PSHCP Dental Benefit: What is covered?
February 14, 2017
As per the Extended Health Provision of the Public Service Health Care Plan (PSHCP), members are entitled to reimbursement under the Dental Benefit. The Dental Benefit provides coverage for certain oral surgical procedures and courses of treatment following accidental injury. Eligible expenses under this benefit are the reasonable and customary charges for these services and procedures when performed by a dentist or a dental surgeon. Expenses incurred for regular dental services such as examinations and root canal treatments do not meet the above-noted criteria. These services are not surgical procedures requiring the intervention of a dental surgeon, and therefore, are not covered under the PSHCP.
In the case of an accidental dental injury to natural teeth, the services of a dental surgeon and charges for a dental prosthesis are reimbursable by the PSHCP. In order for expenses to be eligible, the fracture or injury must have been caused an external, violent, and accidental injury or blow to the natural teeth. Injuries as a result of normal acts such as cleaning, chewing, and eating do not qualify for reimbursement under the PSHCP Dental Benefit.
Treatment of the injury must occur within 12 months following the accident or, in the case of a dependant child under 17 years of age, before the child turns 18 years of age. This time limit may be extended if, as determined by the Plan Administrator, the treatment could not have been rendered in the timeframe specified. A physician’s prescription is not required for cases of accidental dental injury.
When two or more courses of treatment for an oral procedure or accidental injury are considered appropriate, the PSHCP will pay for the treatment that is least expensive. Should the member choose to undergo the more expensive treatment, the Plan will only reimburse the member up to the amount quoted for the less expensive treatment, so long as the treatment chosen is not excluded under the Plan.
The Dental Benefit is not to be confused with a separate dental care plan administered by an alternate insurance provider. If a member is covered under the Public Service Dental Care Plan, the RCMP Dependants Dental Care Plan, the CF Dependants Dental Care Plan or the Pensioner’s Dental Services Plan, only claims for expenses incurred as a result of accidental injury and/or certain oral surgical procedures may be submitted to the PSHCP.
For more information on the Dental Benefit, click here.