Oral health is an important part of our overall health and well-being. Yet, we know that a third of the people living in Canada do not have dental insurance, and in 2022, almost one in four Canadians reported avoiding visiting an oral health professional because of the cost.
We are pleased to provide you with this information kit which contains details and resources on the Canadian Dental Care Plan (CDCP). The CDCP is a federally delivered public plan that will help ease financial barriers to accessing oral health care for up to nine million uninsured Canadian residents with an adjusted family net income of less than $90,000.
To meet anticipated demand and ensure a smooth onboarding process, the CDCP is being rolled out using a phased approach with various age groups, with a priority on serving vulnerable population segments first.
A wide range of oral health care services are covered under the CDCP to prevent and treat oral health disease. Examples of these services include preventive care such as scaling (cleaning), as well as other services such as exams, x-rays, fillings, removable dentures, and root canal treatments.
Oral health professionals play a vital role in delivering oral health care, and this plan will allow more Canadian residents to benefit from their care. In choosing to participate in the CDCP, oral health care providers are playing an important role in advancing more equitable access to oral health care and towards improving health outcomes in Canada.
To facilitate access to the CDCP for eligible Canadian residents, there will be two ways for oral health providers to participate in the CDCP and provide care to CDCP clients; either by:
- Signing up formally through Sun Life.
- Submitting claims directly to Sun Life for payment, on a claim-by-claim basis.
In both options, oral health providers agree to bill Sun Life directly for payment of services covered under the CDCP to limit out-of-pocket costs for CDCP clients.
The CDCP is not a free dental care plan. Depending on their household income, CDCP patients may have to pay a co-payment, as well as additional charges or fees that are not covered under the plan. Before receiving any services, CDCP patients should confirm the amount that is not covered by the CDCP and that they will need to pay directly to their provider. CDCP clients should not pay the full amount and seek reimbursement from Sun Life, as this is not possible.
For more information, please visit Canada.ca/Dental or read the following FAQ.
Frequently Asked Questions
The Canadian Dental Care Plan (CDCP) is a federally delivered public plan that will help ease financial barriers to accessing oral health care for up to nine million uninsured Canadian residents with an adjusted family net income of less than $90,000.
In December 2022, the Government of Canada launched the interim Canada Dental Benefit (CDB) as the first step towards a long-term Canada-wide dental care plan. The CDB provides a direct payment up to $650 per eligible child, sent directly to parents to help pay the cost of oral health care for that child.
The CDB is a temporary benefit that provides a direct, tax-free payment to help eligible families pay for oral health care services for their children under the age of 12. As of May 2024, more than 449,000 Canadian children have benefited from the CDB. The CDB will remain in place until June 30, 2024. Once the interim CDB ends, those children will be eligible to transition to the CDCP assuming they meet the eligibility criteria.
Once fully implemented, the CDCP will help ease financial barriers to accessing oral health care for up to nine million uninsured Canadian residents with an adjusted family net income of less than $90,000.
Public Services and Procurement Canada (PSPC) ran an open, multi-stage, competitive procurement process to select a contracted service provider. As a result, a contract was awarded to Sun Life to act as the service provider for the CDCP.
PSPC engaged the services of a third-party firm to act as an independent Fairness Monitor. The Fairness Monitor’s duties included, but were not limited to, observing the procurement process from start to finish; providing feedback to the Government of Canada on any potential fairness issues; and attesting to the fairness, openness, and transparency of the entire procurement process.
The CDCP is administered by Health Canada with the support of Employment and Social Development Canada (ESDC), through Service Canada. Service Canada acts as a service delivery partner for processing applications for the CDCP, drawing on applicant provided information as well as taxpayer information provided by the Canada Revenue Agency (e.g., to assess family income). Service Canada provides qualified applicant information to Sun Life, the contracted service provider, to enrol them in the CDCP and process claims.
Private businesses should not be cancelling their dental plans. The Government of Canada will continue to work with industry partners and provincial and territorial governments to put in place mitigation solutions that avoid displacement of existing dental plans.
