Dental & Orthodontic Services

Effective:  January 1, 2020

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.]

Eligibility Criteria

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

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 Health Coverage Tab 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 - 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:

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, 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.

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.

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.

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.

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. 
 

Answer  When a person in BC reaches the age of majority, 19 years, that person is no longer eligible for services under the Healthy Kids Program.  The Healthy Kids coverage remains active until the end of the month of their 19^th birthday.