Dental & Orthodontic Services

Overview

Emergency dental services for the relief of pain are provided to all recipients of income assistance, disability assistance, and hardship assistance.  Dentures are provided to recipients who meet specific eligibility criteria.

Basic dental services, such as restorations, extractions, and preventative services are provided to recipients of income assistance and disability assistance who are eligible for general health supplements.  Basic dental services are also provided to children of families in receipt of BC Employment and Assistance.

Orthodontic services may be available to children of families in receipt of income assistance or disability assistance and adults with the Persons with Disabilities (PWD) designation who have severe maxio-facial dental deformities.

Crown and bridge services may be available to persons with PWD designation or who meet the Persons with Persistent Multiple Barriers (PPMB) criteria who have a dental condition that cannot be corrected through basic dental services, and have a medical condition that prevents the use of a removable denture.

These services are available under the Employment and Assistance Regulation and Employment and Assistance for Persons with Disabilities Regulation.

Policy

Effective:  September 1, 2015

Recipients who are not eligible for  dental supplements may access emergency dental services, which provide services for the immediate relief of pain.

Recipients who are eligible for  dental supplements [see Related Links – Health Supplement Summary] are eligible for coverage for basic dental services up to a maximum amount every two consecutive calendar years for adults and children.  Recipients who have reached their basic dental limit may be eligible for emergency dental services.

Dental services are provided in accordance with the Ministry of Social Development and Poverty Reduction fee-for-service schedules.  [For information on eligible services and rates, see Additional Resources – Schedule of Fee Allowances – Dentist, Schedule of Fee Allowances – Denturist or Schedule of Fee Allowances – Hygienist.]

Adult recipients with Person with Disabilities (PWD) designation or who meet the Persons with Persistent Multiple Barriers (PPMB) criteria who have a dental condition that cannot be corrected through the provision of basic dental treatment and have a medical condition that prevents the use of a removable denture may be eligible for crown and bridge services.

Children of families receiving income assistance or disability assistance and recipients with the Persons with Disabilities (PWD) designation, who have severe maxio-facial dental deformities may be eligible for orthodontic services.

[For information on optical and dental supplements for non-BCEA children, see Related Links – Healthy Kids.]

Eligibility Criteria

Table: Dental, Orthodontic, Crown and Bridgework, and Denture Supplements

Program Eligible Clients
Emergency dental services
  • Recipients not eligible for basic dental services, including recipients of hardship assistance
  • Recipients eligible for basic dental services who have reached their biennial limit
Basic dental services: $1,400 every two calendar years
(biennial limit)
  • Dependent children of income assistance, disability assistance and hardship assistance recipients
  • Recipients of child in home of  relative (CIHR) assistance
  • Healthy Kids – Dependent children of families receiving premium assistance through Medical Services Plan
Basic dental services: $1,000 every two calendar years
(biennial limit)
  • Recipients with the PWD designation and their spouses
  • Recipients with Persons with persistent multiple barriers (PPMB) and their spouses
  • Persons in a family unit eligible for Medical Services Only (MSO) when that family unit includes either a person with the PWD designation or a PPMB 
  • Persons in a family unit eligible for Transitional Health Services when that family unit includes a PPMB
Orthodontic services
  • Dependent children of income and disability assistance recipients
  • Recipients with the PWD designation
  • Recipients of CIHR

When they meet the following criteria:

  • have severe skeletal dysplasia with jaw misalignment by 2 or more standard deviations
  • are pre-approved
  • have no other resources available to meet the need
  • Requests for orthodontics are initiated by the dental practitioner/orthodontist and are sent directly to the ministry contractor for adjudication. 
Crown and Bridgework
  • Recipients with PWD designation
  • Recipients eligible for PPMB
  • If the dental condition cannot be corrected through the provision of basic dental services and one or more of the following circumstances exist:
    • the dental condition precludes the use of a removable prosthetic
    • the person has a physical impairment that makes it impossible for the person to place a removable prosthetic
    • the person has an allergic reaction or other intolerance to the composition or material used in a removable prosthetic
    • the person has a mental condition that makes it impossible for the person to assume responsibility for a removable prosthetic
  • Pre-approval is required. Requests for crown and bridgework are initiated by the dental practitioner and are sent directly to the ministry contractor, Pacific Blue Cross for adjudication. 
General Anaesthetic or intravenous sedation
  • General anaesthetic or intravenous sedation performed in a dental office may be provided in the following situations:
    • for children under 19 where necessary for the safe performance of dental treatment
    • for children and adults with the PWD designation with severe mental or physical disabilities that necessitate general anaesthetic/IV sedation
  • The Provincial Health Services Authority (PHSA) manages general anaesthetic or intravenous sedation at private facilities through the   BC Children’s Hospital (BCCH) under the Community Dental Partners Program.  The determination of eligibility for general anaesthetic or intravenous sedation at private facilities is between the dentist and the BCCH.
  • Children and adults with the PWD designation who require anaesthetic in a hospital or PHSA approved private facility may be eligible for an additional $1000/year of dental treatment when performed under anaesthetic  See Rate Table: Health Supplements and Programs – Dental and Orthodontic Services.
Dentures
Complete dentures, initial placement (single or both)
  • All recipients (including those with emergency coverage only) if there have been extractions within the last six months that result in full clearance of the arch
  • The ministry’s dental program contractor, Pacific Blue Cross, may make an exception to the six month extraction rule for providing dentures if the client has not received them within that time frame.
Partial dentures in excess of the basic dental financial limit
  • Recipients with the PWD designation and their spouses
  • Children

if the ministry has not paid for a denture on the same arch within the past five years and there has been at least one extraction in the last six months that results in three or more adjacent missing teeth

