Beneficiary Questions:
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What is the purpose of the Adult Dental Program?
The Adult Dental Program is an initiative of the provincial Poverty Reduction Strategy and is anticipated to improve the oral health of adults with low incomes.
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Who is eligible for coverage under the Adult Dental Program?
Adults 18 years or older are eligible for coverage under the Adult Dental Health Program if they are enrolled in the Foundation Plan of the Newfoundland and Labrador Prescription Drug Program (NLPDP).
The Foundation Plan – Includes individuals and families in receipt of income support benefits through the Department of Immigration, Skills and Labour and certain individuals receiving services through the Regional Health Authorities, including children in the care of Child, Youth and Family Services and individuals in supervised care.
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I am not enrolled in the NLPDP. How do I apply?
No application is necessary. A Prescription Drug Program card is automatically issued when the Department of Health and Community Services is notified that an individual is in receipt of income support benefits through the Department of Immigration, Skills and Labour, or receiving services through the Regional Health Authorities, including children in the care of Child, Youth and Family Services and individuals in supervised care.
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What is the budget of the Adult Dental Program?
- A dental examination, bitewing x-rays and basic fillings are covered once every three years.
- Extractions.
- Dentures are covered once every 8 years (maximum dollar amounts apply).
- Denture repairs.
- An information package has been sent to all dentists and denturists with further details.
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What services are not covered?
Services not covered under the Adult Dental Program include but are not limited to:
- Root Canals
- Orthodontics
- Preventive services such as cleanings
- Major services such as posts, crowns, bridges and implants
- Services received that exceed the annual per client cap (see question 11 for further details
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What do I need to bring to the dentist/denturist office?
Foundation Plan Members (those whose eligibility stems from services received through the Department of Immigration, Skills and Labour) – Bring your NLPDP Drug Card and your valid Department of Immigration, Skills and Labour Client card.
Foundation Plan Members (those whose eligibility stems from services received through the Regional Health Authorities) – The client is required to bring their dental/ambulance card. The dental provider should confirm the client’s eligibility by calling 1-888-859-3535.
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I have a card, but no letter?
Foundation Plan members do not require a letter
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I received an Ambulance/Dental card through a Regional Health Authority. What do I need to bring to the dental/denturist office?
You need only to bring your Ambulance/Dental card. The dental provider will confirm your eligibility with the NLPDP Office by calling 1-888-859-3535.
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Who can I go to for treatment?
Any provider licensed by the Newfoundland and Labrador Dental Board can provide the eligible dental services, including dentures. Any provider licensed under the Denturist Board of Newfoundland and Labrador can provide denture services.
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Is there a co-pay?
There is no co-pay for eligible services received under the Adult Dental Program however as of October 3, 2023, there is an annual cap per patient of $1,800 for dentures and $300 for basic dental services. You are encouraged to discuss with your dental provider what services they are recommending and whether these services are covered under the Adult Dental Program.
You are responsible for the cost of any services received which are not covered by the Adult Dental Program, or any services you choose to receive beyond your annual cap.
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What does the per person cap of $300 in basic dental services each year mean?
Effective July 2, 2015, the annual cap for Basic Services increased from $200 to $300. A per person cap of $300 in basic dental services means your dentist can provide you with eligible dental services for which the Adult Dental Program will pay a maximum of $300 each year. Any services you choose to receive above your cap would be outside the program and you would be responsible for these costs. Emergency dental services (specific definitions apply) for program clients who are in receipt of income support are exempted from the cap.
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What does a per person cap of $1,800 in dentures each year mean?
A $1,800 annual cap came into effect October 3, 2023. A per person cap of $1,800 for dentures each year means that your denturist or dentist can provide you with eligible dentures (once every 8 years), denture repairs or denture relines for which the Adult Dental program will pay a maximum of $1,800 annually. Any services you choose to receive above your cap would be outside the program and you would be responsible for these costs.
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When is the per person cap renewed?
Calendar or Fiscal Year?The per person caps will be renewed on April 1st of each year.
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Will I have to pay anything?
There are some providers who do not bill the Adult Dental Program directly for services delivered. In these cases, you will be required to pay at the time of service and then be reimbursed by the Program. You will have to submit an itemized paid in full receipt on your own behalf and the submission will be assessed in accordance with eligible services and the annual cap. In addition, any services received above your annual cap must be paid directly to the provider.
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Where do I send receipts for payment?
Attn: Adult Dental Program
MCP
P. O. Box 5000
Grand Falls-Windsor, NL A2A 2Y4 -
Does my card/letter cover any other members of my family?
Your card/letter applies only to you. Each family member who is 18 years of age or older has to have their own card and where required, a letter.
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My dentist/denturist says I need a ‘special’ denture?
Rates allowable under the Adult Dental Program are based on a standard denture. In cases where a provider indicates that a specialized denture is necessary and a standard denture will not be sufficient, the Adult Dental Program will pay up to the rate allowed for a standard denture in the provincial Adult Dental Payment Schedule and subject to the per client annual cap of $900. This amount can be applied toward the cost of the specialized denture. However, the difference in cost between the eligible amount for a standard denture and the special denture is the responsibility of the client.
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What if I have dental insurance?
Government is payer of last resort. As such, the service costs must first be submitted to your private insurance. Depending on the rates being paid by your private insurer it is possible that you may have to pay some portion of the total cost.
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My dentist/denturist told me he/she has to submit a Prior Approval Application for dentures. How does the prior approval process benefit clients of the Adult Dental Program?
A prior approval process for dentures came into effect March 6, 2013. The prior approval process will allow the client and his/her dentist/denturist to ensure coverage for the denture that will be delivered, prior to the start of the work.