Canadian Dental Care Plan Consent Form

Introduction

The Canadian Dental Care Plan (CDCP) is a federal government program designed to provide coverage for Canadian residents who do not have dental benefits and have a household income of less than $90,000 a year. It is important to understand that the CDCP is a government dental benefit and not a free dental program, which means you might still have an out-of-pocket expense. The CDCP is managed by Health Canada and administered by Sun Life, and dentists are not involved in determining eligibility or covered services. Before you visit our dental office as a CDCP patient, we ask that you review and sign the following consent form. If you have any questions, please contact us.

How The CDCP Works

As a CDCP member, you will receive a welcome package from Sun Life within 3 months of completing your application. This package will include coverage details, a member card, and an effective coverage start date. Please note that the CDCP will not reimburse you for services received before the start date.

Before scheduling a visit at Atlas Dental, please contact our dental office to verify your eligibility for covered services under the CDCP. We will strive to send pre-determinations to verify your eligibility for these procedures whenever possible to mitigate unexpected out-of-pocket expenses.

There may be a co-payment requirement based on your adjusted family net income, as outlined in the provided chart. Please be prepared to cover any applicable co-payment using acceptable forms of payment, including cash, debit, credit card (Visa, Mastercard accepted), or e-transfer.

Balance Billing

Dentists have the option to bill their usual and standard fees. At Atlas Dental, our fees are consistent with the Ontario Dental Association Fee Guide. However, fees under the CDCP Benefit Grids are lower than our customary fees, sometimes up to 30%. This means that you would be responsible for covering the difference, which is known as “balance billing”, in addition to any applicable CDCP co-payment.

Services Covered By CDCP And Pre-Authorizations

The CDCP covers a range of preventative and basic services, including preventive, diagnostic, restorative, endodontic, prosthodontic, periodontal, and oral surgery services. Some services may require preauthorization, and frequency restrictions and limitations may apply. Authorization from Health Canada takes into consideration your oral health history and medical conditions. 

Services that are not covered under CDCP, or rejected for authorization by Health Canada under the auspices of the CDCP, may be rendered by your dentist at Atlas Dental under our usual and customary ODA fee guide as an out-of-pocket expense.

The full list of services under Schedules A and B can be found here. 

Services requiring preauthorization (Schedule B services) will be available starting in November 2024. 

Orthodontic services that would improve oral health outcomes for eligible clients will become available beginning in 2025.

Collection of Your Private Health Information By Health Canada

By participating in the CDCP, you consent to the collection of your health information by Sun Life on behalf of Health Canada for CDCP purposes, under the authority of the Government of Canada’s Department of Health Act and will be handled in accordance with the Privacy Act.

Additional documentation or CDCP client records may be asked by Sun Life on behalf of Health Canada to support a claim. Examples of documentation that could be requested include:  

• CDCP client chart/records 
• CDCP client radiographs / photographs
• Daily appointment records / Evidence of financial transactions 
• Laboratory invoices / receipts 
• Evidence of additional coverage (e.g., coordination of benefits)

Non-Participation With Other Public Dental Care Progarms

Please note that Atlas Dental not currently participate or coordinate benefits with the following public dental care programs:

• Ontario Works
• Healthy Smiles Ontario
• Ontario Disability Support Program
• Ontario Seniors Dental Care Program

Terms Of The Program Are Subject To Change

Please be aware that the terms and conditions of the CDCP may change at any time by Health Canada, potentially affecting your eligibility for dental procedures and Atlas Dental’s participation in the program. Atlas Dental reserves the right to exit the CDCP at any time. You will be informed of any changes.

Additional Resources About CDCP

For more information about about the Canada Dental Care Plan, feel free to contact us at Atlas Dental or visit these online resources:

• Ontario Dental Association CDCP Frequently Asked Questions
• 2023 CDCP Dental Benefit Grid from Sunlife
• Government of Canada information page about CDCP