Replacement dentures (partial or complete) once every five years
  • Recipients with the PWD designation and their spouses
  • Recipients eligible for PPMB and their spouses
  • Children

if the recipient has been in receipt of income assistance or disability assistance for at least two years  

Pacific Blue Cross may authorize a one-time only exemption to the once every five years replacement policy if the following criteria have been met:

  • The  client is eligible for replacement dentures (see above)
  • The dentures being replaced were lost or damaged beyond repair, and the loss or damage was beyond the control of the client; and
  • Failure to provide replacement dentures would result in compromised health

Procedures

Effective:  September 1, 2015

If a recipient is enquiring on the eligibility process for basic dental services, emergency dental services, and denture services, EAWs are to follow these steps:
 

  1. Review the MSP Information Query (MSP Q) screen to ensure that Medical Services Plan coverage has been applied for on behalf of the recipient. [For information on initiating MSP Coverage, see Related Links – Medical Services Plan and Medical Coverage – Procedures – Initiating MSP Coverage.]
  2. Inform the recipient to confirm with the dental office that they accept the ministry’s dental plan for billing purposes and provide the dental office with their  Personal Health Number, prior to treatment.
  3. Inform the recipient that the dental office will contact the dental program contractor to confirm their  eligibility and the procedure to follow.

Note: Not all dentists accept the ministry’s dental plan. Individuals looking for a dentist who is accepting new patients in their community and will bill the ministry’s dental may be referred to the BC Dental Association’s (BCDA) Find-a-Dentist service located on their website. An up-to-date list of clinics in British Columbia that offer reduced rates for dental services can also be found on the BCDA website.  [see Contacts and Additional Resources]

For enquires on the ministry’s dental supplements, clients can be referred to the Dental Information Line at 1-866-866-0800. [see Additional Resources]

Clients can be referred to the dental fee schedules to view the eligible services and amounts the ministry pays for services. [see Additional Resources – Schedule of Fee Allowances – Dentist, Schedule of Fee Allowances – Denturist or Schedule of Fee Allowances – Hygienist]

Effective:  November 3, 2014

To request orthodontic services, the client’s orthodontist should contact Pacific Blue Cross (PBC) to start the process of determining eligibility for orthodontic services.

To assess a recipient’s eligibility for orthodontic services, PBC follows these steps:
 

  1. Confirm the recipient’s eligibility.
  2. Where eligibility is confirmed, PBC advises the orthodontist what supporting documentation is required. The orthodontist has 120 days to respond to PBC, with the required records, for adjudication.
  3. Once all diagnostic records and supporting documentation have been received, make a final decision.
  4. Advise the orthodontist directly of the decision. The orthodontist will advise the recipient of the decision.

Effective:  December 1, 2003

To request crown and bridge services, the dentist sends a request for preauthorization, including a treatment plan and current x-rays, to the dental program contractor. Upon review of the treatment plan, a final decision is reached and the dentist is advised of the outcome by mail. The recipient will then be advised directly by their dental office.

Effective: September 1, 2015

General anaesthetic or intravenous sedation performed in a dental office may be provided in specific circumstances outlined in the Schedule of Fee Allowances.  

The Provincial Health Services Authority (PHSA) manages general anaesthetic or intravenous sedation at private facilities through BC Children’s Hospital (BCCH) under the Community Dental Partners Program. Arrangements for anaesthetic services through  BCCH are made between the dental office and the hospital.

Effective: November 3, 2014

In cases where a client is not eligible for replacement dentures due to replacements being requested within the five year replacement period, the client can provide to their dentist or denturist, a written request with the explanation of why they require the replacement and how their health will be compromised. The service provider then can submit the explanation with a treatment plan to Pacific Blue Cross who will review the request and will advise the dentist or denturist of the outcome.

Authorities and Responsibilities

Effective:  November 3, 2014

Health Assistance Branch (HAB) is responsible for:

  • Responding to Ministry enquiries regarding dental and orthodontic supplements

The Dental Program Contractor, Pacific Blue Cross, is responsible for:

  • Advising dentists and denturists of client eligibility for dental supplements
  • Assessing eligibility for the orthodontic supplement.
  • Assessing eligibility for exceptions to the once every five years replacement policy for dentures and the exceptions for the post 6 month extraction time limit.

Dental Information Line is responsible for:

  • Responding to enquiries from clients regarding dental and orthodontic supplements.

Frequently Asked Questions

 

Question  What do people do when they need dental services that cost more than their maximum eligibility for dental services?

Answer  Individuals have access to services that fall within their basic dental limit and the Emergency Dental Supplement.  Individuals may have to delay some services until the next year or until they or their family members are able to pay for the services themselves.  Individuals may also try to negotiate alternative payment arrangements with the supplier of the service.

 

Question  Can a recipient who is not eligible for  dental supplements be eligible to receive dentures?

Answer  The ministry will provide dentures, according to the ministry’s fee schedule, for recipients who have had their complete upper and/or lower arch of teeth extracted in the previous 6 months for the relief of pain, on recommendation of a dentist.

 

Question  How does a recipient access their dental coverage?

Answer  To request dental services, a recipient shows a piece of BC government issued identification which displays the recipient’s Personal Health Number to the dentist.  The dentist contacts the dental program contractor to confirm eligibility of the recipient.  If the recipient is eligible the dentist bills the dental program contractor directly, based on the Ministry of Social Development and Poverty Reduction’s fee for service schedule. 
 

 

Question  Who notifies a recipient if they are denied a request for dental services?

Answer  If the recipient is not eligible for the dental service that has been requested of the dental program contractor, the dentist advises the client of the outcome of the eligibility inquiry.  The request for reconsideration is handled through the Reconsideration Branch.