PDSP Communique Newsletter Edition 22

Coordination of benefits

If you are a PDSP member and you have dental coverage under another plan (such as your spouse's plan), you may be eligible to coordinate your benefits and receive up to 100% of the eligible dental expenses.

Coordination of benefits between two PDSP members is not permitted, as a PDSP member cannot be enrolled as both a member and a dependant.

Which plan pays first?

• If you are claiming expenses for your spouse or common-law partner, and they are covered for those expenses under another plan, you are required to send the claim to your spouse's or common-law partner’s plan first.
• If you are claiming expenses for your children, and both your and your spouse's or common-law partner’s different plans provide coverage for your children, you are required to claim under the plan of the parent with the earlier birthday (month and day) in the calendar year. For example, if your birthday is May 1 and your spouse's or common-law partner's birthday is June 5, you must submit the claim under the PDSP first.

Deadline to submit dental expenses

To be eligible for reimbursement for dental expenses, you must submit your claim to Sun Life within 15 months following the date the expense was incurred. Claims received after the 15-month period will not be reimbursed unless you can demonstrate that it was impossible to submit the claim within this time period.

Public Service Compensation Email Notification System

Subscribe to the Public Service Compensation Email Notification System at Canada.ca/pension-benefits to receive important general information about your public service pension and benefits plans, such as changes to the contribution rates, that may affect you.

This email platform will never be used to communicate personal information regarding your public service pension and benefits nor will it replace any existing communication methods.

Note: If you do not have an email address or access to the internet, you can ask someone to subscribe to the email notification system and receive the emails for you.

COVID-19 temporary measures

The temporary PDSP measures implemented in response to COVID-19 are still in effect.

The PDSP flexibilities include a temporary extension of dependent children's eligibility to receive required dental services or treatments.

For additional information please consult the COVID-19 temporary administrative measures Information Notice or the January 2021 Communiqué.

Anesthesia

The PDSP reimburses the cost of anesthesia administered by a dentist or oral surgeon for common surgical procedures, such as:

• Tooth removal;
• Surgical removal and tooth repositioning;
• Surgical incision and excision;
• Removal of excess mucus;
• Removal of cysts;
• Removal of impacted teeth;
• Repair of soft tissue;
• Alveoloplasty (smooths and reshapes the jawbone after an extraction);
• Gingivoplasty (reshapes gum tissues);
• Stomatoplasty (reconstructive mouth surgery);
• Osteoplasty (reshapes and recontouring of bone);
• Tuberplasty (reshapes or reduces the maxillary bone);
• Frenectomy (correction of tongue-tie or lip tie);
• Dislocations and other miscellaneous surgical services.

Dental Tomography

Tomography is a technique used to obtain detailed x-ray images of the jaw, dentition, and facial bone structure. Tomography is used when more detailed images than traditional x-rays are needed. Dental tomography can:

• provide accurate measurements for implant and reconstructive surgery;
• diagnose airway sleep and jaw disorders;
• detect lesions, bone cancer, infections, and root decay;
• evaluate facial trauma, sinuses, nerve canals and nasal cavity.

Tomography is covered at 90%, subject to the yearly deductible, plan maximums and reasonable and customary amounts.

Note: Cone-beam computed tomography is not covered under the PDSP.

Pre-determinations for treatments over $300

Sun Life will review treatment plans for any major dental treatment or procedure you may undergo that will cost more than $300, including orthodontic treatments and additional units of scaling and planing.

Before your treatment or procedure, please submit the treatment plan from your dentist to Sun Life. They will inform you of eligible expenses that will be covered under the PDSP, and any costs that you may be responsible for. Sun Life’s approval is valid for 180 days from the date you submit the treatment plan.

Reminders:

Direct deposit - for fast and secure claim payment

With Direct deposit you will receive your reimbursement payments within 24-48 hours of your claim being processed. To register:

1) Sign in to sunlife.ca/pdsp.
2) Click on Benefits centre.
3) From the Take me to menu, select Direct deposit and online claim statements.
4) Enter your banking information and click Submit.

Note: Have your banking information (transit, institution and account numbers) ready to sign up for Direct deposit.

Keep your dental provider up to date

If you have recently retired and transferred from the Public Service Dental Care Plan to the PDSP, you will have new dental plan and certificate numbers. Don’t forget to notify your dental provider of these new numbers to prevent a delay in your reimbursements.

Extra Fees

Any additional fees that a provider may charge for cleaning or personal protective equipment are not eligible for reimbursement under the PDSP. It is recommended you contact your provider before your dental appointment regarding any extra fees you may be charged as these will be at your own expense.

If you have questions

The PDSP is administered by Sun Life on behalf of the Government of Canada. Sun Life's role is to adjudicate claims and answer benefit-related inquiries. For questions about your PDSP benefits or claims, consult your Member Booklet at www.sunlife.ca/pdsp or contact the Sun Life Call Centre: 1-888-757-7427 (Toll-free in North America) or 613-247-5100 (in the National Capital Region). Call Centre Representatives are available from Monday to Friday, 6:30 a.m. to 8:00 p.m., Eastern Standard Time.