The Canadian Dental Care Plan is open to any Canadian resident for tax purposes who has filed their most recent tax return, has an adjusted family net income under $90,000, and does not have access to dental insurance through an employer, pension, professional association, or a spouse or common-law partner's plan. If you opted out of a workplace plan, that still counts as having access and you will not qualify. Coverage under a separate government program such as Healthy Smiles Ontario does not disqualify you; the plans may coordinate your coverage to avoid duplication.
Your adjusted family net income decides your co-pay tier under Sun Life, the plan administrator:
- Under $70,000: the CDCP reimburses 100 percent of the eligible fee. You pay nothing for covered services performed at the established CDCP rate.
- $70,000 to $79,999: the CDCP reimburses 60 percent. You pay a 40 percent co-pay on the eligible fee.
- $80,000 to $89,999: the CDCP reimburses 40 percent. You pay a 60 percent co-pay on the eligible fee.
A second cost can sit on top of any co-pay. The CDCP has its own fee schedule (the CDCP Dental Benefits Grid). If a dentist's usual fee is higher than the CDCP fee for a procedure, the patient pays the difference. At Fairmont Dental Centre we tell you in writing, before you commit, whether any balance billing applies to your treatment plan and what each line item will cost.
What's Covered, What's Not, and How We Submit at Fairmont
The plan covers a defined list of medically necessary services. Preventive services include scaling, polishing, fluoride, and oral hygiene instruction. Diagnostic services include exams, X-rays, and treatment planning. Restorative services include fillings (amalgam and composite, with limits by tooth) and certain crowns when criteria are met. Endodontic services include root canal therapy on permanent teeth. Prosthodontic services include complete and partial removable dentures plus relines and repairs. Periodontal services include scaling and root planing. Oral surgery covers most extractions including some surgical removals. Some treatments, notably crowns, partial dentures, deep scaling beyond annual unit limits, and certain other major work, need preauthorization from Sun Life before we begin.
The plan does not cover dental implants, implant-supported prosthetics, purely cosmetic procedures such as whitening or cosmetic veneers, orthodontic treatment including Invisalign and braces, sedation outside narrow medical criteria, or any treatment above the frequency limits in the benefits grid. If you want a treatment the plan does not cover, we will quote it separately so you can decide.
Here is how we handle the paperwork at our Hamilton Road clinic so you don't have to:
- Before your visit: tell our front desk you are a CDCP member when you book. Have your Sun Life member ID and coverage start date ready.
- Verification: we confirm your active status and tier with Sun Life and pull your benefits grid for the services we expect to perform.
- Exam and plan: Dr. Edward Pham or Dr. Alain David completes your exam and walks you through the recommended treatment, what the plan covers, what (if anything) requires preauthorization, and any co-pay or balance-billing amount in writing.
- Preauthorization (when needed): we submit to Sun Life and follow up.
- Treatment and direct billing: we bill Sun Life directly for the covered portion. You pay only your co-pay (and any balance-billed difference you agreed to) at the time of service.
To apply, go to canada.ca/dental or call Service Canada at 1-833-537-4342. Sun Life handles claims and provider questions. The Canada.ca application asks for your Social Insurance Number, date of birth, name, addresses, and any dental coverage you have through government social programs. To check the status of your application, use the Check your CDCP application status page on Canada.ca. Service Canada sets your coverage start date. For your first visit, please bring your CDCP member card or welcome letter from Sun Life, government-issued photo ID, a list of current medications, and any radiographs or records from a previous dental office.
CDCP stacks with other coverage in a specific order. If you also have Healthy Smiles Ontario or ODSP dental, Health Canada's guidance is that the CDCP is billed first and the provincial program may cover part of what remains, where coordination is possible. Ontario Works dental and the Ontario Seniors Dental Care Program are handled differently, so ask us and we will confirm before treatment. You cannot stack CDCP on top of a private employer plan; if you have employer coverage, you are not eligible for CDCP. To start care or ask a question, call us at (519) 451-4490 or email info@fairmontdental.ca.
