If a dental accident occurs, health plans with dental accident coverage will pay benefits before dental plans. 0000109609 00000 n 0000038192 00000 n 0000002973 00000 n %PDF-1.6 %���� 0000063630 00000 n 0000006613 00000 n <]/Prev 203778>> SFE business rates change briefing (PDF: 91KB) You can view more information about SFE payments.. Sun Life is responsible for the administration of claims under the Public Service Health Care Plan. 0000063993 00000 n 0000037636 00000 n 0000080400 00000 n 4 | Co-ordination of benefits – complete this section if your spouse and/or children has coverage under any other dental plan or contract. For more detailed information on your benefits coverage and other forms, please refer to the PEBA Benefits Booklet (SGEU, CUPE) or visit the PEBA website. 0000041924 00000 n 0000044269 00000 n 0000064687 00000 n Provide evidence of insurability required for benefits that need medical underwriting like excess life insurance coverage. 0000022981 00000 n I am so happy with the results on this complex case, she was very confident and made me feel at ease throughout the whole time. 0000072278 00000 n 0000072574 00000 n Enhanced Diagnostic Services. tells you where to send the completed form. The Canada Life Assurance Company. i understand that the fees listed in this claim may not be covered by or may exceed my plan benefits. City Prov. endstream endobj 122 0 obj <. 0000095084 00000 n 0000091486 00000 n %PDF-1.5 %���� startxref 0000013011 00000 n The voluntary PDSP was established by the Government of Canada in 2001. 0000040802 00000 n Member Services; Wellness; Advocacy; ... members with access to claim forms, applications, and miscellaneous forms and documents. 0000110977 00000 n Dental claim reviews and exceptions. 0000034185 00000 n 0000026463 00000 n The Block G Imaging Centre for civil service eligible persons (CSEPs) at Queen Elizabeth Hospital (QEH) commenced services on 3 January 2011. The PSHCP is a voluntary health care plan for federal employees, federal retirees and their eligible dependents. 0000034857 00000 n If you are already retired or become entitled to a survivor benefit, you can obtain the … This form must include: an explanatory letter that the claim is for dental treatment or services for a dependant under this temporary eligibility extension 0000036749 00000 n 0000019343 00000 n 0000072969 00000 n The cost to call 0330 numbers is the same as calling a normal local or national ... any claim form such costs will be at your expense. 0000033754 00000 n Confirmation in the form of a letter or an e-mail will be sent to them by the Dental Service Central Office. Topics. 0000003493 00000 n 1 | To be completed by Dentist 0000052207 00000 n 0000098285 00000 n 0000035804 00000 n A DHMO or prepaid plan has a network of participating dentists who agree to accept a copayment for services covered by the plan. Please choose from the categories below. Approved by the Canadian Dental Association. ir���Idǖ��ƅ�0�dP�r�v@-@;Xz����?�7���d��p�(z��̣l� ��7�U��V�v��ڡ���7�퐮,�lM�4��B������+�K̏��Lv�f�����5��q�[5��+�+Z�&I0�1h Accidental injury: ; Processes and pays for your eligible claims and life insurance submissions. 0000028239 00000 n 0000002077 00000 n 0000040932 00000 n 0000045715 00000 n 0000024651 00000 n 0000030213 00000 n The form is designed so that the name and address (Item 3) of the third-party payer receiving the claim (insurance company/dental benefit plan) is visible in a standard #9 window envelope (window to the left). The date an expense is incurred is the date the service is rendered or supplies are purchased or rented, not the date the claim is submitted. 0000110077 00000 n 0000028749 00000 n ��D�Q���¦ 0000010714 00000 n 0000073218 00000 n part 1 dentist. It provides dental coverage to eligible federal pensioners and their family members who qualify, including survivors. 0000008823 00000 n 0000068283 00000 n For a dependant to be eligible for the temporary extension, you must submit a paper PDSP claim form, available on the Plan Member Services site (www.sunlife.ca/pdsp), to the Sun Life address indicated on the form and include an explanatory letter that 0000079760 00000 n 0000008913 00000 n 0000043627 00000 n 0000092106 00000 n 0000110001 00000 n The Commonwealth provides assistance for 2-17 year olds through the Child Dental Benefits Schedule (CDBS). Fill out a form for the plan you want to put money in. All employees participate in the Public Employees' Pension Plan (PEPP). 0000042471 00000 n 0000037434 00000 n 0000043811 00000 n 0000083277 00000 n I am so happy with the results on this complex case, she was very confident and made me feel at ease throughout the whole time. PSHCP Claim Form; PSHCP Claim Form for Out-of-Country claims (Comprehensive Coverage) PSHCP Travel Emergency Expense Form (The Plan Administrator will send this form to members following a medical emergency outside of Canada) Official PSHCP Documents. 0000110321 00000 n 121 0 obj <> endobj 1-800-305-5905 or access the Sun Life Financial Member Services web site at www.mysunlife.ca. ]���x��/qͿ'~>����:�L3��6�M����*���U��X'�o��������zJ�gY. 0000143477 00000 n 0000006866 00000 n 0000026675 00000 n H�\��j�0����l/Jm 0000023663 00000 n 0000034406 00000 n It reimburses members for allowable health care services and products. After that time, there will be a six-month waiting period before the newborn can join GEHI; 4. 