Canadian Dental Care Plan

The CDCP covers a part of the cost of your care. You may have to pay the portion of costs that are not covered. For full information on all services covered, go to the CDCP Dental Benefits Guide.

Before your dentist begins to treat you, always ask if:

• the recommended services will be covered under the CDCP;
• you may have to pay for some services out of pocket. If that is the case, ask for the specific amount in advance.

If your dentist is not participating, you can find a list of participating dentists near you using Sunlife’s CDCP Provider Search.

The online application portal is available for seniors 65 and older.

If you have a valid Disability Tax Credit certificate or have a child under the age of 18, you will be able to apply online as of June 2024. All remaining eligible Canadians will be able to apply online in 2025.

Before booking an appointment with a dentist of your choice, please ask if the dentist agrees to participate in the CDCP program and direct bill Sun Life for services provided under the plan, as some dentists may decide not to participate in the CDCP program.

Please notify the dentist if you are covered under any other dental program (e.g., Ontario Disability Support Program, Healthy Smiles).

Your dentist needs to submit a preauthorization for complex services (e.g., partial dentures, crowns) to the CDCP administrator (Sun Life).

Requests for preauthorization are reviewed by Sun Life to determine if the recommended treatment meets the clinical criteria for coverage under the CDCP.

Balance billing is when a dentist charges for the difference between their fee for the service provided (based on suggested provincial fee guides) and the amount allowed under a public insurance program. Balance billing is permitted for patients using the CDCP. 

Co-pay is part of the initial fee that some patients may be charged based on their adjusted family income. The rate of co-pay that a patient may be charged under the CDCP is 40% or 60% of the cost of the treatment, depending on adjusted family income. Learn more about the CDCPP and co-payments.

Yes. CDCP fees may not be the same as what providers charge. This is called balance billing and is permitted for patients using the CDCP. You may have to pay balance billing fees in addition to a potential co-payment if the cost of your oral health care service is more than what the CDCP will reimburse based on the established CDCP fees.

You should always ask your oral health provider about any costs that won’t be covered by the CDCP. Make sure you know what you’ll have to pay directly to your oral health provider ahead of receiving treatment.

You can visit Sun Life’s CDCP webpage for more information such as FAQs and contact information: https://www.sunlife.ca/sl/cdcp/en/support/contact-us/.

You can also contact the Government of Canada: https://www.canada.ca/en/services/benefits/dental/dental-care-plan/contact.html.

Enrollment in the CDCP started on March 11th, 2024, through SLD (Sun Life Direct). Dentists can sign up for SLD in order 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 will be able to direct bill Sun Life for services provided on a claim-by-claim basis as of July 8, 2024. > Learn more 

As of May 1, 2024, eligible seniors are able to start using the program and dentists are able to submit claims through Sun Life. 

Please note that the CDCP coverage start date varies. An individual’s coverage date is based on when their application was received and when they were enrolled in the CDCP. See application schedule above.

It’s important for oral health providers to validate their patient’s effective coverage date before confirming an appointment.

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 oral health care service 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.

The CDCP wishes to avoid any confusion about who is eligible for services in order to 
avoid placing any undue financial hardship on patients you are seeing. You need to make reasonable efforts to validate an 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.  

After November 2024 when preauthorization comes into effect, 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. 

As of November 1, 2024, 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:

1. Access your practice management software.
2. 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.
3. 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.

4. 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

5. 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.

You can visit Sun Life’s CDCP webpage for more information such as FAQs and contact information: https://www.sunlife.ca/sl/cdcp/en/support/contact-us/.

You can also contact the Government of Canada: https://www.canada.ca/en/services/benefits/dental/dental-care-plan/contact.html.