3. Learn how much is covered - Steps to Justice

The Canadian Dental Care Plan (CDCP) covers a maximum amount for each service included in the plan.  

If a dental professional charges more than the CDCP maximum and you do not have dental benefits through the Ontario Disability Support Program (ODSP) or Health Smiles Ontario (HSO), you have to pay the difference. For example, if your dentist charges $150 for a general oral examination, the CDCP will only cover $133.59. You have to pay the balance of $16.41. 

Make sure that you do not pay for the portion of dental services that's covered by the CDCP. Your dental professional sends that part of the claim directly to Sun Life Insurance. If you pay the full amount, Sun Life will not pay you back. 

Co-payment

You may also have to pay a co-payment if your is over a certain amount. A co-payment is when the CDCP pays a percentage of the cost and you pay the rest.

If your family net income is:	The CDCP covers:
Less than $70,000	100%
Between $70,000 and $79,999	60%
Between $80,000 and $89,999	40%

 Before making your appointment with a dental professional, you should ask:  

if they're part of the CDCP, 
if the service is covered by the CDCP, and 
how much the service costs.

If you're covered by Ontario's dental programs

If you have dental benefits through ODSP or HSO you can still qualify for the CDCP. Your coverage is co-ordinated between the 2 plans. This means that if the CDCP cannot cover the full cost of the service, your other benefit will cover the difference, up to a certain amount.  

If both dental benefits combined do not cover the cost, you do not have to pay the rest.  

For example, if your dental professional charges $35.00 for 0.5 units of polishing: 

CDCP covers: $8.75  
ODSP or HSO covers: $12.67
Total covered: $21.42

Your dental professional cannot charge you the remaining $13.58.  