Guides
Canadian Dental Care Plan Eligibility: Proof of Coverage You Must Show
Canadian Dental Care Plan eligibility proof of coverage: what applicants provide, the four rules, and the proof you show in a review and at the dentist.
What to take away
- Canadian Dental Care Plan eligibility proof of coverage comes down to three moments: what you provide when you apply, the proof Service Canada can ask for in a review, and what you show your dental provider.
- You must meet all four requirementsno access to private dental insurance or coverage, a tax return filed in Canada, adjusted family net income below the federal limit, and Canadian residence for tax purposes.
- The application asks for information, not a bundle of documents. Proof is requested later, when what you attested does not match your T4 or T4A slips.
- At your first appointment you show your CDCP member ID, a piece of identification, your coverage start date and your co-payment level.
What you provide when you apply
Canada.ca lists what you need for each applicant, yourself and any dependants, and for your spouse or common-law partner if you have one:
- Social Insurance Number (SIN), if available for children
- date of birth
- full name
- home and mailing address
- a list of dental coverage through government social programs, if applicable
You and your spouse or common-law partner must also have filed your tax returns in Canada and be Canadian residents for tax purposes, so that your full family income can be assessed. There is no fee to apply or renew.
Income limit and co-payment level
Your tax return is the income proof. Under the CDCP income requirement, your adjusted family net income must be less than $90,000: your family net income from line 23600, minus any UCCB and RDSP income (lines 11700 and 12500), plus any UCCB and RDSP amounts repaid (lines 21300 and 23200).
The same figure sets the co-payment level by income shown in your confirmation letter. Lower than $70,000: the CDCP covers 100% of eligible costs at its established fees, with no co-payment. Between $70,000 and $79,999: it covers 60%, and your co-payment is 40%. Between $80,000 and $89,999: it covers 40%, and your co-payment is 60%.
You may also pay extra when a provider charges more than the CDCP fee, so ask about costs before treatment.
How provincial health coverage gaps change your proof
Some provinces run their own dental programs for children, seniors, or low income adults. Coverage of dental services through a provincial, territorial or federal government social program does not make you ineligible: you could still qualify, and the plans may coordinate your coverage so that nothing is paid twice. That is why the application asks you to list it. A provincial health card that covers doctor visits but not dental gives no dental coverage, so there is nothing to list for it.
Read provincial health coverage gaps to see why the same age and income can produce different answers.
The role of the Canada Dental Benefit vs CDCP
The Canada Dental Benefit was a temporary payment for children under 12. It ended when the CDCP began. When you apply for the CDCP, you do not need to prove you received the Canada Dental Benefit. What you do have to confirm is that you have no access to private dental insurance or coverage.
Keep your Canada Dental Benefit records. They are not proof of CDCP eligibility, but they can help trace your dental history.
The proof that matters: no access to private dental coverage
You cannot have access to private dental insurance or coverage, including health spending accounts that cover dental costs, through your work or pension plan, a family member's work or pension plan, a professional or student organization, or insurance you or a family member bought. It counts even if you never used it or chose not to enrol.
Before you attest, check the tax slips in your household: box 45 on a T4 if you work, box 015 on a T4A if you receive a pension. A 1 means the plan reported no access; a 2, 3, 4 or 5 means you were offered some kind of dental coverage for you and your family. If a code looks wrong, contact the employer or pension plan administrator to confirm or correct it before you apply.
If you are selected for review, the letter asks for documents from your or your spouse's or common-law partner's work or pension plan showing that you do not have access to private dental coverage. If you believe you do not have access, contact the employer or pension plan administrator that reported it to provide that proof, and send it by email or mail before the deadline in the letter.
Proof of coverage at the dentist
Once you are enrolled, the confirmation letter from Service Canada gives your CDCP plan number, member ID, benefit coverage start date and co-payment level. Sun Life then mails a welcome package with your physical member card. You do not need to wait for the card: at your first appointment, provide your CDCP member ID, a piece of identification, your coverage start date and your co-payment level. Do not book before your start date, and confirm your coverage is active at every appointment.
Step by step: assembling your CDCP application
- Check the four requirements, using line 23600 of your and your spouse's or partner's tax returns for family net income.
- Check box 45 of each T4 and box 015 of each T4A.
- Gather each applicant's SIN, date of birth, name and address, and list any government dental program coverage.
- Apply online through My Service Canada Account or Canada.ca, or call Service Canada at 1-833-537-4342.
Example: A partial provincial health card
Suppose your provincial health card covers doctor visits but not dental, and your employer offers a dental plan you never joined. The health card does not matter: it gives no dental coverage. The employer plan does. Being offered it counts as access, so you do not qualify, and your T4 would normally show a code from 2 to 5 in box 45.
Getting records and appealing a decision
If you need a government record, for example a copy of a federal file, the access to information process sets out how to request it. Canada.ca access to information explains the steps.
The federal Access to Information Act sets out the time limits for those requests. Access to Information Act gives the full legal text.
For the CDCP itself, eligibility can be reviewed at any time after enrolment. Service Canada notifies you by mail, and the letter sets out the next steps and how to confirm your eligibility. Anyone declared ineligible is removed and may have to repay the Government of Canada for services the plan paid while they were ineligible.