0000008647 00000 n 0000165557 00000 n ANNEX B - Eligible dental services . 0000110241 00000 n Oregon Kaiser Dental Plan All dental services are provided at Oregon Kaiser facilities listed below. ANNEX C - Exclusions and limitations ANNEX D - Claims offices Claim Forms - Adobe PDF Top of Page. 0000023476 00000 n To find out whether you can move money into a specific plan, sign in and go to My Profile -> View My Plan Material or call us at 1-888-727-7766, Monday to Friday, 8 a.m. to 8 p.m. 0000023924 00000 n If you are covered under the Public Service Dental Care Plan, the Dependants Dental Care Plan, the CF Dependants Dental Care Plan or the Pensioners' Dental Services Plan, you must submit your claims for oral surgery to that plan first. Any amount not covered by your dental plan may then be submitted to the PSHCP. 0000092886 00000 n 0000108991 00000 n 0000040143 00000 n Access complete information on your group benefits in a secure environment: 1. claims history, 2. eligibility for specific products or services and 3. online registration for direct deposit of your claims. &0�r��� ��t��1Nz����fH����_QU�j�����48C�;po� \��;��`{3�w���W%7�4�P�nTZC�A������wW�|U������f��,�bG�����5mW[:��eG9���#��>�f�hq��к+*�*A�i� The CDBS provides individual benefits for a range of services including examinations, x-rays, cleaning, fissure sealing, fillings, root canals and extractions. 0000110403 00000 n You are eligible for public dental services if you: Live in Victoria and; Are aged 0-12 years of age, irrespective of family income or; Are aged between 2–17 and are eligible for the Child Dental Benefits Schedule or; Are aged between 13-17 with a Health Care card or Pension Card or whose parents hold a Health Care card or Pension Card or 0000000016 00000 n Plan Directive (Plan Document) Plan Information Booklet (Member Booklet) 0000037697 00000 n 0000172353 00000 n 0000010305 00000 n 0000032795 00000 n 0000024048 00000 n 0000040593 00000 n Postal Code Unique Number Spec. Below are other pages relating to this topic. 0000027101 00000 n 0000006502 00000 n 0000043865 00000 n 0000061019 00000 n Forms for Group Plan Administrators to register and administer a Medical Services Plan Group Plan. Pensioners’ Dental Services Plan (PDSP) Authorization for Claims Submission and Re-direction of Payment Form; Note: If you are about to retire, you can obtain the Pensioners’ Dental Services Plan (PDSP) form (used to enrol, amend or terminate PDSP coverage) from the Government of Canada Pension Centre. to read information, use the down arrow from a form field. Forms for Medical and Health Care Providers to register or claim services through MSP. 0000022720 00000 n 0000111267 00000 n 0000041296 00000 n Jg��X��&gM� 328 0 obj <>stream I also authorize the communication of information related to the coverage of services described in this form to the named dentist. There are no claim forms to fill out and no prior authorization of treatment is required. I�����6b�}��i��&�M 0000077383 00000 n 0000024208 00000 n 0000039934 00000 n ]��k�f��Z��k=&i\||��p=��!�*���7o��pO�v8��$�6�a���{��=>��x�?���en�vm8�B_��k} . 0000031845 00000 n 0000042683 00000 n Complete this form to submit a claim for dental services. 0000079062 00000 n 0000038370 00000 n Dental Claim Form. This form is used to designate your dependents for both the Dental Plan and the Extended Health Care Plan. PDSP stands for Pensioner's Dental Services Plan (also Pensioners' Dental Services Plan and 32 more ) What is the abbreviation for Pensioner's Dental Services Plan? Child Dental Benefits Schedule. Treatment may not be commenced without the relevant schemes form. 0000111447 00000 n 0000057402 00000 n 0000025716 00000 n The Block G Imaging Centre for civil service eligible persons (CSEPs) at Queen Elizabeth Hospital (QEH) commenced services on 3 January 2011. 0000036015 00000 n 0000022342 00000 n 0000031173 00000 n Pensioners’ Dental Services Plan (PDSP) Claim Form (PDF Document – 54 KB) (Sun Life Financial) Pensioners’ Dental Services Plan Authorization for Claims Submission and Re-direction of Payment Form (00093-E-3-05) Public Service Health Care Plan. If you submit your claim by mail, you will always need to complete a paper claim form. 0000029536 00000 n trailer <]/Prev 233585>> startxref 0 %%EOF 94 0 obj <>stream 0000111371 00000 n 0000029105 00000 n 0000069919 00000 n Dentist’s Declaration (to be completed by dentist) Sections 1, 4, 5 and 8should be completed by the policyholder Sections 2and 3should be completed by the dentist n I confirm that the treatment detailed on the invoice provided has been paid in full to the sum of £ 0000030907 00000 n i hereby assign my benefits payable from this claim to the named dentist and authorize payment directly to him/her. 0000110508 00000 n Submission of Claims Rules Disability Claims (DBL1) Your first claim (DBL1- Initial application) must be filed no later than thirty (30) days following your waiting period or thirty days (30) following the issuance of your Leave, whichever is later. 0000050616 00000 n With a DHMO/prepaid dental plan, you know exactly what you are going to pay out of pocket when you go to the dentist, but you are required to select and be assigned to a dentist within the network. 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