Canadian Dental Care Plan (CDCP) In Hamilton
The Canadian Dental Care Plan (CDCP) is a dental care program that was introduced to make dental care more affordable for eligible Canadians who lack access to dental insurance.
The program aims to bridge the gap between oral health needs and the high costs of dental care, helping many Canadians who would otherwise forgo necessary treatments due to financial constraints.
Administered by Sun Life, the CDCP is designed to ensure that Canadians from different income brackets can access a wide range of dental services, from preventive care to major procedures.
Eligibility Criteria
To qualify for the CDCP, you need to meet specific eligibility criteria that focus on your residency, income, and access to other forms of dental coverage. Let’s take a closer look at who is eligible for this plan.
1. Canadian Residents
One of the fundamental requirements is that applicants must be Canadian residents for tax purposes. This means that individuals who file taxes in Canada and live in the country year-round are eligible to apply.
2. Adjusted Family Net Income
Income is a critical factor in determining your eligibility for the CDCP. The program is designed to assist households with an adjusted family net income of less than $90,000 a year. The amount of dental coverage you’ll receive varies depending on your specific income bracket:
- If your income is below $70,000, you are eligible for 100% coverage of your dental costs.
- Families with incomes between $70,000 and $79,999 will have 60% of their dental costs covered, leaving a 40% co-payment.
- Those with incomes between $80,000 and $89,999 will receive 40% coverage, with the remaining 60% covered out-of-pocket.
3. Disability Tax Credit Certificate Holders
Adults who hold a valid federal Disability Tax Credit certificate for 2023 are also eligible to apply for the CDCP. This is particularly important as many individuals with disabilities often face higher healthcare costs, including dental care. The CDCP ensures that these individuals receive much-needed financial relief for their oral health needs.
Coverage Details
1. Scope of Dental Coverage
The CDCP covers a broad range of dental services. From a routine oral health care service such as a check-up to more extensive dental treatments, this program ensures that Canadians have access to necessary oral healthcare services without worrying about prohibitive costs.
It covers diagnostic services like x-rays, preventive services such as teeth cleanings, and even major services like dentures and crowns.
2. Start Date and Duration of Coverage
Once enrolled in the CDCP, your coverage start date begins on the benefit start date, as indicated in your welcome letter from Sun Life.
It’s essential to wait until this date before scheduling any dental appointments to ensure your services are covered. Each year, your eligibility will be reassessed, and as long as you continue to meet the criteria, your coverage will remain active.
3. Co-Payments and Deductibles
As mentioned earlier, the coverage you receive depends on your family’s household income.
Depending on where your income falls, you may be responsible for a co-payment of 40% to 60%. This ensures that even as dental services are subsidized, families contribute according to their financial ability.
Importantly, patients should confirm any additional charges with their dental provider before treatment to avoid unexpected costs.
Dental Services Included
1. Preventive Services
The CDCP covers essential preventive services, such as regular check-ups, cleanings, and fluoride treatments. These services play a vital role in maintaining good oral health and catching potential issues early, before they develop into more serious and costly problems.
2. Restorative Services
Restorative dental services, including fillings, are also covered under the CDCP. These services help restore the function and appearance of your teeth after damage caused by decay or trauma. Restorative care is crucial for maintaining long-term oral health and preventing further complications.
3. Major Dental Procedures
The plan also covers major dental procedures such as root canals, dentures, and crowns, which can be particularly expensive without insurance. In 2025, orthodontic services will be added to the CDCP, though these will only be available for cases with a demonstrated medical need.
Service Providers and Accessibility
List of Participating Oral Health Providers
The CDCP allows a wide range of oral health professionals to participate. Dentists, denturists, dental hygienists, and dental specialists are all eligible to provide services under the plan. These professionals must agree to bill Sun Life directly for their services to reduce out-of-pocket costs for patients.
Nationwide Accessibility
No matter where you live in Canada, the CDCP is designed to be accessible nationwide.
To find an oral health provider near you, Sun Life offers a Provider Search tool that helps you locate a dentist who accepts CDCP patients. It’s important to confirm with your provider that they participate in the federal government program before making an appointment.
Registration and Claims
1. Enrolling in CDCP
To enroll in the CDCP, eligible individuals need to apply online. Applications are currently open for seniors aged 65 and over, children under the age of 18, and adults with a valid Disability Tax Credit certificate. Those not falling into these groups will be able to apply starting in 2025. When applying, you’ll need essential information like your Social Insurance Number, Canada Revenue Agency tax returns, and proof of residency.
2. Submitting Claims
After you receive care, oral health providers will start the claims process and submit claims to Sun Life on your behalf, ensuring you don’t have to navigate complex billing processes. Importantly, clients do not receive reimbursement directly; payments are made directly to the provider. Only the amount not covered by the CDCP will need to be paid out-of-pocket.
3. Preauthorization Process
Some treatments and services beyond regular limits will require preauthorization by the CDCP, starting in November 2024. Preauthorization ensures that more complex or high-cost treatments are reviewed before they’re provided to ensure coverage is applicable.
When can you visit an oral health provider
Once you’ve received your welcome package from Sun Life and your benefit start date has passed, you can begin scheduling appointments.
Be sure to double-check the date listed on your welcome letter before visiting a provider. You should also confirm that the provider accepts CDCP clients and verify any potential out-of-pocket costs.
Costs and Financial Considerations
The CDCP covers a significant portion of dental services depending on your income level.
For families earning less than $70,000, 100% of eligible costs are covered.
For those with incomes between $70,000 and $89,999, a co-payment ranging from 40% to 60% will apply. Additional fees may be incurred if the provider’s rates exceed the CDCP’s established fees or if non-covered services are requested.
Always confirm the cost of services with your dental provider before treatment to avoid unexpected charges.
Frequently Ask Questions
Eligibility for the CDCP includes Canadian residents with no private dental insurance, an adjusted family net income of less than $90,000, and those who file taxes in Canada. Seniors, children, and individuals with a Disability Tax Credit are also eligible.
CDCP-participating dentists, denturists, and other oral health professionals must sign up with Sun Life or submit claims directly. You can use Sun Life’s Provider Search tool to find local participants.
Seniors can benefit from comprehensive coverage for preventive and major dental services under the CDCP, ensuring they maintain oral health without facing financial burdens.
