Oral health provider FAQ

The CDCP will help ease financial barriers for Canadian residents that have an adjusted family net income of less than $90,000 and don’t have access to dental coverage. 

View the services that are covered by the CDCP.

Oral health providers can confirm their participation by signing up with Sun Life or by participating on a claim-by-claim basis.

Oral health providers can sign up online through Sun Life Direct. They can sign in to their existing Sun Life Direct account and select the "Sign up" button to confirm their participation.

Don’t have a Sun Life Direct account? Simply print and complete the provider participation form, then mail it back to the address provided.

Advantages of signing up for the CDCP

Oral health providers who sign up to participate in the CDCP can:

1. Confirm coverage for CDCP clients through Sun Life Direct.
2. Appear in the CDCP Provider Search Tool.

Providers have the option to opt-out at any time by contacting Sun Life's CDCP Contact Centre at 1-888-888-8110.

When an oral health provider confirms their participation in the CDCP through Sun Life Direct, they’ll receive a confirmation email immediately.

When an oral health provider confirms their participation in the CDCP by completing and submitting a paper form, they’ll receive their confirmation (via the communication preference that they selected) within 7 business days.

Oral health providers only need to confirm their participation in the CDCP once, even if they work at multiple locations across Canada.

Sun Life will send enrolled Canadian residents a member card that includes the CDCP plan number and their member ID.

On Sun Life Direct, oral health providers can validate a patient’s eligibility for services and frequency limits before confirming any dental care appointments and prior to patient treatment.

Oral health providers that aren’t on Sun Life Direct, should confirm a patient’s eligibility by calling the Sun Life CDCP Contact Centre at 1-888-888-8110 before confirming any dental care appointments and prior to patient treatment.

The CDCP will reimburse a percentage of any eligible expense at the CDCP established fees, but some CDCP Clients may have a co-payment based on the adjusted family net income (AFNI).

• AFNI under $70,000 there is no co-pay.
• AFNI between $70,000 and $79,999 there is a co-pay of 40%, the plan will cover 60% of the eligible expenses.
• AFNI between $80,000 and $89,999 there is a co-pay of 60%, the plan will cover 40% of the eligible expenses.

CDCP Clients may have to pay additional fees (beyond the potential co-payment), if the cost of their oral health care services is more than what the CDCP will reimburse based on the established CDCP fees or if they agree to receive care that isn’t covered under the plan.

The CDCP fees, as described in the CDCP dental benefit grids, have been designed using the existing methodology of other federal dental programs to pay a fair rate to oral health providers for evidence-based procedures.

The plan will reimburse oral health providers a percentage of any eligible expense, up to the approved CDCP established fees, which may differ from what the provider charges.

The CDCP will only pay for oral health care services covered within the CDCP and in accordance with the CDCP established fees.

For more information, view the CDCP dental benefit grids page.

A co-pay or co-payment is the percentage of CDCP fees that is not covered by the CDCP, and that people covered under the CDCP will have to pay directly to the oral health provider.

Those without or with co-payment, may still face additional charges if their oral health providers charge more than the CDCP established fees.

Oral health providers can submit claims for CDCP clients through Electronic Data Interchange (EDI) or by paper claim (starting November 1, 2024).

Both the oral health provider and the member or the parent/legal guardian or representative will need to sign the paper claim form to validate that the treatment was proposed or completed. Also, the assignment box on paper claims must be signed by the member or the parent/legal guardian or representative in order for the paper claim to be processed. Paper claims received without the member’s or the parent/legal guardian’s or  representative’s signature will be denied.

Paper claims should be sent to Sun Life at the following address: ​

Sun Life Assurance Company of Canada
Canadian Dental Care Plan (CDCP)
PO Box 99865 STND
Montreal, QC H3C 0E6

The CDCP will be rolled out using a phased approach (starting with seniors, persons with disabilities and children under 18). Individuals covered under the CDCP will be able to visit an oral health provider as early as May 2024 (depending on when they apply). 

The CDCP coverage start date will vary from one person to another. An individual’s coverage date is based on when their application was received and when they were enrolled in the CDCP.

It’s important for oral health providers to validate their patient’s effective coverage date before confirming an appointment for those covered under the CDCP.

The CDCP basket of services is designed to cover urgent services needed outside a hospital or emergency health care setting, or that are needed until the patient can be stabilized and brought back for any needed follow up treatment. For instance, emergency exams, caries, trauma and pain control, pulpotomies/pulpectomies and open and drain services are covered without preauthorization requirements.

The CDCP does not define emergency care. It is up to oral health providers to determine the urgency of a patient’s needs. It is important to distinguish between "emergent care," which refers to situations that pose an immediate threat to life or health and require immediate action (such as oral-facial trauma), and situations that are serious but not clinical emergencies (such as the distance a patient travels for care, or an intent to avoid follow-up visits). 

Many emergency care needs are treated in hospitals and insured under provincial and territorial health systems. These services should continue to be billed or paid for through those systems and not billed under the CDCP.

Emergency exams by dentists are covered, and there are no preauthorization requirements, frequency limits or maximums for this type of exam.

Emergency or specific examinations submitted with recall services will be considered as a recall examination and frequency limitations for recall examinations will be applied. 

Verification processes are in place to ensure accurate claim codes are being submitted.

Claims for services covered under the CDCP must be submitted by a participating CDCP oral health provider directly to Sun Life.

