7B.4. Orthodontics

POLICY  

Authority OW Act: Sec. 8 and 74(4) & OW Directives: Dir. 7.2 

Effective February 1, 2013, the Manitoulin-Sudbury District Services Board will no longer pay for orthodontics. This policy will allow the Director of Integrated Social Services to make an exception only where the applicant has exhausted all other avenues, including Healthy Communities Fund (HCF), Our Kids Count (OKC), local service clubs and community organizations. Where this exception is applied the maximum allowable will be $2,000 per individual. If the cost for the service is higher, the participant will be required to demonstrate how the balance of the cost will be paid.   

Exceptions will be considered for a dependant child of an Ontario Works (OW) or Ontario Disability Support Program (ODSP) recipient. Orthodontics will only be considered when the treatment is medically necessary and not primarily for cosmetic reasons. The participant will be expected to provide a letter from the Orthodontist outlining the medical need for the treatment.  

Payments will only be made while the participant/beneficiary is in receipt of OW. Should financial assistance terminate, the former participant will become responsible for the balance of the cost.   

Two estimates are required. The lower estimate may be accepted. The cost of orthodontic pre-treatment assessment is the responsibility of the participant.

Only work completed by a qualified Orthodontist will be approved.
 

PROCEDURE

1. Participant submits two estimates from qualified orthodontists to verify the need and cost. 

2. Case Manager verifies that the patient is a dependant child and the estimates are from qualified orthodontists.

3. Request forwarded to Supervisor who will seek approval from the Director of Integrated Social Services.

4. Letter mailed to participant to advise them of outcome of request. If case is approved, the participant is advised to make arrangements for the cost of the orthodontic work that is over $2,000.

5. Once Case Manager verifies that arrangements have been made to cover the additional cost, a letter of authorization is mailed to the orthodontist approving an initial payment of $500 with the balance to be paid as the work is completed up to the maximum of $2,000. The orthodontist will submit invoices as the work is completed.

   Upon receipt of the invoice, the Case Manager will verify the status of the case. If the case is on-going, the Case Manager will request the benefit via the social assistance computer system. The Case Manager will document in the notes section of the social assistance computer system.

6. If case is no longer in receipt of OW or ODSP the orthodontist is to be advised immediately that the approval is no longer valid. 

7. When the approved amount has been paid in full, the Case Manager will document such in the social assistance computer system.