Canadian residents without dental coverage will be excited to learn about the new Federal Canadian Dental Care Plan (CDCP), which builds on the Canada Dental Benefit (CDB) launched in December 2022 for children under 12. The CDCP is not intended to replace existing dental plans through employer/pension or private sponsored plans, but it is intended to complement existing provincial and territorial dental programs and fill existing gaps in coverage for those programs.

Advisors and group benefit plan sponsors should be educated on the CDCP because they may receive questions from their clients, their employees, or their retirees. A Stakeholder Toolkit has been developed by Health Canada to give you a better understanding of the CDCP and help respond to questions. The Canadian Dental Care Plan (CDCP) Stakeholder Toolkit now includes a recording of a recent information session. The toolkit will continue to be updated, and you are encouraged to check this link from time to time.

Additional information on the CDCP can also be accessed by visiting Canada.ca/dental and www.sunlife.ca/cdcp.

Here is a quick overview:

  • Eligibility:
    • Individuals must be Canadian residents for tax purposes
    • Have an annual adjusted family net income under $90,000.
    • Have filed their tax return for the previous year.
    • Not have access to dental insurance. This means the individual has no access to any type of dental insurance or coverage through:
      • employment benefits or a family member’s employment benefits, including health and wellness accounts
      • a professional or student organization
        • Note: If eligible for dental coverage through employment benefits or through a professional or student organization, the individual is not eligible for CDCP. This is true even if:
          • they decide not to take it
          • they have to pay a premium for it
          • they don’t use it
      • their own pension benefits or a family member’s pension benefits
        • This includes federal, provincial, and territorial government employer pension plans
        • Exception: An individual may be eligible for the CDCP if they are retired and:
          • opted out of pension benefits before December 11, 2023, and
          • can’t opt back in under the pension rules
      • coverage purchased by the individual or a family member or through a group plan from an insurance or benefits company
  • If the individual purchased their current dental insurance policy privately (and not as part of any of the coverage described above), they are not eligible for the CDCP while that coverage is in effect.
  • Anyone considering cancelling an existing privately purchased policy should be mindful that the CDCP is designed to reimburse a percentage of the cost of dental care services, based on established CDCP fees, which may not be the same as what oral health providers normally charge. In addition, a co-pay between 40% and 60% may be applied based on an individual’s adjusted family net income.
  • Enrolment:
    • Seniors 70 and older were sent an invitation and instructions on how to apply starting in December 2023 in a phased approach.
    • Seniors 65 to 69 will be able to apply online starting in May 2024. Older seniors who have yet to apply will also be able to use the online portal at this time.
    • Persons with a valid Disability Tax Credit certificate and children under 18 will be able to apply online starting June 2024.
    • All remaining Canadian residents will be able to apply online starting in 2025.
  • Coverage start date:
    • Those who qualify will be sent a welcome package from Sun life with a member card and the start date of their coverage under the CDCP, which can start as early as May 1st, 2024, for seniors. The coverage start date depends on when the application is received, and they are enrolled.
  • Co-payments for Canadians varies depending on adjusted family net income as follows:
    • 0% below $70,000
    • 40% between $70,000 and $79,999, and
    • 60% between $80,000 and $89,999.

Note: CDCP clients may have to pay fees in addition to the potential co-payment if the cost of their oral health care services are more than what the CDCP will reimburse based on the established CDCP fees and/or they agree to receive care that the plan doesn’t cover.

  • Most services will be available in May 2024 while some requiring preauthorizing will become available in November 2024:
    • Preventive and diagnostic services, including cleaning, examinations, and x-rays
    • Restorative, including fillings
    • Endodontic, including root canal treatments
    • Prosthodontic services, including dentures
    • Periodontal, including deep scaling
    • Oral surgery services, including extractions.
  • As of March 11, 2024, oral health providers can now confirm their participation in the CDCP by visiting sunlife.ca/cdcp. Participation in the CDCP will be on a voluntary basis. Oral health providers eligible to participate and who can bill for services include dentists, dental specialists, dental hygienists, and denturists.

The CDCP 2024 Benefit Grids will be made available on the Sun Life website on April 11, 2024 and take effect as of May 1, 2024, the start date of when participating providers can submit CDCP claims electronically for direct payment by Sun Life.

We would like to thank Lindy VanAmburg, Director General, Policy and Programs, and Marika Nadeau, Director General, Engagement and FPT Relations from Health Canada’s Oral Health Branch for their assistance in developing this update for you.

Excerpted from the Connex Health Consulting Blog published on April 5, 2024.