Yes, starting November 1, 2024, oral health providers can submit CDCP paper claims for services administered since May 1, 2024. CDCP clients must have been eligible at the time the service was administered for claims to be paid. ​

Note, that if a CDCP client/patient subsequently sought the same service at a clinic who submitted EDI before November, the claim for that patient’s treatment could be denied.

When submitting paper claims to Sun Life, providers must include CDCP members' signatures in the Assignment of Benefits section of the claim form to ensure that claims are not declined, which will result in claims processing and payment delays.

Sun Life encourages oral health providers to sign up for electronic fund transfer (EFT) to receive their claim payments via direct deposit within days. Direct deposit forms are available on Sun Life Direct.

Otherwise, Sun Life will send oral health providers their claim payments through monthly cheques.

Electronic Data Interchange (EDI) submission through your practice management software is the fastest and easiest way to get preauthorization requests approved. Ensure that your practice management software also supports submission of attachments through EDI.   

If you’re unable to submit through EDI, CDCP claims and preauthorization requests can be sent by courier to the following address:

Sun Life Assurance Company of Canada
CDCP Claims
1155 Rue Metcalfe, Suite 1024
Montreal, QC H3B 2V6

To avoid potential delays, please ensure you include all applicable supporting documentation. CDCP preauthorization requests have different documentation requirements than other insurance plans, including  a requirement to provide treatment plan details. Consult the Preauthorization Supporting Documentation Reference Guide for a quick summary of the required documents, or consult the CDCP Dental Benefits Guide.

Most services covered under the CDCP will not require prior approval (up to certain frequency limits). Some services, such as major oral health services or services above the established frequency limits, will require preauthorization. Oral health providers should consult the claims submission information and CDCP Dental Benefits Guide for details. ​

Services that require preauthorization have been eligible as of November 1, 2024.

As of November 1, 2024, providers can request preauthorization by submitting the requested procedure code(s) along with required supporting documentation and information to Sun Life through digital submission via Electronic Data Interchange (EDI) or by mail. 

Submission by EDI:

Some practice management software programs have the capability to include digital attachments as part of an electronic (EDI) submission. Providers are encouraged to confirm the capability of their software program to understand whether it supports digital submissions before submitting a request for preauthorization. 

If a practice management software does not have the capability to submit supporting documents as attachments, the claim and supporting documentation will need to be mailed to the CDCP dedicated PO Box  listed below.

Submission by mail:

Sun Life Assurance Company
Canadian Dental Care Plan (CDCP) 
PO Box 99865 STND 
Montreal, QC  H3C 0E6

Document requirements vary depending on the service requested. Please consult the CDCP Dental Benefits Guide for information, and the Preauthorization Supporting Documentation Reference Guide for a quick summary of the required documents.

Post-determination is the process through which coverage for procedures typically requiring preauthorization is administratively reviewed and adjudicated after the  services have been rendered. Post-determination is intended to be used rarely, and only in emergent clinical situations.

The CDCP Dental Benefits Guide and the Dental Benefits Grids outline the plan’s policies, including which services require preauthorization or post-determination.

Post-determination requests will be assessed based on the same clinical criteria as preauthorization requests, with an additional rationale explaining the emergent clinical situation for the post-determination submission. Approval is not guaranteed.

Preauthorization is always highly recommended, but when not possible, it is important for the provider to have clear conversations with the client about their potential financial responsibility before treatment begins.

Requests for post-determination must include all the documentation that would be required to request preauthorization for the same service, in addition to a rationale explaining why post-determination is being sought instead of preauthorization.

The turnaround times for preauthorization requests varies based on the volume and complexity of submissions received. To help minimize delays, please do not submit the same request multiple times. You will only receive a decision once your submission has been processed. Thank you for your patience.

Generally, a preauthorization will be valid for 12 months from the date of approval.  Approved preauthorizations for select preventive and periodontal services are valid for 24 months, provided that the client is still eligible for coverage under the CDCP.

The CDCP covers 4 sessions in 12 months of  nitrous oxide, oral sedation and nitrous with oral sedation without preauthorization. The CDCP also covers parenteral conscious sedation and combined techniques of inhalation plus IV (intravenous) and/or IM (intramuscular) injection, deep sedation, and general anesthesia with preauthorization. Based on their scope of practice, oral surgeons do not require preauthorization for sedation and general anesthesia up to frequency limits noted in the Dental Benefit Grids.

Additional sessions can be requested through preauthorization or post-determination in emergency cases where preauthorization cannot be sought.

The CDCP allows for flexibility in cases where a client’s higher or more complex needs are demonstrated and necessitate extra care.  

For example, the CDCP may cover oral hygiene services above frequency limits through preauthorization for patients covered under the CDCP with a physical disability who, as a result of the disability, requires additional support to conduct routine care, such as brushing. Providers must submit preauthorization requests to Sun Life for services above plan frequency limits.

Sun Life Direct is Sun Life’s self-serve portal for oral health providers. They can use Sun Life Direct to:

• Verify their patients’ CDCP coverage eligibility
• Sign up and manage their banking information for electronic fund transfer payments from Sun Life
• View their estimate history
• View their payment history

Oral health providers will need an Access ID and password to sign in. They must contact the Sun Life CDCP Contact Centre at 1-888-888-8110 to obtain their Access ID and temporary password.