Canadian Dental Care Plan FAQ
April 17, 2024
The CDCP is a publicly funded federal dental care plan that brings equity in access to oral health care to
Canadians with lower socioeconomic status. It is managed and run by the Oral Health Branch of Health Canada.
Canadian residents who have a family net income below $90,000 and do not have access to dental insurance
qualify for CDCP. Currently it is open to seniors. Children under 18 and those
with
disabilities will be able to apply in June 2024
and all remaining Canadians in 2025.
To view eligible services that are covered by the CDCP, visit canada.ca/dental.
No. There is a tiered system of coverage based on the net family adjusted income:
- Below $70,000, 100% of the established CDCP services fees are covered.
- Between $70,000 and $79,999, 60% of the established CDCP services fees are covered.
- Between $80,000 and $89,999, 40% of the established CDCP services fees are covered.
A co-payment is the percentage of the CDCP fees that is not covered by the CDCP, and that the CDCP client
will
have to
pay directly to the oral health provider. The co-payment is based on the CDCP client’s adjusted family
net
income.
It is possible that the CDCP established fees for services may not be the same as what the oral health
provider
charge.
The CDCP eligible client may have in addition to the co-payment, additional cost, if the cost of the
services
received
is more than what the CDCP will reimburse the oral health provider. Oral health providers must inform
all CDCP
clients
of any additional charges beyond what the plan covers before the services are performed.
Currently and until May 1st, 2024, Service Canada is sending letters to eligible seniors based on their
2023
income tax
records inviting them to apply. Oral health providers do not play a role in determining if a patient is
approved.
Seniors, people with disabilities, and children under 18 years of age. Full implementation is scheduled
for 2025.
When a client is approved for CDCP coverage, they are sent a welcome package that includes a benefit card
with
their
name and plan number. To verify coverage, the oral health provider will input the name of the client and
the
plan number
into Sun Life Direct to verify copayment amount, if any, or call the Sun Life CDCP call centre.
The date of the first appointment will be based on the CDCP client’s application approval date. The
client’s
welcome
package will inform them of this date, and it can be verified by the oral health provider through Sun
Life
Direct
portal. The first appointments will start in May.
NOTE: The date is not listed on their benefit card.
No. There is no maximum spending limit; only limits on type and frequency of services covered.
Sun Life is the administrator of the CDCP on behalf of the Government of Canada.
NOTE: Sun Life is not responsible for determining the Terms and Conditions under the CDCP nor the
services
covered, the
frequency of services or the CDCP fees.
Sun life Direct
is a
portal that allows oral health providers to:
- Confirm their participation in the CDCP.
- Verify their patients’ CDCP eligibility and availability of coverage.
- Sign up and manage their banking information for direct deposits from Sun Life.
- View their payment history.
No. The office dentist/clinic/employer you work for/in will be the one that will register as an oral
health
provider
with the CDCP.
- Be a CDHA
member.
- Join the Independent
Practice Network (IPN).
- Apply for a Unique Identification Number (UIN).
- Complete a CDHAnet application form (you must have software)
to obtain an office number.
- Enrol in Sun
Life
Direct.
- Review the CDCP Claims Processing and Payment Agreement document.
- Agree to participate into the CDCP Claims Processing and Payment Agreement. (can be done online on the Sun Life Direct portal or mailed using the paper form).
OR
As of July 8th, providers can see CDCP clients without full enrolment in the plan.
For any questions, call 1- 888-888-8110 from Monday to Friday 7:00am to 6:00pm local time.
Starting in May, claims can only be submitted through Electronic Data Interchange (EDI). As of November
2024,
both EDI
and paper claims will be processed.
The CDCP fee
grids
can be found in the Sun Life Oral Health Provider section of their website. Providers will be able to
upload the
fee grids into their software system.
CDCP clients must be informed about any fees that will not be covered by the CDCP before they receive
care.
Validation
of services and fees can be done through Electronic Data Interchange (EDI), Sun Life Direct or by
calling the
contact
centre.
