ARCHIVED CD 2006-013
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July 21, 2006
SUBJECT: Changes to the Dental Care Plan Process
1.1 The purpose of this directive is to inform the compensation advisors of recent system enhancements made to the Dental Care Plan (DCP) screen and the creation of a Dental Plan History (DCH) screen in the Contributor System. These system changes will improve the process used to produce monthly reports sent to the Great-West Life (GWL) Assurance Company.
2.1 The Public Works and Government Services Canada (PWGSC) Compensation Sector is responsible for the Public Service Dental Care Plan (PSDCP) administration. There is a requirement to provide the Plan administrator with information on Regional Pay System (RPS) paid employees as well as non-Regional Pay System (RPS) paid employees. The Plan is administered by the Great West Life (GWL) Assurance Company whose principal function is to adjudicate and pay claims submitted by employees. When a claim is submitted by an employee, it is cross-referenced to the monthly report provided by PWGSC to ensure the claimant is covered by the Plan.
2.2 For several years, the process used to produce the monthly report sent to the Great-West Life Assurance (GWL) Company has been omitting many eligible employees as the Contributor System could not establish the employees'eligibility as it has not been kept up to date with any developments/changes done in RPS. For example, the Contributor System was not updated each time new Leave Without Pay (LWOP) codes were introduced in RPS. This has caused benefit claims to be refused as they are not listed on the monthly report and has resulted in numerous complaints by employees and clients.
2.3 PWGSC conducted a review of the process to assess if the problems were created by either input into the RPS or because the Contributor System did not take into consideration the related business rules. The conclusion is that the Contributor System did not recognize all of the current business rules.
3.1 The following provides a summary of the changes and enhancements made to the Contributor System's daily process and to the monthly PSDCP process to ensure that all current business rules are recognized.
3.2. Contributor System Changes
- All PSDCP conditions related to the type of employment will be recognized to determine eligibility.
- The duration of service breaks will be taken into consideration so that coverage continues or is suspended until the employee regains eligibility after returning from the service break.
- All of the leave without pay (LWOP) situations residing in the RPS will be reflected in the Contributor System and the PSDCP conditions associated with the LWOP will be taken into consideration to determine eligibility.
- Control tables were developed to record organization names, Bargaining Unit Designator (BUD) codes and union status.
- Legislation related to acting situations will be applied when determining eligibility.
- The DCP screen was modified to reflect the current eligibility status and status code reason.
- The DCH screen was created to display a history record of changes to the employees'DCP status.
3.3 Dental Care Plan Screen (DCP) Modifications were made to facilitate the validation of the current eligibility status and status code reason. The PLAN TYPE was moved below the CERTIFICATE NUMBER as these fields are related and belong together.The ELIGIBILITY INDICATOR was removed and replaced by DENTAL PLAN STATUS which will reflect the current situation of the employee's coverage. The information is derived from the status reason code found in the DCH screen (refer to section 3.4 for information on this screen). In situations where the coverage is suspended or terminated the effective date of termination of the coverage will be indicated.
3.4 Dental Care Plan History Screen (DCH) The DCH screen was created to display a history record of changes to the employees Dental Care Plan status. The Contributor System will perform a screening process on all accounts that are active, temporarily struck off strength (T-SOS) or struck off strength (SOS) and have an SOS date greater than the processing date minus three years, in the database in order to determine eligibility and coverage date. The DCH screen can be viewed in the Contributor System.The definition of the DCP status and reason codes are described below:
|DCP Status codes (DCP STS)||Description|
|W = Waiting for coverage||This status code indicates that the employee is eligible for the Dental Care Plan and is qualifying (waiting) for coverage.|
|C = Covered||This status code indicates that the employee is eligible for coverage. The effective date of coverage will appear on the DCP screen.|
|O = Employee paid coverage Optional||An employee may have temporarily lost his eligibility to submit dental claims. Employer-paid coverage is suspended but the employee has the option of paying for his own coverage.|
|S = Suspended coverage||An employee has temporarily lost his eligibility to submit dental claims. Employer-paid coverage has been suspended and the employee does not have the option of paying for his own coverage.|
|T = Terminated from Plan||An employee has lost his eligibility to participate in the Dental Care Plan and his coverage will be terminated until he qualifies again for eligibility or an employee, who was waiting for coverage, has had his future effective date of coverage put off indefinitely.|
|I = Ineligible||An employee is not eligible to participate in the Dental Care Plan.|
|Q = Qualifying for DCP Eligibility||An employee will be eligible to participate in the Dental Care Plan.|
|Status Reason Codes||Description|
|3||Break in service <=3 months|
|5||Break in service <=5 working days|
|6||Transfer from an immediate DCP eligible position to a non-immediate eligible position before completing coverage eligibility.|
|C||Re-employed in casual position after SOS <=5 working days|
|I||Transfer from a non-immediate eligible position to an immediate eligible position before completing coverage eligibility.|
|L||Leave without pay (LWOP)|
|R||Rehabilitation leave from the Armed Forces|
|S||Struck off strength (SOS)|
|U||Laid off at end of LWOP surplus status leave|
|W||Laid off under a work force adjustment|
|X||Extension of suspension of coverage by SOS or LWOP event from end of event until coverage reinstatement date.|
4.1 Any inquiries on the information contained in this document should be addressed to your Public Works and Government Services Canada (PWGSC) Compensation Services Office.
Original Signed by
Acting Director General
Accounting, Banking and Compensation
Reference(s): CJA 9246-2A and B
- Date modified: