Canadian Dental Care Plan FAQ
November 10, 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 with a family net income below $90,000 and who do not have access to dental insurance qualify for CDCP. It is open to seniors aged 65 and over, children under 18, those with
disabilities, and all remaining Canadians in
2025.
To view eligible services that the CDCP covers, 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 the CDCP does not cover, 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
charges.
If the cost of the services received exceeds what the CDCP will reimburse the oral health provider, the
CDCP-eligible
client may have additional costs besides the co-payment. Oral health providers must inform all CDCP clients of
any
additional charges beyond what the plan covers before the services are performed.
Potential eligible Canadians can verify and apply for the CDCP online by visiting canada.ca/dental. Oral health
providers do not determine whether 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 at
1-888-888-8110.
The first appointment date will be based on the CDCP client’s application approval date. The client’s welcome
package
will inform them of this date, which the oral health provider can verify through the Sun Life Direct portal.
NOTE: The date is not listed on their benefit card.
No. There is no maximum spending limit, only limits on the 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, Health Canada is.
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 in the CDCP
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.
Claims can 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 on the Sun Life Oral Health Provider section of their website. Providers can upload the fee grids
into their software systems.
CDCP clients must be informed about any fees that are not covered by the CDCP before they receive care. Services
and
fees can be validated through Electronic Data Interchange (EDI), Sun Life Direct, or by calling the call centre
at
1-888-888-8110.
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 directly to Sun Life by a participating CDCP
oral
health provider.
Provider participation in the CDCP is voluntary. Given that CDCP is publicly funded by taxpayers, the Government
of
Canada determines the terms and conditions of the program. Providers have two pathways to provide dental
hygiene care.
They can fully enroll in the plan acknowledging the terms in the Claims Processing and Payment Agreement OR
provide
dental hygiene care to eligible CDCP clients and claim services rendered on a claim-by-claim basis.
Yes. You can opt out at any time.
Yes, but you are strongly encouraged to bill the fees 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 before the services are
rendered
about any fees that the CDCP will not cover.
The Government of Canada negotiated 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. For more information on programs within your
province, consult canada.ca/dental.
Yes. The preauthorization process for additional services was made available in November 2024. For more
information,
consult Section 5.0 of the Dental
Benefits Guide.
The CDCP Provider Search tool allows 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 anytime.
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. The Government of Canada made a
commitment
in October 2024 to review the differences between dental hygiene services delivered in clinics operated by
dentists
versus those delivered in clinics operated by dental hygienists so that fees reflect the parity principle.
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 communicated directly 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.
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), increased frequency limitations for certain services, no limitations on patients’ examinations,
parity of
reimbursement rates with dentists, and more.
CDHA is exclusively responsible for developing the National List of Service Codes and their definitions. Each
provincial
association is responsible for developing its 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. Participating dental hygienists must
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 of being a participating oral health provider under the CDCP.