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. 

Oral health providers can participate in the CDCP through Sun Life Direct.

If an oral health provider isn’t interested in having a Sun Life Direct account, they can confirm their participation by completing and submitting a paper form.

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.

If an oral health provider is registered for Sun Life Direct, they’ll receive their communications via email automatically. If not, their communications will be sent via email or mail, depending on their communication preference.

Oral health providers can change their communication preference by speaking with a Client care representative.

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 call centre at 1-888-888-8110 to obtain their Access ID and temporary password.

Oral health providers only need to confirm their participation once, for all their dental care locations in Canada.

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.

Initially, oral health providers will only be able to submit claims for the CDCP through electronic data interchange (EDI).

Paper claims will be accepted starting in fall 2024.

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

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 CDCP contact centre before confirming any dental care appointments and prior to patient treatment.

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.

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

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.

View the services that are covered by the CDCP. 

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.

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.

Starting in May 2024, most services covered under the CDCP will not require prior approval (up to certain frequency limits). Some services, starting in November 2024 will require preauthorization, which for most include major oral health services as well as services that would be required above frequency limits, based on the medical need of the patient.