To participate in the Canadian Dental Care Plan (CDCP), dentists can:
- Sign up as a participating CDCP provider directly with Sun Life or,
- Direct bill Sun Life for services provided on a claim-by-claim basis if they do not wish to formally sign up. Learn more.
Dentists participating in the CDCP need to sign the CDCP Claims Processing and Payment Agreement.
The agreement asks that all participants undertake the following steps:
- Validate CDCP client information
- Confirm eligible services under the CDCP
- Agree to receive direct payment from Sun Life for the services covered under the CDCP
- Provide information related to the claims submitted to the CDCP in accordance with the CDCP claims verification process and procedures
How do I enroll in the program?
Dentists can sign up for Sun Life Direct (SLD) to complete the enrollment process online.
Contact the Sun Life call centre at 1-888-888-8110 to obtain an Access ID and temporary password.
If you do not wish to have a SLD account, you can manually enroll by completing and submitting a form.
Please note if you do not wish to formally sign up, you are able to direct bill Sun Life for services provided on a claim-by-claim basis. Learn more.
Balance billing is what a dentist charges for the difference between their fee and the amount allowed under a public insurance program. Balance billing is permitted for patients using the CDCP. Learn more.
The CDCP will reimburse a percentage of fees based on adjusted family net income*, with the following requirements for patient payments to the provider:
- No co-payment for patients with an adjusted annual family net income under $70,000.
- A 40 per cent co-payment for patients with an adjusted annual family net income between $70,000 and $79,999.
- A 60 per cent co-payment for patients with an adjusted annual family net income between $80,000 and $89,999.
Learn more about the CDCPP and co-payments based on the established CDCP fees.
*Adjusted family net income generally refers to annual gross income after certain adjustments have been subtracted from it.
Yes. CDCP fees may not cover all costs. This is called balance billing and is permitted under the CDCP. Patients may have to pay balance billing fees in addition to a potential co-payment if the cost of the oral health care service provided is more than what the CDCP will reimburse based on the established CDCP fees.
You should always make sure patients are aware about any costs that won’t be covered by the CDCP. You can advise patients to read the CDCP Dental Benefits Guide for full information on services covered.
Yes, existing patients using other methods of payment are still able to see and be treated by you. The CDCP is designed for patients who do not currently have dental coverage through private insurance programs.
The CDCP will be the primary payer relative to all Ontario dental programs. Where coordination is possible, Ontario's programs (such as the Heathy Smiles Ontario Program and the Ontario Disability Support Program) will serve as the secondary payer for CDCP recipients.
Read this fact sheet for more information on the coordination process for each of Ontario's dental programs available on the government's website.
You need to make reasonable efforts to validate the identity of a person eligible for CDCP services through your existing patient intake process, prior to providing care.
You need to inform patients which of your recommended services will and will not be covered by the CDCP before they agree to receive care.
You can also ask the patient if they are covered under any other dental program (e.g., Ontario Disability Support Program, Healthy Smiles).
Please read this document for more information.
There are no limitations on emergency examinations under the CDCP, and almost all services that could be done on an emergency basis do not need preauthorization.
In rare cases where a service that would normally need preauthorization is needed on an emergency basis, providers can submit any needed minimal documentation after the fact.
Providers can submit paper claims to the CDCP in the same way they submit paper claims for other insurance plans.
Follow these steps to submit a paper claim for the CDCP:
- Access your practice management software.
- Enter all information required for the claim, including your patient’s CDCP plan number (333333), member ID, and service details. All claims must be sent under the name of the oral health provider who provided the service.
- The claim must be submitted “Assigned”, to be processed.
- Both the oral health provider and the member, parent/legal guardian or representative need to sign the claim form to validate that the treatment was completed.
- Important note: the assignment of benefit box on the form must be signed by the member, parent/ legal guardian or representative. Paper claims received without this section signed will not be processed and will be returned for signature.
- Proceed to submit the paper claim and any supporting documents to Sun Life.
- Paper claims should be mailed to the CDCP dedicated PO Box: Sun Life Assurance Company of Canada, Canadian Dental Care Plan (CDCP) PO Box 99865 STND Montreal, QC H3C 0E6
- When the claim is processed successfully, you’ll receive an Explanation Of Benefits (EOB) through Sun Life Direct or by mail depending on your communication preference. The EOB will not be sent to the member.
You should review the “At-A-Glance Reference Sheet” for information on the required documentation to support a request for preauthorization.
Each preauthorization request will be assessed thoroughly on a case-by-case basis to see if the course of treatment recommended meets the clinical criteria for coverage under the CDCP.
