The Government of Canada announces a new option for all providers to provide care.
April 17, 2024 | Ottawa, ON | Government of Canada
To date, more than 1.7 million Canadian residents have been approved to receive oral health care services through the Canadian Dental Care Plan (CDCP). We are grateful to the more than 5,000 oral health providers who have already agreed to help CDCP clients get the care they need, and to the many more who continue to join every day.
Today, informed by consultations and conversations with oral care providers and their associations across Canada, we are taking a series of new actions to all suppliers may provide care to CDCP clients.
Choice for suppliers and their customers
Oral health providers across the country are encouraged to participate in this plan so that we can lay the foundation for more equitable access to oral health care and make a difference in the lives of nearly 9 million Canadians. We understand that some oral health providers may choose not to fully participate as CDCP providers, but would still like to provide care to CDCP clients. Beginning July 8, 2024, oral health providers will be able to directly bill Sun Life for services provided on a claim-by-claim basis without formally registering with the CDCP. This will make it easier for providers to treat patients and submit CDCP claims to Sun Life for direct reimbursement, whether they choose to formally participate or not. This also means that CDCP customers can see any oral health provider they choose for their care, as long as the provider agrees to bill Sun Life directly for services provided under the plan.
Emergency Care and Prior Authorization
We know that providers want their patients to be able to receive emergency care when they need it. The Government of Canada designed the CDCP basket of services with the CDCP-eligible population in mind, including their need to access care in emergencies. There are no limitations on emergency exams under the plan, and almost all services that could be done in an emergency do not need prior authorization. After November, when prior authorization goes into effect, in rare cases where a service that would normally require prior authorization is needed in an emergency, providers may submit any minimum necessary documentation after the fact.
Additionally, to further streamline administrative processes under the CDCP, we continue to work with provider associations to determine where additional improvements to prior authorization requirements could be helpful for CDCP clients who have long-standing special needs (for example, through the use of general or multiple programs). one-year preauthorization when a patient’s underlying health condition is unlikely to change, rather than requesting prior authorization each time).
To make sure oral health providers have the details they need, 2024 CDCP Dental Benefit Charts are now published, which outline the rates CDCP will pay oral health providers for all procedures covered by the plan. The CDCP fee structure is based on similar federal programs and will be reevaluated annually. Health Canada will work with oral health provider associations to inform our work related to rates for 2025 and beyond.
The CDCP will help make the cost of dental care more affordable for Canadian residents who currently do not have access to dental insurance. CDCP customers are reminded that they may be required to pay additional charges in addition to any copays, and should always ask their oral health provider about any costs that will not be covered by the plan.
The Government of Canada is committed to making it as easy as possible for oral health providers to serve CDCP clients so they receive the care they need and deserve.
More information is available at Canada.ca/dental and at sunshine life website for oral health professionals looking for accurate and clear information about the plan.