Providers who submit claims to Sun Life using Electronic Data Interchange (EDI) and are enrolled with Sun
Life
Direct
will receive direct deposit to their business bank account within 24-48 hours. Those who opt for payment
by
cheque will
receive them once a month.
No. Claims for services covered under the CDCP must be submitted by a participating CDCP oral health
provider
directly
to Sun Life.
Provider participation in the CDCP is voluntary. Given that CDCP is publicly funded by tax payors, the Government of
Canada determines the terms and the conditions of the program. Providers have two pathways to provide dental hygiene
care. They can fully enrol in the plan acknowledging the terms in the Claims processing and Payment Agreement OR as of
July 8th, they will be able to provide dental hygiene care to eligible CDCP clients and claim services rendered on a
claim-by-claim basis. Note that only fully enrolled providers will be listed on the CDCP provider search tool available
to eligible CDCP clients.
Yes. You can opt out at any time.
Yes, but you are strongly encouraged to bill the fees set out in the CDCP Dental Benefit Grids. The CDCP
was
designed to
ensure that lower-income residents can access the oral health care services they need to improve their
oral and
overall
health. If you choose to, you will be required to obtain informed consent from the CDCP client ahead of
the
services
being rendered about any fees that will not be covered by the CDCP.
The Government of Canada is in negotiation with all provinces and territories that have publicly funded
dental
care
programs to determine which plan will be the first payer and the second payer.
No. The preauthorization process for additional services is not available until November 2024.
The CDCP Provider Search will allow CDCP eligible clients to search from a network of participating oral
health
providers from across Canada including dentists, dental specialists, denturists, and dental hygienists.
Note: When you complete full enrollment in the CDCP you will automatically be entered in the Provider Search function, but
you can
opt out
at any time.
The CDCP dental benefit grids have been designed using the existing methodology of other federal dental
programs
to pay
a fair rate to oral health providers for evidence-based treatments and services.
The Government of Canada is using current dental hygiene provincial fee guides as a starting point to set
the
CDCP fees
which are, in most provinces, lower than the provincial dentists’ fee guide.
Since early 2022, CDHA, with the help of a team of dental hygienists and other oral health stakeholders,
has been
involved in reviewing all publicly funded programs to inform our requests to the government with
suggested
evidence-informed services and processes that this new plan should include, along with recommendations
regarding
the
frequency of these services for every segment of the population. Throughout the development process,
CDHA and
other
national key stakeholders have been in direct communication with various levels of government to help
shape the
CDCP.
After reviewing many submissions, the government opted to mirror the CDCP in the Non-Insured Health
Benefits
program for
First Nations, another federally funded program.
CDHA staff meets weekly with government representatives and sits alongside other dental hygienists in
various
working
groups (Engagement, Communications, Fees, Preauthorization, and Administrative Processes) to help refine
the
program
well beyond the scheduled launch of services in May 2024. CDHA will continue to be present during
negotiations
and act
in the best interests of all its members including dental hygienists practising independently.
Since the announcement of an upcoming federal dental care plan for low-income Canadians, CDHA has been
involved
with
Health Canada, oral health associations, other stakeholders, and various levels of government officials.
We have
been
advocating for the plan to cover population-specific evidence-informed preventive services with
reasonable
frequency
limits for each service, fair and equitable reimbursement rates for services provided, the
administration of the
plan
that would not rely heavily on predetermination/pre-authorization of services or be an administration
burden for
business owners, and for proper surveillance of services offered to inform future changes to the plan.
We also
continue
to advocate for the addition of some preventive services including (e.g., oral health education, health
promotion, daily
mouth care), increase in frequency limitations for certain services, no limitations on patients’
examinations,
parity of
reimbursement rates with dentists, and more.
CDHA is responsible for developing the National List of Service Codes and their definitions exclusively.
It is
the
responsibility of each provincial association to develop their respective fee guide based on a stringent
analysis of the
cost of operating an independent dental hygiene practice.
The CDCP reflects a fee for service approach identical to clinical practice. It is imperative that
participating
dental
hygienists claim the correct service codes and fees for the services rendered to eligible CDCP clients.
Failure
to do so
may result in the removal of the privilege to be a participating oral health provider under the CDCP.