CDCP

The CDCP has developed their own fee guide, which determines the fees the CDCP will pay for services covered under the plan. These fees can differ from provincial or territorial fee guides. Not all patients will receive complete financial assistance through the CDCP due to required co-payments, so it is important to ask about costs not covered by the plan. These co-payments are the portion of treatment costs you would be expected to cover out of pocket, and the percentage is determined by your family’s net annual income shown on the previous year’s tax return. Co-payment or fees not covered are paid directly to the dental office.

Table on co-payments based on adjusted family net income.

Please note the percentages covered are for the CDCP fee guide, which is sometimes lower than the provincial guides.

Additionally, when a dentist follows their established fee structure, it may be higher than the CDCP’s fees, in which case there is a gap in payments. The gap can be filled by balanced billing, where the patient is billed for the difference between the CDCP fees and the fee their dentist would charge a patient who does not qualify for coverage under the plan.

For example, if a dentist follows the provincial fee guide and charges $100 for a recall dental exam but the CDCP fee structure only covers $90 the patient is responsible for the $10 difference. In the same example, for a patient with a net family income of $85,000, the plan would cover $36 (40% of the CDCP established fee) and the patient would be responsible for $54 (the remaining 60% of the CDCP established fee) plus the additional $10. Please note these

If you are a senior (age 65 or older), there is no need to do anything, as you will receive a letter with instructions on applying and an application code. You can then apply over the phone by following the instructions included in the letter.

If you are eligible but haven’t received a letter, check the mailing address used for your 2022 tax filing is current. If your address is out of date, you will need to contact the Canada Revenue Agency (CRA) to update it.

From May 2024, people can apply online. At the time of writing, no information is available on applying online.

Once you have applied, Health Canada will confirm your eligibility and share your information with Sun Life to enroll you in the plan. You will receive a welcome package from Sun Life within three months of your application, which will include:

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

Once enrolled, you must meet the eligibility requirements each subsequent year with an annual reassessment. Details about the reassessment process have yet to be released.

The CDCP covers oral health services designed to prevent and treat oral disease and to maintain healthy teeth and gums. Services that are covered when recommended by a dental professional can include the following listed below.

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

Coverage under the CDCP is limited to basic services that protect and preserve natural teeth so people can benefit from teeth that function properly. Many people have missing teeth or teeth that are failing and need removing. When this is the case, the CDCP includes the provision of removable dentures, allowing people to eat and talk effectively.

The plan is not designed to improve the overall appearance of teeth or provide purely aesthetic benefits. It also excludes more complex treatments. Treatments not considered for coverage under the CDCP include those listed below.

1. Composite resin or porcelain veneers
2. Three-quarter crowns
3. Inlays and onlays made from any dental materials
4. Temporomandibular appliances and therapy
5. Fixed dental bridges
6. Teeth whitening
7. Mouthguards and bruxism appliances
8. Crown lengthening
9. Dental implants and any associated treatments
10. Bone grafting
11. Precision attachments for partial dentures
12. Extensive rehabilitation

Certain services, such as deep sedation, are not covered in all cases. If a provider believes the treatment is medically necessary, they can submit a preauthorization request on behalf of the patient. Approval of the preauthorization request is based on the recommendations of the dental care professional and considers the patient’s dental and medical history.

Services that need preauthorization, including coverage beyond the established frequency limitations, will not be covered under the plan until November 2024. If a service is given without preauthorization, for example, if urgent dental care is required, it may be submitted for post-determination beginning November 2024, with no guarantee that the service will be covered.

Treatments requiring preauthorization are listed below.

1. Specialist dental examination
2. Crowns
3. Posts and cores
4. Moderate sedation, deep sedation and general anesthesia
5. Major surgical procedures
6. Orthodontic services when clinically necessary (starting in 2025)