Dental & Orthodontic Services
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 in receipt of BC Employment and Assistance.
Orthodontic services may be available to children 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.
Effective: September 1, 2017
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's 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 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.]
Table: Dental, Orthodontic, Crown and Bridgework, and Denture Supplements
|Emergency dental services||
|Basic dental services: $2,000 every two calendar years
|Basic dental services: $1,000 every two calendar years
When they meet the following criteria:
|Crown and Bridgework||
When the meet the following criteria:
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||
|Complete dentures, initial placement (single or both)||
|Partial dentures in excess of the basic dental financial limit||
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||
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:
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:
- 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.]
- 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.
- 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 - Dental Coverage].
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:
- Confirm the recipient’s eligibility.
- 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.
- Once all diagnostic records and supporting documentation have been received, make a final decision.
- 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, Pacific Blue Cross. 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, 2017
Coverage for conscious sedation may be provided to children under 19 years of age in specific circumstances as outlined in the Schedule of Fee Allowances - Dentist.
Coverage for 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.
Effective: February 3, 2019
For Dental and Orthodontic requests that have been denied, the Dentist or Orthodontist will advise the client of the reasons for denial. Should the client not agree with the decision they have a right to request reconsideration.
A request for reconsideration can be initiated by contacting the ministry. The worker will complete an Employment and Assistance Request for Reconsideration (HR0100) using the denial reasons provided by Pacific Blue Cross and forward to the client for submission to the Reconsideration Branch.
Authorities and Responsibilities
Effective: November 3, 2014
Health Assistance (HA) is responsible for:
- Responding to Ministry enquiries regarding dental and orthodontic supplements
The Dental Program Contractor, Pacific Blue Cross, is responsible for:
- Advising dentists, dental hygienists and denturists of client eligibility for dental supplements
- Assessing eligibility for the orthodontic supplement.
- Assessing eligibility for the crown and bridge 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 and parents with children eligible for coverage through the Healthy Kids Program 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's fee for service schedule.
Question What happens when my child turns 19 or ages out of the Healthy Kids Program?
Answer When a person in BC reaches the age of majority, 19 years, that person is no longer entitled to dental services for children under the ministry’s Dental Supplement or the Healthy Kids Program.