An update to the Canadian Dental Care Program
Oral health is crucial for overall well-being, yet many Canadians face financial barriers to dental care. In 2022, one in four Canadians avoided dental visits due to costs. Poor oral health not only impacts physical health but can also lead to mental health issues and social challenges.
The Canadian Dental Care Plan (CDCP) provides dental care coverage to Canadian residents with an adjusted family net income below $90,000 and who don’t have access to dental insurance. For eligible Canadian residents, the CDCP will help cover the cost of various oral health care services.
As a trusted partner in the healthcare insurance industry, we want to ensure that you have all the necessary information to help your clients navigate this new program effectively.
Who is eligible?
The government has decided to roll out the CDCP in phases to facilitate a smooth implementation.
Applications are now open for:
- Seniors aged 65 and over
- Children under the age of 18
- Adults with a valid Federal Disability Tax Credit certificate for 2023
Eligibility for the CDCP is based on several factors, including:
- 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 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.
Children under 18 will be considered eligible based on their parent or guardian’s income eligibility.
Note: eligibility will be reassessed annually.
What will be covered?
The CDCP covers a wide range of oral health services, including preventive procedures like cleanings, polishing and fluoride treatments, as well as diagnostic services such as exams and X-rays. Additionally, more complex procedures like cavity fillings, dentures and root canals will be included.
Some oral health care services such as crowns, initial placement of partial dentures and general anesthesia require preauthorization.
Each service covered by the plan will be compensated at the 2024 CDCP fees, which may differ from provincial and territorial suggested fee guides. The CDCP will reimburse a percentage of the cost based on these established CDCP fees.
It’s essential to note that not all applicants will be eligible for 100 per cent coverage. The CDCP will reimburse a percentage of eligible expenses based on applicants’ income levels, with the remainder being a copayment. For example:
- Canadians with an adjusted annual family net income of less than $70,000 will have no copayment;
- Canadians with an adjusted annual family net income between $70,000 and $79,999 will have a 40 per cent copayment; and
- Canadians with an adjusted annual family net income between $80,000 and $89,999 will have a 60 per cent copayment.
The program aims to streamline the billing process by allowing oral health providers to directly bill the federal plan, reducing the need for patients to pay out-of-pocket. Oral health providers participating in the CDCP will bill Sun Life, the insurer handling the program, directly for the eligible services provided to ensure timely reimbursement.
Individuals covered under the program may still incur out-of-pocket expenses. This could include co-payments or additional charges, which will be paid directly to their oral health provider.
When will coverage start?
An application must be submitted. Coverage under the CDCP will commence once eligibility has been confirmed and applicants have been enrolled in the program.
Upon confirmation of eligibility, applicants will receive a welcome package from Sun Life, the insurer handling the program, detailing their coverage start date and plan specifics.
It’s crucial to remind clients that appointments with oral health providers should be scheduled on or after the specified coverage start date provided in the welcome package. The CDCP will not reimburse for services received before the start date.
The introduction of the Canadian Dental Care Plan represents a significant step forward in improving access to dental services for Canadians. As a licensed insurance advisor, your role in guiding clients through this transition is vital. We encourage you to stay informed and assist your clients in understanding their eligibility, coverage options, and enrollment process under the CDCP.
If you have any questions or require further assistance, please don’t hesitate to reach out to a Saskatchewan Blue Cross Account Executive.