Canadian Dental Care Plan Oral Health Provider Newsletter Volume 1 – May 29, 2025

Canadian Dental Care Plan: Oral Health Provider News

This is your quarterly oral health provider update to help keep you and your staff informed of the latest Canadian Dental Care Plan (CDCP) news.

CDCP Statistics at a glance:

• Close to 1.9 million Canadians have received services to date
• Over 25K eligible oral health-providers are participating in the CDCP to date
• More than 3.6 million Canadians have been deemed eligible for CDCP services to date

CDCP statistics are updated on a monthly basis and are found on the Government of Canada CDCP statistics webpage.

Preauthorization processing information

Sun Life is currently processing a high volume of preauthorization submissions. The turnaround times for preauthorization requests vary based on the volume and complexity of submissions received. We acknowledge that the turnaround times are longer than expected and both Sun Life and Health Canada are continuing to work together to reduce these timelines and improve the process, where possible. 

To minimize delays, providers are reminded to avoid submitting the same requests for preauthorization or claims multiple times as this creates additional backlogs and delays in adjudication. Providers will only receive a decision once their submission/claim has been processed. Claims and submissions are being processed on a first-in, first-out basis. 

Note: Preauthorization submissions that are submitted again as a result of their Explanation of Benefits indicating the submission was declined due to missing documentation are also going to be processed on a first-in, first-out basis, as they are considered a new submission. Please ensure to review all required documentation before submitting your request to avoid further delays.

Once the preauthorization is adjudicated, decisions will be sent to your Sun Life Direct account or if you do not have a Sun Life Direct account, by mail. Claims for preauthorized services will be paid according to the CDCP fee grid rates and the co-payment level on the date of service.

Providers and their staff should call the Sun Life Contact Centre at 1-888-888-8110 for any questions related to preauthorization and/or claims submissions, agents are there to help answer your questions.  

Preauthorization resources

The Government of Canada's CDCP website offers valuable resources to assist with the preauthorization process. These Preauthorization resources include:

• Table: Supporting documentation requirements for preauthorization submissions
• Tutorial video on Preauthorization for Partial Dentures
• Tutorial video on Preauthorization for Additional Units of Scaling

Annual member renewal has started

Eligibility for the CDCP is reassessed annually and existing CDCP clients must renew their coverage under the CDCP before June 1, 2025, to avoid a potential gap in coverage. All existing CDCP clients have received a letter from the Government of Canada informing them that they need to submit a renewal application prior to June 1, 2025, to avoid a potential gap in coverage, and how they can renew.

It is important that oral health providers always validate a CDCP client’s coverage and co-payment level before providing services or treatments for each visit.

• When a CDCP client completes the renewal process, they will receive a confirmation letter from the Government of Canada outlining their eligibility for the next benefit period including any changes to their co-payment level (if applicable).
  • Note: some CDCP clients who renewed their coverage for the 2025-2026 benefit coverage period with no changes to their co-payment level may have received a confirmation letter from the Government of Canada with their initial benefit effective date from 2024-25, as opposed to June 1, 2025. These clients remain covered for the 2025-2026 benefit coverage period – from June 1, 2025, to June 30, 2026 - with no changes to their co-payment level.
• Clients who do not renew or become ineligible for the next benefit period will have their coverage end on June 30, 2025, and will receive an end date notification letter from the Government of Canada.
• Services are only covered by the plan if your CDCP patient is eligible on the date the service is completed. This also means that any estimates or preauthorization submissions previously approved will not be valid if your patient is no longer covered under the plan and the care is received after June 30, 2025.
• CDCP clients can renew after the June 1, 2025, deadline, but may experience a gap in coverage. Their coverage can be reinstated if they still meet the eligibility criteria; however, any treatment received during a gap in coverage will not be covered nor reimbursed retroactively.
• CDCP clients who continue to be covered under the plan will keep the same CDCP member ID and member card. Providers can confirm coverage through Electronic Data Interchange (EDI) estimates, calling Sun Life's dedicated CDCP Contact Centre, or using the CDCP coverage look-up tool in Sun Life Direct.
• Providers should always discuss any services or costs with their clients before providing care to ensure they understand what their co-payment may be, if any, and any additional costs they might incur.
• There are no changes to the CDCP Billing Agreement. Providers who accept to treat CDCP clients agree to bill and receive payment directly from Sun Life. There is no reimbursement to CDCP clients.

Providers can direct their clients to call the Service Canada CDCP Contact Centre should they have issues with or questions about the CDCP renewal process. Health Canada has also prepared a renewal poster for oral health providers to print and use in their offices to help remind their CDCP patients that they need to renew their coverage.

Applications opening for all eligible canadians

Eligible Canadians of all ages can apply for the CDCP with coverage starting as early as June 1, 2025, based on when they are enrolled in the CDCP.

The Government of Canada is sending letters to Canadian residents aged 18 to 64 who may be eligible based on their 2024 adjusted family net income, encouraging them to apply.

Canadians can visit the Government of Canada CDCP website for more information on the application process.

Important note: As of May 1, all CDCP clients’ determination letter received from the Government of Canada will include their member ID, benefit coverage start date and co-payment level. With this letter they can receive care and not wait to receive their welcome package and physical CDCP member card which may take a few months to arrive.

Payment processing time

Oral health providers who use direct deposit can receive payment within 48 hours after the claim has been processed, not based on when it is submitted. Note that while 90% of claims are processed immediately, some claims may take several days to be processed. For any questions related to claims, please call the Sun Life Contact Centre at 1-888-888-8110.

2025 CDCP dental benefit grids

The 2025 CDCP Dental Benefit Grids for all oral health providers and all provinces and territories are now available on Sun Life’s CDCP website. They include information and updates on CDCP dental procedure codes, pricing and policies.

Note that pricing for dental services is determined based on the date the service is rendered, not the date of preauthorization approval. For example, in the event that a preauthorization request was submitted in March 2025, but the corresponding treatment is not administered until May 2025, the applicable 2025 CDCP Dental Benefit Grids on the date of service would apply.