Canadian Dental Care Plan - Member eligibility review
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To be eligible for coverage under the Canadian Dental Care Plan (CDCP), applicants must attest every year that they do not have access to private dental insurance. The Member eligibility review process allows Health Canada to verify the accuracy of these attestations by reviewing documentation, such as tax records, to demonstrate that CDCP members do not have access to private coverage.
Eligibility review for CDCP members
Your eligibility under the CDCP may be further reviewed at any time throughout the benefit year and your eligibility status may be subject to change.
We conduct ongoing member eligibility reviews to ensure all CDCP members are eligible for CDCP coverage as part of our continued commitment to sound stewardship of public funds.
Specifically, you must not have access to private dental insurance or coverage through any of the following:
- your job or a family member’s job
- your pension plan, or a family member’s pension plan
- a professional or student organization
- coverage you or a family member purchased privately
This applies even if you:
- choose not to enrol in a private dental plan
- do not use a private dental plan
- have to pay a premium for private dental insurance or coverage
How we further review member eligibility
You may be selected for review if there is a difference between the information you provided on your CDCP application, and the information received through other sources, such as T4 or T4A tax slips, showing that you have access to private dental insurance.
In 2023, the Dental Care Measures Act came into force to support the CDCP. The Act requires your employer or pension plan administrator to report any access to private dental insurance on your T4 or T4A tax slip. This information is found in box 45 on your T4 or box 015 on your T4A. These boxes use codes 1 to 5 to show what kind of dental coverage you may have.
To learn more about what each code means, please refer to:
- T4 slip – Information for employers - Canada.ca – Box 45
- T4A slip – Information for payers - Canada.ca – Box 015
If you realize that you have access to private dental insurance or coverage and, you attested that you did not, please contact Service Canada as soon as possible to update your information. Your CDCP coverage will be terminated.
If you are selected for review, you will receive a letter by mail, with detailed information and next steps. You will need to submit documents to prove that you do not have access to private dental insurance or coverage.
Documents you can send
If you need to submit documentation proving you do not have access to private dental insurance, you can send:
- a letter from your employer or pension plan administrator, confirming:
- you do not qualify for their dental insurance and the effective date
- the date your dental insurance ended or became unavailable
- updated insurance information
- your opt-out date and confirmation that you cannot opt back in, or
- the date your employment ended
If you cannot reach your employer or pension plan administrator or if you have questions, please contact Service Canada for information about other acceptable documents.
All documents must:
- include your full name as listed on your CDCP application, and
- be signed by an authorized representative, such as a business owner, Chief Executive Officer, Human Resources representative, or pension plan administrator
How to submit your documents
Your documents must be mailed to:
Oral Health Branch
Health Canada
Government of Canada
P.O. Box 10301
Matane QC G4W 0A9
If you do not take action
If we requested documents from you and you do not submit them by the deadline included in your letter, you will be considered ineligible, and your CDCP coverage will end. This means that your oral health care services will no longer be covered under the plan. You will be required to repay any amounts claimed for services provided to you under the plan during the time you were ineligible. Before you receive any care, please confirm the status of your coverage with your oral health provider.
If you’re found ineligible
If you are found ineligible, you will receive a letter informing you that your coverage will end. You will be required to repay any amounts claimed for services provided to you under the plan during the time you were ineligible. You will not be able to reapply for CDCP coverage until you have repaid the full amount owed and meet all CDCP eligibility requirements at the time of application.