The CDCP is intended to help those who currently have no access to dental insurance, not to replace current employer benefits packages they offer employees as part of their competitive compensation packages. In addition, based on the income threshold and associated co-payment structure under the CDCP, most employees will be better off under their current employer-sponsored plans.
We anticipate that in most cases employer-sponsored insurance will be maintained by private businesses as a means of recruitment and retention of their employees (i.e., competitive compensation package).
Eligibility
To qualify for the CDCP, the following criteria must be met. Eligibility will be reassessed annually:
- no access to dental insurance*;
- an adjusted family net income of less than $90,000;
- be a Canadian resident for tax purposes; and
- have filed their tax return in the previous year.
Canadian residents who have access to dental benefits through provincial, territorial or federal government social programs, can still qualify for the CDCP. If they meet all the eligibility criteria, their coverage will be coordinated between the plans to ensure there are no duplication or gaps in coverage.
* What does not having access to dental insurance mean?
This means you do not have access to any type of dental insurance or coverage through:
- your employment benefits or a family member’s employment benefits, including health and wellness accounts
- a professional or student organization
Note: If you’re eligible for dental coverage through your employment benefits or through a professional or student organization, you’re not eligible for CDCP. This is true even if:- you decide not to take it**
- you have to pay a premium for it
- you don’t use it
- your pension benefits or a family member’s pension benefits
- this includes federal, provincial and territorial government employer pension plans
- Exception: You may be eligible for the CDCP if you’re retired and:
- you opted out of pension benefits before December 11, 2023, and
- you can’t opt back in under the pension rules
- coverage purchased by you or a family member or through a group plan from an insurance or benefits company
- if you purchased your current dental insurance policy privately (and not as part of any of the coverage described above), you’re not eligible for the CDCP while that coverage is in effect.
**Canadian residents are still considered to have access to dental insurance if they choose to opt out of available benefits like these.
If an individual has access to dental coverage/insurance, whether they use it or not, through anywhere other than a publicly-funded social program, they will be ineligible for the CDCP.
If that coverage comes from a plan the individual purchased privately on their own (unrelated to employment, pension, union or other group coverage), while that self-purchased coverage is in effect, they are ineligible for the CDCP.
The Government of Canada has determined the eligibility criteria for the CDCP with the intention of helping as many Canadian residents as possible access needed oral health care while also ensuring the sound stewardship of public funds.
Based on the Canada Revenue Agency definition and calculation, the adjusted family net income is:
- your family net income (line 23600 of your tax return plus line 23600 of your spouse’s or common-law partner’s tax return, and any world income not reported in a tax return to the CRA, such as by a new resident)
- minus any universal childcare benefit (UCCB) and registered disability savings plan (RDSP) income received (line 11700 and line 12500 of your or your spouse’s or common-law partner’s tax return)
- plus any UCCB and RDSP amounts repaid (line 21300 and line 23200 of your or your spouse’s or common-law partner’s tax return)
Family net income is your net income plus the net income of your spouse or common-law partner, if you have one. Family net income does not include your child’s net income.
For the vast majority of individuals, adjusted family net income is their and their spouse or common-law partner’s net income.
As part of the CDCP application process, potentially eligible applicants will be required to attest that they do not have access to any dental insurance, which will be verified through a sample audit process by Health Canada. This attestation will be further validated using the T4/T4A dental requirement where employers, through the Dental Care Measures Act, are required to report if their employees or pensioners are eligible to access dental insurance.
The CDCP is an income tested program. To confirm a person’s eligibility to the income threshold of less than $90,000, the individual and their spouse or common-law partner, if they have one, must have filed the previous year’s income tax return.
If you need help to get started with filing your taxes, go to Canada.ca/cra.
Further, a person can claim dental costs as medical expenses on their tax return, as long as they only claim expenses that have not or will not be reimbursed by the CDCP.
Your adjusted family net income is calculated in consideration of your marital status when you apply for Canadian Dental Care Plan. This means that if you have a spouse or common-law partner when you apply, your adjusted family net income will be based on both your incomes. Both you and your spouse or common-law partner must have completed your taxes to qualify. It is important that you advise the CRA of any changes in your family situation.
