Canadian Dental Care Plan (CDCP)

Some Canadian Dental Care Plan (CDCP) patients won’t receive full financial assistance with the cost of their care through CDCP due to co-payments. Government required co-payments are the percentage or portion of the CDCP rate that the patient is expected to pay out of pocket. The required co-payment is determined by patients’ annual family income:

• No required co-payment for patients with an adjusted annual family net income under $70,000. Patients may face additional charges as described below.
• 40% required co-payment for patients with an adjusted annual family net income between $70,000 and $79,999. Patients may face additional charges as described below.
• 60% required co-payment for patients with an adjusted annual family net income between $80,000 and $89,999. Patients may face additional charges as described below.

In addition to co-payments, patients may be required to pay additional charges. These additional charges are to cover a portion of the cost of their care when the Canadian Dental Care Plan (CDCP) rate is lower than the dentist’s usual and customary fee or if the patient chooses to proceed with care that is not covered by CDCP. Although Health Canada has encouraged dentists to bill patients according to the CDCP benefit rates, dentists may charge their usual and customary fees. Health Canada asks patients to confirm their dentist’s participation in the program and billing practices when booking an appointment.

The CDCP pays only for services covered within the plan at the established CDCP rates. These rates are not the same as provincial and territorial fee guides that dentists usually utilize as reference to establish their usual and customary fee.

The CDCP is not intended to replace existing workplace or private dental benefits.

Individuals must meet all of the following criteria in order to be eligible for Canadian Dental Care Plan (CDCP) coverage.

• No access to dental insurance, meaning:
  • no coverage through employer or a family member’s employer benefits; including health and wellness accounts;
  • no coverage through pension (previous employer) or a family member’s pension benefits; or
  • no coverage through a purchased plan by yourself or by a family member or through a group plan from an insurance or benefits company.
• 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 a social program offered by their province or territory and/or by the federal government will be eligible for the CDCP if they meet all the eligibility criteria.

Patients who decide to opt out of available benefits to them will be considered as having access to dental insurance for the purposes of determining qualification criteria.

Health Canada has stated that the following services will be covered under the Canadian Dental Care Plan (CDCP), with some services only becoming available in the fall of 2024:

• Preventive services, including scaling (cleaning), polishing, sealants, and fluoride;
• Diagnostic services, including examinations and X-rays;
• Restorative services, including fillings;
• Endodontic services, including root canal treatments;
• Prosthodontic services, including complete and partial removable dentures;
• Periodontal services, including deep scaling; and
• Oral surgery services, including extractions.

Details related to frequency and amount covered have yet to be made public.

The Canadian Dental Care Plan (CDCP) is not intended to replace existing insurance coverage. It is important that Canadians do not drop their existing coverage, as they might not be eligible for the CDCP if they do.

The CDCP is designed to provide coverage for Canadians who do not have any existing coverage. The Government of Canada is working to ensure employers and insurance carriers do not reduce or eliminate the coverage Canadians rely on.

The Canada Revenue Agency now requires employers to report on their T4/T4A whether their employees and their families had access to dental insurance coverage, including spending and wellness accounts.

If you have dental coverage through a provincial, territorial, or federal government social program, you can still qualify for the Canadian Dental Care Plan (CDCP). If you meet all the eligibility criteria, your coverage will be coordinated between the plans to ensure there are no duplications or gaps in coverage.

Health Canada has indicated that as of March 11, 2024, oral health providers will be able to enter into an agreement directly with Sun Life to participate in the Canadian Dental Care Plan (CDCP). A provider awareness campaign will be launched, with the support of Sun Life, that will invite providers to participate. Participation in the CDCP will be voluntary.

The Canadian Dental Association and the Provincial and Territorial Dental Associations recommend that providers assess and understand the terms and conditions of CDCP and how participating fits with their practice before signing any agreement. Health Canada has yet to provide many key details that providers will need to make this important decision.