What Oral Health Providers Need to Know About the CDCP
What Oral Health Providers Need to Know About the CDCP
Oral health professionals play a vital role in delivering oral health care, and the Canadian Dental Care Plan (CDCP) will enable more Canadian residents to benefit from their care.
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To be eligible for the CDCP, you must meet the following criteria:
- Participation in the CDCP
- CDCP Established Fees
- Coordination of Benefits
To be eligible for the CDCP, you must meet the following criteria:
CDCP Participation
Oral health providers can now confirm their participation in the CDCP directly with Sun Life. Participation is voluntary, and eligible providers who can bill for services include:
- Dentists
- Denturists
- Dental Hygienists
- Dental Specialists
Providers are encouraged to confirm their participation in the CDCP to receive direct payment from Sun Life. This reduces out-of-pocket costs for CDCP patients, lowering financial barriers to accessing care for eligible Canadian residents.
Providing Dental Services on a Claim-by-Claim Basis
Starting July 8, 2024, oral health providers can direct bill Sun Life for services on a claim-by-claim basis without formally signing up for the CDCP. This flexibility allows providers to treat patients and submit CDCP claims to Sun Life for direct reimbursement, whether or not they formally participate.
CDCP clients are responsible for paying any remaining amounts directly to their provider. Sun Life will reimburse only providers, not patients, for services covered under the CDCP.
By submitting a CDCP claim and accepting payment, providers agree to the terms of the CDCP, either on a claim-by-claim basis or through a formal participation agreement with Sun Life.
Before providing care to CDCP patients, providers must:
- Confirm patient eligibility for the CDCP through their existing patient intake process.
- Confirm the patient is covered for select services.
- Submit a claim with assignment of benefits (non-assigned claims will be rejected).
What are CDCP Established Fees?
Oral health providers will be reimbursed according to the CDCP-established fees for each service covered under the plan. These fees may differ from those in provincial and territorial suggested fee guides. However, the CDCP fees for the most frequently used procedure codes are set to cover at least 80% or more of the provincial or territorial oral health provider associations’ suggested fees.
Full lists of the 2024 CDCP dental benefit grids for each province and territory are now available.
[Full 2024 CDCP dental benefit grids]
Fees will be reassessed annually to account for new scientific evidence, inflation, and cost changes. The Government will collaborate with oral health provider associations to determine fees for 2025 and beyond.
Coordination Between Programs
Provincial and Territorial Social Dental Programs
Health Canada is working with provinces and territories to coordinate benefits between the CDCP and their public dental programs. Individual factsheets have been developed for each province and territory to help providers understand the billing process and coordinate benefits with other public dental program coverage.
[Factsheets on the coordination of benefits]
Other Federal Social Dental Programs
For other federal social dental programs that offer dental coverage to specific populations, these programs will be billed first before the CDCP:
- Non-Insured Health Benefits Program
- Veterans Affairs Canada Dental Services Program
- Interim Federal Health Program
- Correctional Services Canada Dental Care for Inmates
Since the established fees and coverage are similar, it is expected that limited to no coordination will be needed. Services not covered by these plans can be submitted to the CDCP for coordination.
Private Dental Coverage
Individuals are ineligible for the CDCP if they already have access to private dental coverage, such as through an employer. There will be no coordination with private, employer, or other such plans.
Frequently Asked Questions (FAQ)
No, the CDCP will not reimburse for services received before your coverage start date. Reimbursement is only for services covered under the CDCP and provided by participating providers.
The provider search tool is updated regularly as new providers join the CDCP.
After receiving care, patients are responsible for paying any costs not covered by the CDCP directly to their provider.
Eligibility for the CDCP must be reassessed each year. This process ensures continued qualification for the plan. More details on the annual reassessment will be provided later.