What is the
Canadian Dental Care Plan?

Anyone wishing to participate in this plan must meet the eligibility requirements.

To be eligible for the CDCP, you must meet the following 4 eligibility criteria:

• Be considered a Canadian resident for tax purposes.
• Have completed and submitted a tax return for the previous year.
• Have no access to dental insurance through a private, retirement, or employer plan.
• Have a net adjusted family income (after taxes) of less than $90,000.

Application Timeline

Applications for the CDCP will be processed in stages, prioritizing seniors. Children under 18 and individuals with disabilities can apply starting in June 2024. Other Canadian residents can apply starting in 2025.

! Important
Veuillez prêter attention aux dates spécifiques d’ouverture des inscriptions pour chaque groupe afin de soumettre votre demande dans les délais. Assurez-vous de consulter régulièrement notre site pour les mises à jour ou les changements éventuels.

CDCP Coverage: What You Need to Know

The CDCP has developed a specific fee guide that determines the fees the plan will pay for covered services.

The fees listed may vary from provincial or territorial guides. Not all patients will receive full financial assistance from the CDCP due to co-payments required. It is therefore essential to be informed about the costs not covered by the plan.

Co-payments represent the portion of treatment costs that you must cover, and the percentage is based on the net adjusted family income as indicated on the previous year’s tax return. Co-payments or non-covered fees must be paid directly to the dental clinic.

Before receiving dental care services, it is recommended to check which costs are not covered by the plan. Services not covered by the CDCP must be paid in full by the patients.

Additionally, cancellation or no-show fees for a dental appointment cannot be billed to the CDCP and will therefore be the responsibility of the patients.

Here is a summary of the coverage and financial responsibility of patients based on their net adjusted family income:

Net Family Income

• Less than $70,000
• Covered by the CDCP 100%
• Covered by the patient 0%
• $70,000 to $79,999
• Covered by the CDCP 60%
• Covered by the patient 40%
• $80,000 to $89,999
• Covered by the CDCP 40%
• Covered by the patient 60%

Example Calculation: If a dentist follows the provincial fee guide and charges $100 for a recall dental exam, but the CDCP fee structure only covers $90 for a recall dental exam, the patient must pay the $10 difference. In this same case, for a patient with a net family income of $85,000, the plan would cover $36 (40% of the fees set by the CDCP) and the patient would need to pay $54 (the remaining 60% of the fees set by the CDCP) as well as the additional $10.

These figures are provided for informational purposes.

Dental Care Fee Schedule

Check the codes and rates defined by the CDCP for dental services. Canadian residents receiving dental coverage through a provincial, territorial, or federal government social program may also be eligible for the CDCP. If all eligibility criteria are met, coverage coordination between programs will be ensured to avoid duplication or gaps.

Steps to Submit an Application

If you are 65 or older, you don’t have to do anything for now: you will receive a letter with instructions on how to enroll, along with an enrollment code. You can then submit your application by phone following the instructions in the letter.

If you are eligible but have not received a letter, make sure the mailing address used for your 2022 tax return is correct. If not, you will need to contact the Canada Revenue Agency (CRA) to update it.

Starting in May 2024, it will be possible to apply online. As of the writing of this document, no information is available regarding the online application process.

Validation of Enrollment

Once you have submitted your application, Health Canada will verify your eligibility and forward your information to Sun Life for your plan enrollment. You will receive a welcome package from Sun Life within three months of your application, including:

• The effective date of your coverage
• Your membership card
• Information about the CDCP

After your enrollment, you must meet the eligibility criteria each year and will be subject to an annual reassessment.

Details of this reassessment process have not yet been specified.

The CDCP covers health services aimed at preventing and treating oral diseases while maintaining the health of your teeth and gums.

The services covered, upon recommendation by a dental care professional, may include:

• Diagnostic services
• Dental X-rays
• Preventive services
• Periodontal services
• Restorative services
• Endodontic services
• Prosthodontic services
• Sedation dentistry
• Oral surgery

The CDCP coverage is limited to essential services intended to protect and preserve natural teeth, ensuring everyone has a functional dentition.

Many people have missing or damaged teeth that require extraction. In such situations, the CDCP provides for the supply of removable dentures, allowing individuals to eat and speak properly.

Additional services and treatments requiring prior authorization will be available starting in November 2024.

The plan is not intended to improve the overall appearance of teeth or offer purely cosmetic benefits. It also excludes more complex treatments.

The services not covered by the CDCP include:

• Composite resin or porcelain veneers
• 3D crowns
• Inlays and onlays of any dental material
• Devices and therapies for temporomandibular disorders
• Fixed dental bridges
• Teeth whitening
• Mouthguards and bruxism appliances
• Crown lengthening
• Dental implants and associated treatments
• Bone grafts
• Precision attachments for partial dentures
• Complete rehabilitation

Some services, such as deep sedation, are not systematically covered. If a dental care provider deems a treatment medically necessary, they can submit a request for prior authorization for the patient. The approval of this request is based on the recommendations of the dental care professional and considers the patient’s dental and medical history.

Services requiring prior authorization, including those exceeding established frequency limits, will not be covered until November 2024. If a service is provided without prior authorization, such as in the case of urgent dental care, a request for post-authorization can be submitted starting in November 2024, without guarantee of coverage.

Treatments requiring prior authorization include:

• Specialized dental examination
• Crowns
• Posts and cores
• Moderate sedation, deep sedation, and general anesthesia
• Major surgical procedures
• Clinically necessary orthodontic services (starting in 2025)