Information for oral health professionals
Oral health professionals play a vital role in oral health care. The Canadian Dental Care Plan (CDCP) allows more people to benefit from their care.
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Participation in the CDCP
Participation in the CDCP is voluntary. Eligible providers who can bill for their services include:
- dentists
- denturists
- dental hygienists
- dental specialists
There are 2 ways for oral health providers to provide care to CDCP clients; either by:
- Signing up formally through Sun Life
- Submitting claims directly to Sun Life for payment, on a claim-by-claim basis. Please note, there will be no retroactive payment to providers who offered treatment under this option prior to July 8
How to sign-up through Sun Life
In both options, oral health providers agree to bill Sun Life directly for payment of services covered under the CDCP to limit out-of-pocket costs for CDCP clients.
Note: There is no option for CDCP clients to get reimbursement from Sun Life. CDCP clients should not be asked to pay the full cost upfront. CDCP clients should only pay any outstanding amount not covered by the plan, if applicable.
In all cases, by submitting a CDCP claim and accepting payment, providers agree to the CDCP Billing Agreement, either on a claim-by-claim basis or by signing up with Sun Life.
Before providing care to CDCP clients, providers will still need to:
- confirm that the client is eligible for the CDCP through their existing patient intake process
- confirm that the client is covered for select services
- submit a claim with assignment of benefits (non-assigned claims will be rejected)
Side-by-side comparison of the 2 types of provider participation
| CDCP process | Signed up provider | Claim-by-claim provider |
|---|---|---|
| Accepting the CDCP Billing Agreement | Providers who sign-up to the CDCP will review and accept the CDCP Claims Processing and Payment Terms (Billing Agreement), which will apply to all claims submitted under the CDCP. This will only need to be done once. Providers can sign up to the CDCP with Sun Life either by:
Providers have the option to opt-out at any time by contacting Sun Life at 1-888-888-8110. |
Providers will submit a claim to Sun Life for services covered under the CDCP. By doing so, the provider will agree to the CDCP Claims Processing and Payment Terms (Billing Agreement) for the specific claim being submitted, as is the case with private plans. The provider makes a decision to agree to the Billing Agreement each time a claim is submitted under the CDCP. Claim-by-claim providers can decide to officially sign up to the CDCP at any time. |
| Confirming a CDCP client's eligibility | Providers can confirm a client's coverage start date is active, their co-payment level and covered services by:
|
Providers can confirm a client's coverage start date is active, their co-payment level and covered services by:
|
| Claims submission | The provider will enter all information required for the claim, including their client's CDCP plan number (333333), member ID and service details. When the claim is sent successfully, the provider will receive an Explanation of Benefits (EOB) that includes the total amount paid to the provider. |
The provider will enter all information required for the claim, including their client's CDCP plan number (333333), member ID and service details. When the claim is sent successfully, the provider will receive an Explanation of Benefits (EOB) that includes the total amount paid to the provider. The Explanation of Benefits will include a notice of acceptance such as: "By having made this submission, you agree to be subject to the terms of the CDCP Claims Processing and Payment Terms (Billing Agreement) which can be found at http://www.sunlife.ca/CDCP. Should you wish to withdraw your submission, you are able to do so electronically if it is done on the same day as the submission was made, or otherwise by contacting Sun Life's CDCP call centre at 1-888-888-8110." |
| CDCP Provider Search tool | Providers will appear in the CDCP provider search tool (they can still decide not to be listed if they wish). Providers can create their extended profile through their Sun Life Direct account |
Providers will not appear in the CDCP Provider Search tool. |
What providers need to know about payment
If a provider is using Sun Life Direct, they will receive payment by Electronic Fund Transfer (EFT) or cheque, according to their preference.
Only providers with a Sun Life Direct Account can receive payment by EFT.
If a provider is not using Sun Life Direct, Sun Life will issue payment by cheque, using the mailing information provided when the provider signed up or that is provided through EDI. If a provider wishes to change their mailing address, they can contact the call centre at 1-888-888-8110.
Claims submitted by EDI will be processed in the same turnaround time for all providers treating CDCP clients; providers will be paid within 48 hours initially and moving towards a 24-hour turnaround time. Providers will receive notification that their claim statements are in their Sun Life Direct account.
If they're paid by cheque, providers will receive CDCP payments and accompanying statements monthly.
CDCP established fees
We’ll reimburse providers according to the CDCP established fees for each service covered under the plan. CDCP fees may differ from those in provincial and territorial suggested fee guides, that providers often use to charge for services. However, on average, the CDCP fees for the most frequently used procedure codes are set to cover at least 80% or higher of the fees suggested by provincial or territorial oral health provider associations.
Full lists of the 2024 CDCP dental benefit grids for each province and territory are now available.
Fees will be reassessed annually to account for new scientific evidence, inflation, and changes in costs over time. We’ll continue to work with oral health professional associations to inform the methodology for determining fees for 2025 and beyond.
Coordination of benefits
Provincial and territorial social dental programs
We’ve developed a set of factsheets based on guidance from each provincial or territorial government. These province/territory-specific factsheets can assist providers and their staff with the billing process when their patient asks to coordinate their benefits.
Consult the relevant provincial or territorial factsheet:
- Alberta
- British Columbia
- Manitoba
- New Brunswick
- Newfoundland and Labrador
- Northwest Territories
- Nova Scotia
- Nunavut
- Ontario
- Prince Edward Island
- Quebec
- Saskatchewan
- Yukon
Other federal social dental programs
The following federal social dental programs offer dental coverage to specific populations. They will be billed first, before the CDCP:
- Non-Insured Health Benefits Program
- Veterans Affairs Canada Dental Services Program
- Interim Federal Health Program
- Correctional Services Canada Dental Care for Inmates
The CDCP will be billed after these plans, but given the similarities of the coverage and the established fees paid by these programs, we expect they’ll need either no coordination or only limited coordination. If a service is covered by the CDCP but isn’t covered by these plans, it could be submitted to the CDCP for coordination.
Private dental coverage
People aren’t eligible for the CDCP if they already have access to coverage beyond a federal, provincial or territorial social dental program.
There will be no coordination with private, employer or other such plans.
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