Canadian Dental Care Plan eligibility: How do I apply?

On Monday, the federal government unveiled the details of its new Canadian Dental Care Plan, building on the pre-existing Canada Dental Benefit, stating that access to oral health care should not depend on a person’s ability to pay.

While the first iteration of this program was only offered to children, as officials worked behind the scenes to set up the full-fledged national dental care plan, this new insurance program will be accessible for up to nine million low-income uninsured Canadians of all ages once completely up and running in 2025, the government estimates.

To implement this public program, the federal government has committed $13 billion over five years, starting this year, and is budgeting $4.4 billion annually from there. But there’s lots of nuance to this big announcement, including how and when Canadians can access this support.

Here’s what you need to know.

WHO IS ELIGIBLE?

In order to qualify for the Canadian Dental Care Plan (CDCP), you have to meet the following criteria:

• Have to be a Canadian resident with no access to dental insurance;
• Have an adjusted family net income of less than $90,000; and
• Have filed your tax return for the previous year.

According to the government, Canadian residents with access to a provincial or territorial dental benefit program are eligible. “In that case, coverage will be coordinated to ensure no duplication and avoid gaps in oral health care,” the government’s information page states.

The Canadian government will consider not having access to dental insurance to mean:

• Coverage is not available through your employer or a family member’s employer benefits;
• Coverage is not available through your pension or a family member’s pension benefits; or
• Coverage has not been purchased by yourself, a family member or through a group plan.

Eligibility for children under 18 will be determined based on their parent or guardian’s eligibility.

“This is the largest coverage rollout in the history of Canada,” Health Minister Mark Holland said Monday.

For all, eligibility will be reassessed annually.

PHASED ROLLOUT

Given the scope of this new dental plan, and in an effort to have as smooth of an initial rollout as possible, the government has decided to offer access to this new coverage in phases.

First up will be seniors.

Starting in December 2023, applications to enter the program will open for seniors aged 87 and older. Those aged 77 to 86 will have their turn to apply in January 2024. In February, seniors aged 72 to 76 will have access, followed by those aged 70 to 71 in March. Seniors aged 65 to 69 can apply for the program in May.

Then, Canadians with a valid Disability Tax Credit certificate, as well as children under the age of 18, can start applying as of June 2024.

All remaining eligible Canadians are scheduled to gain access in 2025.

HOW WILL APPLICATIONS WORK?

Broadly, as Citizens’ Services Minister Terry Beech said Monday, Canadians don’t need to do anything yet other than make sure they have filed their taxes.

To start, seniors who may be eligible will receive letters in the mail inviting them to apply through Service Canada, with information about how to verify their eligibility and apply by telephone via an automated Interactive Voice Response system.

“This letter will include a personalized application code and instructions on how to apply,” according to background information provided to reporters on Monday.

How do you know if you should keep an eye out for one of these letters? If you are or will be 70 years old as of March 31, 2024; if you meet the income threshold based on your 2022 tax filing; and if you were a Canadian resident for tax purposes that year.

Applicants going through the telephone process will be notified immediately whether they are eligible and if their application has been accepted.

The first online applications — through a yet-to-be-created portal — will be accepted as of May 2024 for the age groups allowed to apply by then. Once this online system is up and running, it will be how all future applications are accepted.

Parents and caregivers who are already using the “Canada Dental Benefit” system can continue to use that Canada Revenue Agency-run application process, until their turn comes to tap in to the expanded system as of June 2024. Here’s some more information on this existing benefit program.

WHAT WILL BE COVERED?

According to the government, “a wide range of oral health care services will be covered,” including preventative dental procedures such as cleanings, polishing and fluoride treatments.

Diagnostic services such as exams and X-rays, as well as more involved procedures such as cavity fillings, dentures and root canals, are also expected to be covered.

The expectation is that through the CDCP, oral health providers will directly bill to the federal plan being operated by Sun Life, rather than make patients first pay out-of-pocket and seek a refund after the fact.

Though, not all applicants will be eligible for 100 per cent coverage.

The CDCP will reimburse a percentage of eligible expenses, depending on applicants’ income level, with the remainder being a copay with the patient. For example:

• Canadians with an adjusted annual family net income of less than $70,000 will have no copayment;
• Canadians with an adjusted annual family net income between $70,000 and $79,999 will have a 40 per cent copayment; and
• Canadians with an adjusted annual family net income between $80,000 and $89,999 will have a 60 per cent copayment.

“A 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,” reads the government’s information page.

WHEN WILL COVERAGE START?

If you’ve read through and are now wondering when you can start making claims for dental care, you may want to hold off on planning to have any upcoming appointments covered.

While the start date to access this system will depend on when you’re eligible to apply and the completion of your enrolment, seniors in the program will be able to see an oral health provider “as early as May 2024.”

Once Service Canada has deemed an applicant eligible, their information will be shared with the insurance company. Sun Life will then handle the enrolment and notification of Canadians on their specific coverage start date, details of their plan and accompanying member card via a welcome package.

“Your coverage will begin on the date provided in the welcome package you receive from Sun Life. Appointments with an oral health provider should be scheduled as of that date, and no sooner, for the eligible oral health care services to be covered under the plan,” reads the government’s information page. “The CDCP will not reimburse you for oral health care services received before the start date.”

Lastly, when the time comes to make an appointment, Canadians will have to ask their oral health-care provider if they have enrolled in the federal plan, as there are also requirements for dentist and hygienists to opt in.

 

Source link