Dental insurance can sometimes feel like a mystery—what’s covered? What’s not? How do you make the most of your benefits? It’s a crucial part of managing your oral health, but for many, it remains an area of confusion. In this post, we’ll break down the new Canadian Dental Care Plan and what it means for Canadians
What is the CDCP Dental Insurance?
The CDCP is a new coverage policy released by the Canadian Government in May of 2024. It is accessible to Canadians falling into different tax brackets. The Insurance is covered under the Sun Life Insurance Company. Depending on each individual the insurance policy helps cover the cost of dental care, providing financial assistance for a range of services, from routine cleanings and exams to more complex procedures like fillings, crowns, and orthodontics. Much like other forms of insurance, the goal is to help reduce the out-of-pocket expenses associated with dental care and ensure that preventive and necessary treatments are more affordable.
How do I qualify for the CDCP?
To qualify for this coverage under the CDCP, you must meet the following criteria: You do not have access to dental insurance, and you and your spouse or common-law partner (if applicable) must have filed your tax returns in Canada for the previous year to allow for assessment of your family income. Additionally, your adjusted family net income must be less than $90,000, and you must be a Canadian resident for tax purposes. Meeting these requirements ensures that you are eligible for coverage under this plan.
How do I apply for coverage?
Applications can be completed online at the government of Canada website. To complete the application, you’ll need to provide the following information for each applicant and your spouse or common-law partner (if you have one):
- Social Insurance Number (SIN) (if available for children)
- Date of birth
- Full name
- Home and mailing address
- List of dental coverage through government social programs (if applicable)
- You and your spouse or common-law partner (if applicable) must have filed your tax return for 2023 and have received your Notice of Assessment
What Does the CDCP Cover?
Coverage amount are based on the net family income for the previous tax year and is split into 3 tiers:
Tier #1: Family net income Lower than $70,000
100% of eligible oral health care service costs will be covered at the CDCP established fees.
Tier #2: Family net income Between $70,000 and $79,999
60% of eligible oral health care service costs will be covered at the CDCP established fees. With the remaining 40% being the responsibility of the patient
Tier #3: Family net income Between $80,000 and $89,999
40% of eligible oral health care service costs will be covered at the CDCP established fees. With the remaining 60% being the responsibility of the patient
With the different tiers established many treatments options are covered under the CDCP coverage plan. These include:
Preventative services:
These are services to check your oral health status, keep your teeth, gums and mouth healthy, and prevent cavities and gum disease and detect mouth conditions (like cancer) earlier. CDCP covers: dental exams, including complete, routine, specific and emergency exams, x-rays, cleaning (scaling), fluoride applications, and sealants
Restorative services
These services treat cavities and broken teeth. CDCP covers: permanent fillings, temporary fillings, pain control for diseased teeth, other treatments for cavities
Endodontic services
These services treat teeth that are severely decayed, infected or broken. CDCP covers: root canal treatments, pulpectomies (first step of a root canal treatment), procedures to reduce infection and relieve pain, re-treatment of previously completed root canal treatment (requires preauthorization)
Periodontal services
These services treat areas around the teeth, including gums and bone. CDCP covers: cleaning under the gumline, treating abscesses, bonding for mobile teeth (requires preauthorization), post-surgical evaluations (requires preauthorization), non-surgical gum disease management
Additional Restorative services
These services restore teeth when they’re too damaged to be fixed with basic fillings. CDCP covers: posts and post removal, repairs to crowns and re-bonding of crowns and posts, crowns (requires preauthorization), cores (to support crowns) (requires preauthorization), posts for crown (requires preauthorization)
Removable prosthodontic services
These services replace missing teeth. CDCP covers: complete dentures, including standard and temporary dentures, denture repairs, relines and rebases, placing lining in dentures to condition oral tissues (for comfort and healing), complete immediate and overdentures (requires preauthorization), partial dentures (require preauthorization)
Oral surgery
These services remove teeth or tumours and fix other problems in the mouth and jaw that need surgery. CDCP covers: removal of teeth and roots, surgical removal of tumours and cysts, surgical incisions, including draining, treatments for broken jaw bones
The CDCP also covers services to sedate you and control your pain while another service is being performed. CDCP covers:minimal sedation (conscious), moderate sedation (requires preauthorization), deep sedation (requires preauthorization), general anaesthesia (requires preauthorization)
Exclusions and Limitations
While dental insurance can help with many services, there are some exclusions and limitations to be aware of. Some of these exclusions include:
Cleanings: Cleanings are covered on a yearly basis
Cosmetic Dentistry: Whitening, Veneers
Appliances: sports mouth guards and Bruxism appliances (also known as Night Guards)
Therapies: Temporomandibular Joint (TMJ) therapy and associated appliances
This is not a full list of limitations, further treatment limitations feel free to give our office a call for more information.
Conclusion: Investing in Your Oral Health
Dental insurance is an invaluable tool for maintaining your oral health, but it’s essential to understand how it works to maximize its benefits. By understanding if you qualify and applying for the CDCP you can reduce out-of-pocket expenses, prevent dental issues before they become major problems, and enjoy a healthy, confident smile for years to come.
Whether you’re just hearing about the Canadian Dental care plan or you have already been accepted for coverage, our office is here to help you with understanding your coverage to maximize its benefits and keep your teeth happy and healthy as your oral health is our number one priority.
Have any questions about dental insurance or your plan? Feel free to ask our highly trained team for more personalized advice! Give us a call at 519-294-0151 or email us at ParkhillDentistry@execulink.com
If you would like to apply for the CDCP click here.
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