CDCP Explained! | The Ins & Outs of the Canadian Dental Care Plan

CDCP Explained! | The Ins & Outs of the Canadian Dental Care Plan

Dental Education Library

As your Mississauga dental clinic, we want to provide you with information that will make it easier to access and understand dental treatment and procedures.  The Canadian Dental Care Plan has been overwhelming for many of our patients.  Understanding how the plan works, what’s covered and how treatment fees are processed isn’t easy so as your Mississauga dental office, we hope we can provide you with answers to some of the questions you may have regarding the new Canadian dental plan.

The provisions for the New Canadian Dental Care Plan are based on combined household income.  Although coverage states it is 100% coverage, this coverage is limited to CDCP’s fee guide and not the current Ontario Dental fee guide.  So what does this mean for you as a patient?  This means that you will be responsible for paying the difference that is not covered by CDCP.

Firstly, how do you know you’re eligible?  The criteria are as follows:

• Your family net income is less than $90,000
• You don’t have access to dental insurance
• For tax purposes, you’re a Canadian resident
• Your income taxes were filed the previous year

Those who are currently able to apply are:

• Children who are under the age of 18
• Seniors aged 65 or older
• Adults with a 2023 valid federal Disability Tax Credit Certificate
• In 2025, all remaining residents whom are eligible

If you fit all of these criteria and are able to apply, click here to continue with your application.

Once the application process has been completed, you will be informed if you qualify.  If you qualify, your information will then be shared with SunLife and you will be enrolled and sent a welcome package which contains information on the plan, your membership card and a welcome letter that informs you of the date when your benefits will begin.

Once your benefits have begun, it is important to contact your dental office and inform them that your benefits are being provided by the CDCP.  At this time, depending on the treatment necessary, an estimate can be sent or a consultation may be required depending on the services you need

Estimates for treatment are a must. This way, you will be able to determine what your co-payment will be and what your eligibility is. There are frequency limitations for treatment so it’s important to know what your coverage entails. For example, you’re limited to the length of time your hygiene appointments – a standard hygiene appointment is only covered for 2 units which is 30 minutes of time.  The frequency or how often you’re able to have an appointment is also limited.  As it stands now, hygiene appointments are permitted only once yearly.

In terms of coverage, the diagnostic and preventive services that are covered are as follows: dental exams, x-rays, scaling (cleaning), fluoride applications, sealants.  Basic services include restorative treatments, endodontic (root canal) treatments, periodontal and treatments.  Major services include restorative services which includes crowns (requires pre-authorization), removable prostheses (such as dentures), oral surgery and anesthesia or sedation services.

Billing is done directly from your dental office.  You will have a co-payment to pay which will be expected the day the service is rendered.  If an estimate has been sent prior to your treatment, then you should be aware of the co-payment expected.  Payment for treatment will go ONLY to the dental office so you should not pay for anything but your co-payment UNLESS you consented to treatment that is not covered by CDCP.  If this is the case, you will be expected to pay for the treatment in full.

So who takes the CDCP?  It may be worthwhile for you to ask whether or not your dental office takes CDCP coverage because although some dentists may sign up for it and be listed as a provider that accepts CDCP, all dentists are able to accept CDCP coverage.

In Summary, these are the key points to understand:

• The fee guide for the Canadian Dental Care Plan (CDCP) is not the same as the fee guide in dental offices as dental office fees are regulated by their governing body.  Even with 100% coverage, there will be a difference to pay.  For example, if the cost of treatment done at your dental office fee is $10 and CDCP’s fee guide only covers $8, you will be responsible for $2 out of pocket and will have to pay your dental office for this difference.
• Not all dental services are covered so estimates for ALL treatment must be sent
• The co-payment fee is based on your family net income:
  • Lower than $70,000 – CDCP will cover 100% of their fee guide but you will incur additional charges for the difference in fee guide
  • Between $70,000 to $79,000 – CDCP will cover 60% of their fee guide but you will have to incur 40% as well as additional charges for the difference in fee guide
  • Between $80,000 to $89,999 – CDCP will cover 40% of their fee guide but you will have to incur 60% as well as additional charges for the difference in fee guide

As your Mississauga dentist, we hope that we have given you more information on the new Canadian Dental Care Plan.  If you’re eligible for coverage, you can begin the process of application.  If you have any questions or concerns, please don’t hesitate to ask.  You can reach our director of patient relations by calling us at 905-278-4297 and we look forward to giving you more to smile about!