Pensioners’ Dental Services Plan (PDSP) Appeal Checklist

Types of appeals

• Claim: 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 a pensioner, their dependant(s) or survivor
  • amendments to coverage
  • disputed effective date of coverage
  • administrative error
• Other: issues not related to claims or coverage, such as a complaint about services provided by the Pension Centre or Canada Life

Who can submit an appeal

• A PDSP member
• A dental provider or a family member on behalf of a PDSP member
• A legal guardian or someone with power of attorney on behalf of a PDSP member
• A Pension Centre representative on behalf of the PDSP member
• A PDSP member on behalf of their dependant(s), a 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 information:

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 PDSP plan number and certificate number
3. The appeal category: claim, enrolment or other (specify)
4. If the appeal is about a claim, supporting documents such as:
   • the explanation of benefits or letters from Canada Life that deny the claim
   • a copy of Canada Life’s appeal response letter
   • the dental provider’s treatment plan or rationale for treatment
5. If the appeal is about coverage, supporting documents such as:
   • letters from the Pension Centre
   • proof of full-time attendance in school, college or university for a child between 21 and 25
   • for the denial of an over-age dependant child’s coverage for disability, a medical certificate or a physician’s letter
   • legal guardianship or custody documents or a court order (originals) 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 PDSP Board may ask for more information or documents before making a final decision.

Where to mail an appeal

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