January 21, 2021
- GSC Updates
Enhancing orthodontic coverage to include virtual delivery via SmileDirectClub
As another step forward in making health care more accessible for plan members, Green Shield Canada (GSC) is enhancing the scope of orthodontic coverage to include virtual orthodontic care delivered by a licensed dentist, effective March 1, 2021 – and we are pleased to announce that this option is offered through our new partnership with SmileDirectClub, a leader in this field. This virtual option greatly reduces financial and geographical barriers, and is available at a significantly lower cost than in-person treatment. When comparing GSC's preferred pricing through SmileDirectClub to the cost of an average course of in-person/traditional orthodontic treatment, it is approximately one third of the cost.
Many plan designs today include coverage for orthodontic treatment – typically with co-payments and maximums in place. But the benefit has always been used for in-person treatment. As of March 1, as noted in the December 2020 issue of The advantage®, GSC will allow orthodontic coverage to be used for in-person treatment or SmileDirectClub virtual treatment, noting all existing plan limitations will apply in all cases.
Where patients qualify for virtual treatment (not all orthodontic cases will be eligible), licensed dentists will create the treatment plans and follow the patient’s progress along the way, just as they do for in-person treatment. Plan member eligibility will be determined through the evaluation of an at-home impression kit and 3D images that are assessed by a licensed SmileDirectClub dentist or orthodontist.
SmileDirectClub will be positioned to submit claims electronically (in real-time), on behalf of plan members, who will only need to pay out-of-pocket for the portion not covered under their plan. This is a great plan member experience as orthodontic claims are not typically submitted electronically today.
Needless to say, in line with GSC’s focus on health outcomes, we have explored virtual orthodontic care thoroughly. Through an independent review conducted by GSC and a licensed orthodontist, it was determined that there is no risk to patient safety with this model of care – which has already been successfully delivered in the United States. And it is within the current scope of practice for dentists and orthodontists in Canada, as outlined by their provincial regulatory authorities.
As shared in mid-December, if you decide that you do not wish to offer this option to your plan members as an alternative to in-person care, contact your account team by January 29, 2021. For plans that do not include orthodontic coverage, plan members will get the same access to a preferred GSC discount for the virtual orthodontics product to reduce their out-of-pocket cost.