Toronto 
The federal government has announced further details of the Canadian Dental Care Plan (CDCP) administered by Sun Life Canadians earning below $90,000 who lack dental insurance.
The phased rollout of the CDCP, which began in December 2023, currently focuses on seniors. The plan will then gradually expand in subsequent months to include younger age groups, down to those aged 70-71 by March 2024.
The federal government says the CDCP will begin providing a range of oral health services aimed at preventing and treating dental issues starting May 2024.
The news release reads, “To limit out-of-pocket costs, oral health providers participating in the CDCP will bill Sun Life directly for the eligible services provided to ensure timely reimbursement.”
“Before receiving any oral health services, people covered under the CDCP should confirm that their provider is participating in the program and whether there may be any costs that will not be covered by the plan.”
Certain services, like crowns, initial placement of partial dentures, and general anesthesia, will require preauthorization and are expected to be available in fall 2024.
The federal government has published an extensive online guide with what services are covered, frequency (like how often cleaning is allowed) and exclusions (like fixed prosthodontics, implants and all implant-related procedures, veneers, and cosmetic services, etc.).
What is Covered
Diagnostic and preventive services
Intended to evaluate your oral health status, to keep your teeth, gums and mouth healthy and to prevent cavities and gum disease. Services covered include:
- a range of dental exams, including complete, routine, specific and emergency exams
- x-rays
- cleaning (scaling and polishing)
- fluoride applications
- sealants
Basic services
- Restorative services: Intended to treat decayed or fractured teeth. Services covered include:
- permanent fillings
- temporary fillings
- pain control for diseased teeth
- other treatments for cavities
- Endodontic services: Intended to treat teeth that are severely decayed, infected or broken. Services covered include:
- root canal treatments
- pulpectomies (first step of a root canal treatment)
- procedures to reduce infection and provide temporary pain relief
- retreatment of previously completed root canal treatment (requires reauthorization)
- Periodontal services: Intended to treat areas around the teeth, including gums and bone supporting the teeth. Services covered include:
- cleaning under the gumline
- treatment of abscesses
- bonding for mobile teeth (requires reauthorization)
- post-surgical evaluations (requires reauthorization)
- non-surgical gum disease management
Major services
- Restorative services: Intended to restore teeth with a more extensive procedure when teeth are too damaged to be restored by basic fillings.
- posts and post removal
- repairs to crowns and rebonding of crowns and posts
- crowns (requires reauthorization)
- cores (to support crowns) (requires reauthorization)
- posts for crown (requires reauthorization)
- Removable prosthodontic services: Intended to replace missing teeth. Services covered include:
- 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 reauthorization)
- initial placement of partial dentures (requires reauthorization)
- replacement of partial dentures
Oral surgery
Intended to remove teeth or tumours or fix other problems in the mouth and jaw requiring surgical intervention. Services covered include:
- removal of teeth and roots
- surgical removal of tumours and cysts
- surgical incisions, including draining
- treatments for jaw bone fractures
Anesthesia/Sedation services
Additional services are provided in support of another services. Services covered include:
- minimal sedation (conscious)
- moderate sedation (requires reauthorization)
- deep sedation (requires preauthorization)
- general anaesthesia (requires preauthorization)
Orthodontic Services
Some orthodontic services will be added to the CDCP starting in 2025. Orthodontic services will only be covered in cases of medical need based on stringent criteria and will include a maximum spending limit.
The federal government says CDCP will cover a portion of dental service costs according to its fee schedule, which differs from the recommended fees by provinces and territories. Individuals enrolled in the CDCP might be responsible for any remaining balance, including co-payments or extra fees, payable directly to their dental care provider.
Per the news release, individuals who submit their application prior to May 1, 2024 (only seniors above 70 are eligible), will have their eligibility assessed based on their tax filings from 2022. After May 1, 2024, the eligibility for applicants will be evaluated using their 2023 tax year information. Therefore, those applying to the CDCP post-May 1 are required to have their 2023 taxes filed.
The federal government has also made the 2023 CDCP fee structure available on Sun Life’s website to guide providers before the 2024 fees are released, indicating that services will be compensated based on these fees starting in May.
Detailed Canadian Dental Care Plan – Dental Benefits Guide
Fee Structure on Sunlife Website
