Canada's dental plan now allows claim-by-claim reimbursement to increase provider participation
The federal government is adjusting its dental care program, the Canadian Dental Care Plan (CDCP), to attract more providers, as reported by CTV News.
Since its launch, 11,800 dental care providers have signed up with Sun Life Financial. To increase this number, Ottawa now allows providers to seek reimbursement from Sun Life on a claim-by-claim basis, rather than requiring formal program enrollment.
Health Minister Mark Holland, speaking in Dartmouth, explained that many dental professionals had “bad experiences” with previous programs and sought a more flexible participation method. Holland hopes this change will boost the number of dentists accepting CDCP patients.
“One of the things I hear is that, you know, they have been burned by other programs, that they didn't have positive experiences,” Holland said.
“Making sure that they see and feel that this program is really listening to them and is responding to their needs and is there for them, is a fair partnership, is extremely important.”
Previously, clients seeking CDCP coverage could only visit providers listed on the insurance company’s website. Officials believe the new approach will simplify access to preferred dentists.
“There are providers, and we wanted to listen to them, who had concerns about the need to sign up formally to Sun Life but wanted to see CDCP clients,” said a Health Canada official during a technical briefing. “As of today, they can submit a claim and it will be processed by Sun Life.”
The first phase of the $13bn program began on May 1, targeting seniors 70 and over. Health Canada reports that over two million eligible individuals have been approved for coverage, with nearly 250,000 seniors receiving treatment.
Eligibility has since expanded to include seniors 65 and over, adults with a valid Disability Tax Credit (DTC) certificate, and children under 18. Health Canada has received just under 10,000 applications from DTC certificate holders and nearly 25,000 applications for children under 18.
Ottawa plans to expand eligibility further in 2025.
While the program has garnered support from dentists, denturists, dental hygienists, and dental specialists, some have raised concerns about eligibility criteria and the billing arrangement with Sun Life.
