Canadian Dental Care Plan (CDCP)

The Canadian Dental Care Plan (CDCP) will help ease financial barriers to accessing oral health care for eligible Canadian residents who:

• have an annual adjusted family net income of less than $90,000 and

• don’t have access to dental insurance

This new Canadian Dental Care Plan will be replacing the government’s interim Canada Dental Benefit intended to help lower dental costs for eligible families of children less than 12 years of age, earning less than $90,000 per year.

Here is what we know so far about the proposed Canada Dental Care Plan:

Am I Eligible For The Canada Dental Care Plan?

To qualify for the Canadian Dental Care Plan (CDCP), you must meet all of the following eligibility criteria:

• Not having access to dental insurance. This means you don’t have dental insurance:

1. 1. Through your employer or a family member’s employer benefits, including health and wellness accounts
   2. Through your pension (previous employer) or a family member’s pension benefits
   3. Purchased by you or a family member or through a group plan from an insurance or benefits company

• Have an adjusted family net income of less than $90,000
• Be a Canadian resident for tax purposes
• Have filed your tax return in the previous year

If you have a spouse or common-law partner, you both need to meet the eligibility criteria.

Eligibility for children under 18 will be determined by the parents’ or guardians’ eligibility.

If you have dental coverage through government social programs (such as ODSP, OW or HSO), you can still qualify for the CDCP. If you meet all the eligibility criteria, your coverage will be coordinated between the 2 plans to ensure there are no duplications or gaps in coverage.

How Do I Apply For The Canada Dental Care Plan?

Applications for the Canadian Dental Care Plan (CDCP) will open in phases:

Starting in mid-December 2023, letters will be mailed to seniors aged 87 and above who may qualify, followed by those aged 77 to 86 in January 2024, then those aged 72 to 76 in February 2024 and those aged 70 to 71 in March 2024. These letters will include a personalized application code and instructions on how to apply.

If you receive a letter,

1. Follow the instructions in the letter to apply by phone.
2. Wait for Service Canada to let you know if you qualify for the CDCP.
3. If you do qualify, wait to receive your welcome package from Sun Life before scheduling any dental appointments. It will explain how and when you can get your care paid for.

Enrolment confirmation

Sun Life will manage the Canadian Dental Care Plan (CDCP) for the Government of Canada. Once you’ve applied and we’ve confirmed that you qualify, we’ll share your information with Sun Life, who will enroll you in the CDCP.

Sun Life will then send you a welcome package, which will include:

1. Information on the CDCP
2. Your member card
3. Your coverage start date

Once enrolled in the CDCP, you may start seeing an oral health provider as early as May 2024, starting with seniors. Your start date will depend on your age group, when we receive your application, and when we complete your enrollment.

 When Can I Book An Appointment with A Dentist?

Your coverage will begin on the date provided in the welcome package you receive from Sun Life. Appointments should be scheduled on or after that date for the eligible oral health care services to be covered under the plan. The CDCP will not reimburse you for services received before the start date.

1. 1. when we receive your application and
   2. when we complete your enrollment

The first group that will be eligible to visit an oral health provider will be as early as May 2024, starting with seniors.

When booking an appointment with an oral health provider, make sure to ask if they are participating in the CDCP. This will limit any unexpected out-of-pocket payments.

What Services Are Covered By The CDCP?

The CDCP covers a range of preventative and basic services, including preventive, diagnostic, restorative, endodontic, prosthodontic, periodontal, and oral surgery services. Some services may require preauthorization, and frequency restrictions and limitations may apply. Authorization from Health Canada takes into consideration your oral health history and medical conditions.

Services that are not covered under CDCP, or rejected for authorization by Health Canada under the auspices of the CDCP, may be rendered by your dentist at The Teal Umbrella under our usual and customary ODA fee guide as an out-of-pocket expense.

Services not requiring preauthorization (Schedule A services) and which are submitted electronically will be eligible beginning in May 2024 for eligible CDCP clients.

Services requiring preauthorization (Schedule B services) will be available starting in November 2024.

Orthodontic services that would improve oral health outcomes for eligible clients will become available beginning in 2025.

 What Services Are NOT Covered By The CDCP?

These are dental procedures that are outside the scope of the Plan and will not be considered for coverage nor considered for appeal. The list of exclusions will be available to participating providers, and will include (but not be limited to):

How Much Will Be Covered By The CDCP?

The CDCP will reimburse a percentage of the cost, based on established CDCP fees and your adjusted family net income. You may have to pay additional charges directly to the oral health provider, if:

1. your adjusted family net income is between $70,000 and $89,999
2. your oral health provider charges more than the established CDCP fees, or
3. you and your oral health care provider agree to services that the CDCP doesn’t cover; you’ll need to pay the full cost of these services if you receive them

Co-payments

You may have a co-payment based on your adjusted family net income. A copayment is the percentage of the CDCP fees that isn’t covered by the CDCP, and that you will have to pay directly to the oral health provider. Your co-payment is based on your adjusted family net income.

We encourage oral health providers to follow the CDCP fees, which are not the same as the provincial and territorial suggested fee guides. You may have to pay fees in addition to the potential co payment if:

1. your oral health provider charges more than the CDCP fees
2. you agree to receive care that the plan doesn’t cover

Before receiving oral health care, you should always ask your oral health provider about any costs that won’t be covered by the plan. Make sure you know what you’ll have to pay directly to your oral health provider ahead of receiving treatment.

 Does Your Dental Clinic Accept CDCP Patients?

The Teal Umbrella is currently NOT accepting CDCP at this time for new patients. However, patients are welcome to The Teal Umbrella under our customary fee schedule that is consistent with the Ontario Dental Association fee guide.

What Publicly Funded Dental Care Programs Currently Exist For Ontario Residents?

Traditionally, healthcare delivery has been the jurisdiction of the provinces. With the exception of dental care for indigenous peoples and the Canadian armed forces, the Federal government has no role in the direct delivery of dental care to Canadians. Instead, the federal government uses its spending power (Canada Health Transfer payments) under the Canada Health Act to influence each province’s medicare policies.

In Ontario, there are several publicly funded dental care programs:

• Ontario Disability Support Program (ODSP): Free dental program for Ontarians with disabilities

• Ontario Works (OW): Free dental program for Ontarians who temporarily cannot find work or cannot work

• Health Smiles Ontario (HSO): Free dental program that includes regular check-ups, preventive care, and treatment for children and youth 17 and under

• Ontario Seniors Dental Care Program (OSDCP): Free dental services to low-income seniors aged 65 and over

• Interim Federal Health Program (IFHP): Free emergency dental care for certain newcomers to Canada, including refugees and refugee claimants, protected persons, victims of human trafficking and detainees