Public Service Dental Care Plan Appeal Checklist

Types of appeals

• Claims: you disagree with the reason Canada Life gave for denying a dental claim or you believe that an error was made
• Enrolment: enrolment issues such as
  • denied eligibility for yourself or a dependant
  • amendments to coverage
  • disputed effective date of coverage
  • leave without pay coverage
  • administrative error
• Other : issues not related to claims or coverage, such as a complaint about services provided by Canada Life or errors by the Pay Centre or the departmental pay office

Who can submit an appeal

• A PSDCP member
• A dentist or a family member on behalf of a PSDCP member
• A legal guardian or someone with power of attorney on behalf of a PSDCP member
• A Pay Centre representative or departmental compensation office on behalf of a PSDCP member
• A PSDCP member on behalf of their spouse or common-law partner or dependant child(ren)

How to submit an appeal

Write an appeal letter that clearly details the reason for the appeal. Also include the following:

1. The member’s name, address, telephone number and email address
• If the appeal is about a dependant, include the dependant’s full name and date of birth
2. The member’s PSDCP plan number and certificate numbers
3. The appeal category: claim, enrolment or other (specify)
4. If the appeal is about a claim, include supporting documents such as:
   • a copy of Canada Life’s appeal response
   • the explanation of benefits or letters from Canada Life that deny the claim
   • the dental provider’s treatment plan or rationale for treatment
5. If the appeal is about enrolment, supporting documents such as:
   • letters from the Pay Centre or departmental pay office about the member’s employment status and effective date of coverage (indeterminate, term, leave without pay, parental leave) and relevant dates
   • proof of full-time attendance in school, college or university for a child between 21 and 25
   • Canada Life’s response denying the application for a dependant child with an impairment submitted within 31 days of turning 21 or while eligible for coverage (full-time attendance in school before age 25)
   • legal guardianship or custody documents or a court order that reflects the effective date and duration of the relationship to provide coverage for a child for whom you stand in place of a parent

Note: To avoid delays, provide as much detail as possible. The PSDCP Board of Management may ask for more information or documents before making a final decision.

Where to mail an appeal

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

Board of Management
Dental Care Plan (PSAC) Component
90 Elgin St
3rd Floor, Suite 3026
Ottawa ON 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 Dr
Ottawa ON 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 ON  K1A 0R2

For all other PSDCP members:

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

Note: Appeal letters are not accepted by email, fax or in-person delivery. Medical and dental records or information about dependant children and child custody are considered Protected B.