Only one parent will be able to apply to the CDCP on behalf of the child.
Since your adjusted family net income will be calculated in consideration of your marital status when you apply for the CDCP, it is important for everyone to advise the CRA of any changes of their family situation or marital status, especially in the case of shared custody.
The CDCP is intended to help those who have no access to dental insurance. Therefore, only those who do not have access to any form of dental insurance/coverage (private or employer-sponsored) are eligible to apply for the CDCP.
Access to dental insurance means access to any type of dental insurance or coverage through other channels, such as:
- through an employer or a family member’s employer benefits, including health and wellness accounts**;
- through a pension (previous employer) or a family member’s pension benefits. This includes federal, provincial and territorial government pension plans**;
- through a professional or student organization**; or
- purchased by yourself or by a family member or through a group plan from an insurance or benefits company.
**Canadian residents are still considered to have access to dental insurance if they choose to opt out of available benefits like these. If an individual has access to dental coverage/insurance, whether they use it or not, through anywhere other than a publicly-funded social program, they will be ineligible to the CDCP.
If that coverage comes from a plan the individual purchased privately on its own unrelated to employment, pension, union or other group coverage, while that self-purchased coverage is in effect, they are ineligible for the CDCP.
Anyone who purchased private insurance coverage that is still valid at time of application is ineligible. All applicants to the CDCP should exercise caution and confirm the coverage end date of their privately-purchased policies before submitting a CDCP application.
Anyone considering cancelling an existing privately purchased policy should be mindful that the CDCP is designed to reimburse a percentage of the cost of oral health care services, based on established CDCP fees.
Only those who do not have access to dental insurance will be eligible to enrol in the CDCP. Anyone who has access to dental insurance of any kind, whether sponsored by their employer or purchased by the individual, is ineligible.
If an individual has access to dental coverage/insurance, whether they use it or not, through anywhere other than a publicly-funded social program, they will be ineligible to the CDCP. If that coverage comes from a plan the individual purchased privately on its own unrelated to employment, pension, union or other group coverage, while that self-purchased coverage is in effect, they are ineligible for the CDCP.
Canadian residents who have access to dental benefits through provincial, territorial and federal social programs who meet the CDCP eligibility criteria will be able to apply to the CDCP. Coverage will be coordinated to ensure no duplication and avoid gaps in oral health care.
Applications
Applications for the CDCP open in phases. Since May 1, 2024, applications can be made online and are open to seniors aged 65 and over. Applications will open on June 27, 2024 for adults with a valid disability tax credit certificate and children under 18.
All remaining eligible Canadian residents will be able to apply online in 2025.
People covered under the CDCP will be reassessed annually to confirm they still meet the eligibility criteria.
Canadians who are enrolled in the CDCP will be able to start seeing an oral health provider as early as May 2024, starting with seniors. The start date to access oral health care services will depend on:
- when we receive your application and
- when we complete your enrolment
The individual’s coverage will begin on the start date provided in the welcome package from Sun Life. Appointments with an oral health provider should be scheduled as of the individual’s coverage start date, and no sooner, in order for the oral health care services to be covered under the plan. The CDCP will not reimburse you for oral health care services received before the start date.
Coverage
To improve oral health outcomes, the CDCP will cover a wide range of oral health care services, on the recommendation of an oral health care provider.
Examples of services that could be covered under the CDCP include:
- preventive services, including scaling (cleaning), sealants, and fluoride
- diagnostic services, including examinations and x-rays
- restorative services, including fillings
- endodontic services, including root canal treatments
- prosthodontic services, including removable dentures
- periodontal services, including deep scaling
- oral surgery services, including extractions
The majority of services covered under the CDCP will be available in May 2024. Some oral health services such as crowns, initial placement of partial dentures, and general anesthesia will require preauthorization and will not be available until November 2024. The 2024 CDCP dental benefit grids are available on the Sun Life website: https://www.sunlife.ca/sl/cdcp/en/provider/dental-benefit-grids/.
