What is the Canadian Dental Care Plan?

Anyone wishing to participate in this plan must meet the eligibility requirements outlined below:

• Do not have dental insurance through a private or pension plan, or with an employer, nor have coverage from a family group plan.
• Filed an income tax return for the previous year.
• Have a net (after tax) family income of less than $90,000 annually.
• Be a Canadian resident for tax purposes.

The CDCP will reimburse a portion of the cost of your treatment, but it may not pay the full amount. You may have to pay additional charges directly to the oral health provider, if:

• your adjusted family net income is between $70,000 and $89,999,
• the cost of your oral health care services are more than what the CDCP will reimburse for these services, or
• you and your oral health provider agree to services that the CDCP doesn’t cover.

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

Table on co-payments based on adjusted family net income

The CDCP fees may not be the same as what providers charge. You may have to pay fees in addition to the potential co-payment if:

• The cost of your oral health care services is more than what the CDCP will reimburse for these services.
• You and your oral health provider agree to services that the CDCP doesn’t cover.

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.

• Eligible patients can apply online.
• Those who cannot apply online, can apply by phone: 1-833-537-4342.
• If you are hearing impaired, you can use their TTY (teletypewriter) service by calling 1-833-677-6262.

To check the status of your application, you can check it by:

• Accessing their online status tracker tool.
• Calling them at 1-833-537-4342; they are open 24/7.
• If you are hearing impaired, you can use their TTY (teletypewriter) service by calling 1-833-677-6262.

You will need to provide the application code or client number (this number is given to you after you submit your application) and your social insurance number (SIN).

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, which will include:

• Information about the CDCP
• Your membership card
• The start date of your coverage (listed on your welcome letter and not on your member card)

Once enrolled, you must meet the eligibility requirements each subsequent year with an annual reassessment.

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

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:

• Extensive rehabilitation
• Composite resin or porcelain veneers
• Three-quarter crowns
• Inlays and onlays made from any dental materials
• Temporomandibular appliances and therapy
• Fixed dental bridges
• Teeth whitening
• Mouthguards and bruxism appliances
• Crown lengthening
• Dental implants and any associated treatments
• Bone grafting
• Precision attachments for partial dentures

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.

Treatments requiring preauthorization are listed below.

• Orthodontic services when clinically necessary (date to be determined)
• Specialist dental examination
• Crowns
• Posts and cores
• Moderate sedation, deep sedation and general anesthesia
• Major surgical procedures

If you are currently covered under the CDCP, you will need to renew your coverage each year to confirm that you continue to meet all eligibility requirements.

All current members will need to take steps to renew their coverage. Once you have filed your 2024 tax return and received your notice of assessment from the Canada Revenue Agency, you will be ready to renew your coverage online, or in My Service Canada Account (MSCA). You can also call the automated phone at 1-833-537-4342 for service that is available 24 hours a day, 7 days a week. Simply select your preferred language, then press 2.

Make sure to submit your renewal application before June 1, 2025, to avoid a potential gap in coverage.

Once your renewal application is completed, you will receive a determination letter confirming whether you remain eligible under the plan, with coverage effective from the renewal start date and valid until June 30, 2026. Review all the information in your determination letter to confirm any changes, including adjustments to your co-payment level, if applicable, as it could be different based on your 2024 adjusted family net income.

If you have any changes to your coverage or co-payment levels, inform your provider by bringing your letter to your next appointment to avoid unexpected charges for oral health care services.

If you remain eligible, you will be able to use your current member card to access covered services. No new card will be mailed to you.

If you don’t renew in time, your coverage under the CDCP will end on June 30, 2025.

After receiving your welcome package, check the eligibility date on the welcome letter to ensure you’re covered by the CDCP. Then, you can call our clinic at 604-507-7207 to book your appointment! You can provide your CDCP card number over the phone, or bring your CDCP member card with you to the appointment.