members’ contributions

7.(2) Members who proceed on leave of absence without pay due to circumstances other than those referred to in subparagraph 1(b) of Rule 7, shall remit contributions upon the plan member’s return to work to the level of coverage identified prior to the beginning of the leave period.

Seasonal Lay off

7.(3) Members proceeding on seasonal layoff shall have continued coverage paid by the employer for the duration of the seasonal layoff.

7.(4) Members who are laid off as referred to in subparagraph 7(b) of Rule 3, or suspended as referred to in subparagraph 11(a) of Rule 3, shall remit contributions in advance on a quarterly basis, from the first (1st) of the month following the month in which the layoff or suspension period began. Such eligible members shall be provided with reasonable notice to confirm the level of coverage required and to remit such contributions.

Amendments

8.(1) The employer and the unions have the right to enter into an agreement to modify or amend the provisions and Rules of the Plan, which were originally established by Treasury Board decision on December 11, 1986 based on the agreement reached between the employer and the unions of the National Joint Council (NJC) as well as the conciliation decision between the Public Service Alliance of Canada and the Treasury Board dated October 29, 1986.

Directives

8.(2) The employer may, at any time and from time to time, make directives which may be required to provide for the proper administration of the Plan. These directives shall be consistent with the provisions of the Plan.

Rights and limitations

8.(3) The establishment of the Plan shall not be construed as conferring any legal rights upon any employee or other person for continuation of employment, nor shall it interfere with the rights of the employer to discharge any employee and to treat him or her without regard to the effect which such treatment might have upon him or her as a member of the Plan.

Non alienation of benefits

8.(4) No benefit under the Plan shall be subject in any manner to anticipation, alienation, sale, transfer, assignment, pledge encumbrance or charge, and any attempt to do so shall be void, except as specifically provided in the Plan, nor shall any such benefit be in any manner liable for or subject to garnishment, attachment, execution or levy, or liable for or subject to the debts, contracts, liabilities, engagements or torts of the person entitled to such benefit.

No benefit under the Plan shall be subject to assignment, except for assignment to the treating dentist as directed by the member.

Beneficiaries

8.(5) All benefits under this Plan are payable to the member or to their spouse or common-law partner if so directed by the member. Any benefits unpaid at the member’s death may at the option of the administrator, be paid either to the beneficiary or to the estate of such person.

If a benefit under this Plan shall be payable to the estate of the member or to a member who is a minor or otherwise not competent to give a valid release, the administrator may pay such benefit to any relative by blood or connection by marriage of the member or to a person appearing to the administrator to be equitably entitled thereto by reason of having incurred expenses for the maintenance, care or treatment of the member or the member’s dependant. Any payment made by the administrator in good faith pursuant to this provision shall fully discharge the Plan with respect to such payment.

Participating Employers

• Atlantic Pilotage Authority (January 1, 1988)
• Atomic Energy of Canada Limited (May 11, 2015)
• Canada Investment and Savings (previously Canada Retail Debt Agency) (July 15, 1996)
• Canada Revenue Agency (previously Canada Customs and Revenue Agency (November 1, 1999)
• Canadian Centre for Occupational Health and Safety (April 1, 1989)
• Canadian Council of Ministers of the Environment (April 1, 1991)
• Canadian Food Inspection Agency (March 20, 1997)
• Canadian High Arctic Research Station (June 1, 2015)
• Canadian Institutes of Health Research (previously Medical Research Council of Canada) (January 1, 1988)
• Canadian Museum of Human Rights (September 1, 2009)
• Canadian Museum of Nature (July 1, 1990)
• Canadian Nuclear Safety Commission (previously Atomic Energy Control Board) (January 1, 1988 and May 11, 2015)
• Canadian Polar Commission (April 7, 1992)Canadian Security Intelligence Service (January 1, 1988)
• Communications Security Establishment (January 1, 1988)
• Federal Public Sector Labour Relations and Employment Board (previously Public Service Staff Relations Board) (March 1, 1987)
• Financial Consumer Agency of Canada (August 24, 2001)
• Financial Transactions and Reports Analysis Centre (July 5, 2000)
• Great Lakes Pilotage Authority (January 1, 2000)
• House of Commons (January 1, 1988 and October 1, 1988)
• Indian Oil and Gas Canada (January 1, 1988)
• Laurentian Pilotage Authority (January 1, 1988)
• Library of Parliament (January 1, 1988 and January 1, 19889)
• National Battlefields Commission (February 1, 1989)
• National Capital Commission (March 1, 1987)
• National Energy Board (March 1, 1987)
• National Film Board (January 1, 1988)
• National Gallery of Canada (July 1, 1990)
• National Museum of Science and Technology (July 1, 1990)
• National Research Council of Canada (July 31, 1987)
• National Security and Intelligence Committee of Parliamentarians (September 1, 2017)
• National Trust for Canada (previously Heritage Canada (January 1, 1988)
• Natural Sciences and Engineering Research Council (January 1, 1988)
• Northern Pipeline Agency (January 1, 1990)
• Office of the Auditor General of Canada (June 1, 1988)
• Office of the Conflict of Interest and Ethics Commissioner (November 4, 2004)
• Office of the Correctional Investigator (January 1, 1988)
• Office of the Superintendent of Financial Institutions (June 1, 1988)
• Parks Canada Agency (December 28, 1998)
• Parliamentary Centre for Foreign Affairs and Foreign Trade (January 1, 1990)
• Security Intelligence Review Committee (January 1, 1988)
• Senate of Canada (January 1, 1988)
• Social Sciences and Humanities Research Council (January 1, 1988)
• Social Security Tribunal of Canada (December 15, 2016)
• Telefilm Canada (previously Canadian Film Development Corporation (January 1, 1990)

Group or Category of Persons

• Governor in Council Appointees
• Governor General
• Lieutenant Governors
• Members of the House of Commons
• Members of the Senate
• Members of Parliament Staff
• Ministers’ Exempt Staff (appointed pursuant to the Public Service Employment Act)