Essential info

Insured with Canada Life Assurance Company
Policy No. 56565 – Division 10
Toll-free number: 1-800-957-9777
(Select prompt 1 for language preference = English)
(Select prompt 3 for benefit selection = Dental inquires)

General

• Which employees are eligible for coverage under the CISVA, Dental Plan?
• Basic information about the Dental Plan
• How much of our dental costs are paid by our plan?
• Pre-authorizations
• What general expenses are covered in our Dental Plan?
• Dentists can charge anything they want!
• What is the coordination of benefits?

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Which employees are eligible for coverage under the CISVA, Dentalcare Plan?

The eligibility requirements are as follows as defined in our Group Policy Contract:

1. You must be an Insurable Employee
2. You must be Actively at Work
3. You must be in the appropriate Benefit Class

Please refer to the Definitions and General Terms section of your benefit booklet for further clarification. Further details on the Benefits Class structure can be found on the CISVA website: CISVA Benefit Plan Overview / Basic Elements of Our Plan

Basic information about the dental plan

Dental Care coverage pays for eligible expenses that you incur for dental procedures provided by a licensed dentist, denturist, dental hygienist and anaesthetist while this group plan covers you.
For each dental procedure, we will only cover reasonable expenses. We will not cover more than the fee stated in the current Dental Association Fee Guide for general practitioners in the employee’s province of residence on the date that the treatment is received.

Payments will be based on the current guide at the time the treatment is received. If services are provided by a board qualified specialist in endodontics, prosthodontics, oral surgery, periodontics, paedodontics or orthodontics whose dental practice is limited to that speciality, then the fee guide used will be the specialist’s fee guide as set by the applicable governing authority.

The dental benefit year is from January 1 to December 31.

How much of our dental costs are paid by our plan?

There is no deductible for covered dental costs.

Pre-authorizations are recommended for anything over $500.00

Pre-authorizations

Pre-authorization is required for dental claims estimated to cost $500 or more. If you or a dependent requires dental treatment that the dentist estimates will cost $500 or more, a Pre-Treatment description (including x-rays) and fee estimate must be obtained from the dentist and submitted to Canada Life directly for approval before treatment is commenced. If the treatment program is approved, you will be notified, and reimbursement will be based on the applicable fee guide.

It is strongly recommended to obtain a preauthorization with regards to extensive dental procedures performed. This is to prevent unexpected costs.

What general expenses are covered in our Dentalcare plan?

Please refer to the Booklets section of the CISVA website. The available booklets are reflective of the appropriate Benefit Class that pertains to you. Dental benefits are detailed according to your class status. Please ensure that you are referring to the correct benefit booklet.

Dentists can charge anything they want!

The Fee Guide forms the basis of what insurance companies will pay for dental treatments. The Fee Guide is only a guide for what dentists may charge for any particular treatment. Dentists may set their own fees. Specialists usually charge higher fees than those in the Fee Guide.

For more detailed information on the Fee Guide, please contact the BC Dental Association (www.bcdental.org).

What is the coordination of benefits?

If you or your dependents are covered under more than one benefit plan (for example, your spouse’s plan), you can claim up to 100% of an eligible expense (as per the dental fee guide) by coordinating your benefits under both plans. Here’s how:

• The plan that covers you as a plan member pays first. Then, the plan that covers you as a dependent pays any remaining eligible balance. Your spouse’s claims should go to his or her plan first, and then any remaining balance should be sent to your plan.
• Dependent children are covered first by the plan of the parent whose birthday falls earlier in the calendar year. In other words, if your birthday falls in January and your spouse’s birthday is in March, you should submit your children’s claims to your plan first.

Your first benefit plan will send you an explanation of how much of your claim has been covered. You will need to send that explanation, along with copies of your expense receipts, to the second benefit plan to claim any remaining balance that’s eligible.

Is oral pathology covered under dental?

Yes. Oral pathology is the specialty of dentistry concerned with a wide range of abnormalities and diseases. An oral pathologist is therefore concerned not so much with the teeth as with diagnosis, treatment, and study of disorders of the mouth, jaw, and soft tissues.

Orthodontic Services

Orthodontic Services will be reimbursed at 50% of the cost with a lifetime maximum benefit of $3,000 per person. Coverage for ongoing treatment requires that the member continues to be eligible for benefits and that a dependent continues to meet the definition of a dependent as outlined in the Definitions section of your benefit booklet.

At the start of the orthodontic treatment, the dentist or orthodontist will prepare a written outline of the proposed treatment. This is called a treatment plan. The treatment plan will outline the amount of your initial deposit plus your pro-rated monthly fees. Canada Life must have a copy of this in the patient’s file before they can reimburse for orthodontic claims.