The CDCP is not a free plan. To limit the out-of-pocket expenses for people covered under the plan, oral health providers that accepts CDCP clients will be reimbursed directly by Sun Life for the eligible services provided, in accordance with the CDCP established fees, which may not be the same as what providers charge.
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:
- your adjusted family net income is between $70,000 and $89,999, as you will have a co-payment
- the cost of your oral health care services is more than what the CDCP will reimburse based on the established CDCP fees; and
- you are your oral health care provider agree to services that the CDCP doesn’t cover (you will need to pay the full cost of these services).
Based on the adjusted family net income threshold, co-payment for services will apply:
- No co-payments for those below $70,000.
- 40% co-payment for those between $70,000 and $79,999.
- 60% co-payment for those between $80,000 and $89,999.
Before receiving oral health care, individuals covered under the plan should always confirm what costs, if any, will not be covered by the CDCP.
Provider appointment cancellation/no-show fees cannot be billed to the CDCP. Therefore, patients will be responsible for covering these fees.
The collaboration between oral health professionals and the Government of Canada is a critical success factor for the CDCP.
Oral health professionals (including Dentists, Dental Specialists, Denturists, or Independent Dental Hygienists) who are licensed and in good standing with the provincial or territorial regulatory body in the jurisdiction in which they practice will be able to participate in the CDCP.
To facilitate access to the CDCP for eligible Canadian residents, there will be two ways for oral health providers to participate in the CDCP and provide care to CDCP clients; either by:
- Signing up formally through Sun Life (currently possible).
- Submitting claims directly to Sun Life for payment, on a claim-by-claim basis (available as of July 8; note: there will be no retractive payment to providers who provided treatment under this option prior to July 8).
In both options, oral health providers agree to bill Sun Life directly for payment of services covered under the CDCP to limit out-of-pocket costs for CDCP clients.
CDCP clients can use Sun Life’s CDCP Provider Search Tool find participating providers, communicate directly with Sun Life at 1-888-888-8110 or contact their local oral health providers.
Before receiving any oral health care services, people covered under the CDCP should confirm that their provider is accepting CDCP clients and that the services they will be receiving are eligible for coverage. It’s important that you do not pay upfront for the services received. The CDCP will only reimburse providers directly for services received on or after your coverage. If you pay the full costs yourself, you will not be reimbursed. You should only pay any potential amounts not covered by the plan directly to your provider.
Other social programs
Provincial and territorial programs may not cover all oral health care needs of Canadians equally across the country, and that in some cases, these programs focus only on emergency needs.
Canadian residents who have access to dental coverage through provincial and territorial social programs and meet the CDCP eligibility criteria will be able to apply to the CDCP. Coverage will be coordinated between provincial or territorial public dental care program and the CDCP to ensure there is no duplication and to avoid gaps in oral health care.
To help understand how the CDCP will intersect and/or coordinate with provincial and territorial social dental programs, individual factsheets have been developed, based on guidance provided by each provincial or territorial government: https://www.canada.ca/en/services/benefits/dental/dental-care-plan/providers.html
Claims process
Oral health providers are asked to confirm their participation in the CDCP to accept receiving direct payment from Sun Life. To limit out-of-pocket costs for Canadians, oral health providers who accept CDCP clients will directly bill Sun Life for eligible services provided.
The CDCP will only pay for oral health care services covered within the plan at the established CDCP fees. CDCP fees may differ from those set out in the provincial and territorial oral health associations suggested fee guides, which providers often use to charge for oral health services.
People covered under the CDCP may have to pay an outstanding amount such as a co-payment or additional charges, which will need to be paid directly to their oral health provider if:
- their adjusted family net income is between $70,000 and $89,999, as they will have a co-payment
- the cost of their oral health care services are more than what the CDCP will reimbursed based on the established CDCP fees; and
- they agree to receive care that the plan doesn’t cover
Before receiving oral health care, individuals covered under the plan should always ask their oral health provider about any costs, that will not be covered by the plan, and make sure they know what they will have to pay directly to their oral health provider ahead of receiving treatment.
Provider appointment cancellation/no-show fees cannot be billed to the CDCP. Patients will be responsible for covering these fees.
