Dental Services: General Info - Health and Community Services

Dental Health Plan
Children’s Dental Health Program
Income Support Program
Low Income (Access) Program
Adult Dental Program
Surgical Dental Program
Provider Information

Dental Health Plan

Children’s Dental Health Program: 0 – 12 years
Income Support Program Youth: 13 – 17 years
Low Income (Access) Program Youth: 13 – 17 years
Adult Dental Program: 18 + years
Surgical Dental Program

Children’s Dental Health Program

The Children’s Dental Health Program provides universal access to eligible dental services for children aged 12 years and under. The eligible services are:

Examinations at six month intervals
Cleanings at 12 month intervals
Fluoride applications for children aged six to twelve years at 12 month intervals (except where the School Rinse Program is in place)
Routine fillings and extractions
Sealants

Parents should discuss with their dentist if costs for a recommended treatment will be covered under the Children’s Dental Health Plan.

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Income Support Program

The Income Support Program provides ‘Basic Services’ only, as listed in the Dental Health Plan Payment Schedule. For youths aged 13 – 17 years inclusive, whose family is/are in receipt of Income Support. Services limited to a two year cycle.

Eligible services include:

Examinations at two year intervals
Routine fillings and extractions

Ineligible services include:

Extraction of impacted teeth is not eligible under this program
Cleanings and fluorides are not eligible under this program
Sealants are not eligible under this program

The Department of Immigration, Skills and Labour does not authorize the provision of, or payment for, any dental treatment. That department verifies only the patient’s inability to pay for treatment.

All recipients of Income Support are enrolled in the Foundation Plan of the Newfoundland and Labrador Prescription Drug Program and they must have a valid MCP number, a Department of Immigration, Skills and Labour identification number and a Department of Immigration, Skills and Labour file number (Income Support Card). This information must be noted on all dental claim forms.

Note: Providers should verify the date and the validity of all numbers and be prepared to substantiate that validity for the date of the dental services rendered.

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Low Income (Access) Program

The Low Income (Access) Program provides ‘Basic Services’ only, as listed in the Dental Health Plan Payment Schedule. For youth aged 13 – 17 years, inclusive, who are eligible and enrolled in the Access Plan of the Newfoundland and Labrador Prescription Drug Program (NLPDP). Eligible youth will be noted in a letter of eligibility sent to the family from NLPDP offices in Stephenville.

Eligible services include:

Low Income (Access) Program coverage for eligible youths is the same as the Income Support Program:
Examinations at two year intervals
Routine fillings and extractions

Ineligible services include:

Extraction of impacted teeth is not eligible under this program
Cleanings and fluorides are not eligible under this program
Sealants are not eligible under this program

Other information:

Applications and assessment for eligibility is through the NLPDP offices in Stephenville
Proof of eligibility must be given to the dental office at the time of presentation for treatment. This will include a valid MCP number and a letter from NLPDP clearly showing the name of the patient seeking treatment.

For information or to request an application for the Access Plan you may call: 1-888-859-3535

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Adult Dental Program

The Adult Dental Program provides ‘Basic Services’ as listed in the Dental Health Plan Payment Schedule. There is also a denture component. Dentures are limited to ‘Standard Dentures’ only. Basic services limited to a three year cycle. Dentures are limited to an eight year cycle.

The Adult Dental Program will pay up to the cost of standard dentures. Additional costs from the delivery of specialized dentures will be the responsibility of the patient. It is recommended that patients talk with the dental provider prior to commencement of treatment to be informed of any additional charges. If a standard denture is delivered, there will be no cost to the patient as per the no balance billing policy of the Dental Health Plan.

Limited to clients enrolled under the Foundation Plan of the Newfoundland and Labrador Prescription Drug Program (NLPDP).
No preventive services (no cleanings and/or fluorides)
Eligible services include an examination and two x-rays every three years, routine fillings on a three year cycle, extractions, and there is a denture component allowing the delivery of standard dentures once every eight years.
Proof of eligibility required for billing purposes. Beneficiaries will need:
1. MCP number,
2. Department of Immigration, Skills and Labour PIN number and
3. File number

This will be the vast majority of cases .For adults enrolled in The Foundation Plan but NOT transferred from Department of Immigration, Skills and Labour (eg: ambulance cards from Regional Health Authorities), confirmation of enrollment should be obtained from NLPDP offices and the MCP number will be the only identification needed upon submission of claim.

Confirmation of eligibility by dental offices can be done via a toll free number: 1-888-859-3535

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Surgical Dental Program

The Surgical Dental Program provides insured services under the Medical Care Insurance Act. An insured service is defined as one that is:

Listed in Section 3 (b) of the Medical Care Insured Services Regulations
Medically necessary. The clinical need of the provision and claim of an insured service may be evaluated by the Dental Monitoring Committee of MCP.

Policies on pre-existing conditions necessary to define ‘medical necessity’ must exist for the specific services to qualify as MCP insured services.

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