When your orthodontist gives you the completed treatment plan form, please forward it to Canada Life. Make sure you indicate on the form:

• The member’s plan and ID numbers
• Patient’s full name
• Patient’s birth date
• Information on coverage under any other dental care plans. Refer to the narrative on the coordination of benefits (COB).

The orthodontist or dentist may give you a receipt instead of completing a claim form. Submit your receipt, attached to a completed Dentalcare claim form and forward to Canada Life for processing.

Claim submissions

• Where do I mail my claims to?
• Where can I get blank claim forms?
• Is there a claiming deadline for submitting my claims?
• What can I do if I disagree with the amounts paid for my claims, or some claims are declined?

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Where do I mail my claims to?

Most general practitioners provide a service to their patients by submitting any incurred dental claims electronically to Canada Life for assessment. In such cases, you don’t need to concern yourself with submitting a paper claim. However, this is a service that is provided to you; your dentist is not obligated to submit your claim electronically. It is your responsibility to verify if this service is provided to you by your dentist.

IMPORTANT: dental specialists (i.e., endodontists, prosthodontists, oral surgeons, periodontists, paedodontists or orthodontists) rarely ever submit incurred dental claims electronically to Canada Life. The reason is typical because when you receive services rendered by one of these professionals, it is generally to satisfy an immediate dental need. You would not be considered a long-term, ongoing, regular patient; therefore, the service of submitting claims electronically is typically not offered.

Under these circumstances, please submit your dental claim to the following address:

Send to: Canada Life Assurance Co. PO Box 3050 Station Main Winnipeg, MB R3C 0E6

Please note that you also have the option of submitting your claims electronically to Canada Life via GWL’s E-Claims (aka Member Portal).

Where can I get blank claim forms?

The following 3 methods are ways in which you can obtain a Dentalcare Expense Statement claim form:

1. On the CISVA website, refer to the Claim forms/Dental Plan section. This document already includes the plan name, plan number and division number.
   1. Select Dental
   2. Open the document and complete accordingly
2. Log onto the Canada Life GroupNet for Members: http://groupnet.greatwestlife.com.
   1. If you have not already done so, please register yourself as a new user.
   2. Select Form & Cards from the toolbar
   3. Double-click on Claim forms. The claim form is pre-populated; therefore, all of your personal information will automatically download onto your claim form.
3. Log onto Canada Life’s website: www.greatwestlife.com.
   1. On the left side of the page, refer to Clients & Plan Members.
      1. Select Client Services
   2. Select GO under A group benefits plan member?
   3. Select Forms from Basic Forms & Resources
   4. Double-click on the first bullet called, Standard claim forms
   5. Select the second bullet called, Dentalcare Claim Form (M445D)
      1. Complete the form accordingly

Regardless of which method you use to obtain a claim form, please ensure that you copy every claim before sending it to Canada Life. Original documents are always sent to the insurance carrier. Please ensure that receipts are stapled to the back of your claim form.

Is there a claiming deadline for submitting my claims?

Yes. Canada Life must receive proof of claim no later than June 30th of the year following the date that you incurred your expense.

Example: a porcelain crown was placed on one of your molars in September 2007. As a result, you have until June 30, 2008, for Canada Life to receive your claim.

Confirmation of this deadline will be found in the tail-end section of the Dental coverage portion of your benefit booklet under the section entitled, Submitting a claim.

What can I do if I disagree with the amounts paid for my claims, or some claims are declined?

Contact the Canada Life Benefit Payment Office (BPO) directly at 1-800-957-9777 to review the assessment of your claim. If still unsatisfied, send the original claim copy, plus the “Explanation of Benefits” that shows amounts paid and reasons, with your reason for disagreement to my office. I will assist you in investigating the matter further.

What is Member Portal? (Accessing your benefits any time)

Access for your group benefits information has never been easier with Canada Life’s GroupNet for Plan Members (aka Member Portal).

Register once and you’ll connect to a world of secure, user-friendly services – available online, any time! Available features are as follows:

• Sign up for direct deposit claim payments – claim paid directly into your bank account.
• Access expanded coverage information quickly and easily.
• View your claim status and Explanation of Benefits for the past 24 months
• Check your Extended Healthcare balance and the date that you would next be eligible for a particular benefit.
• Check when you’re covered for new glasses or contacts.
• Complete and print personalized claim forms
• Access the Health & Wellness Site that includes:
  • In-depth information on diseases, conditions, drugs and treatment options
  • Interactive health and wellness tools, including the Personal Health Risk Assessment

Registration is simple and secure.

Follow these easy steps to register and log in for the first time:

1. visit http://groupnet.greatwestlife.com
2. have the following information ready:
   1. Plan number (No. 335645) and your employee Identification number (available on the front of your last benefit statement or your wallet certificate – little green card)