Canadian Dental Care Plan – Form

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Eligibility requirements

To qualify for the CDCP, you must meet all 4 of these requirements:

Consent(Required)

You don’t have access to dental insurance(Required)

What does this mean?
It means you do not have access to any type of dental insurance or coverage through:

• your employment benefits or a family member’s employment benefits, including health and wellness accounts

• a professional or student organization
-- Note: If you’re eligible for dental coverage through your employment benefits or through a professional or student organization, you’re not eligible for CDCP. This is true even if:
---- you decide not to take it
---- you have to pay a premium for it
---- you don’t use it

• your pension benefits or a family member’s pension benefits
-- this includes federal, provincial and territorial government employer pension plans
-- Exception: You may be eligible for the CDCP if you’re retired and:
---- you opted out of pension benefits before December 11, 2023, and
---- you can’t opt back in under the pension rules

• coverage bought by you or a family member or through a group plan from an insurance or benefits company
-- if you purchased your current dental insurance policy privately (and not as part of any of the coverage described above), you’re not eligible for the CDCP while that coverage is in effect.

Consent(Required)

You and your spouse/common-law-partner (if applicable) must have filed your tax returns in Canada so that your family income can be assessed for the previous year(Required)

What if my spouse/common law partner is not in Canada?
If you have a spouse or common-law partner that is not living in Canada and does not file their tax return in Canada, you will not be eligible for the CDCP.

Consent(Required)

Your adjusted family net income is less than $90,000(Required)

What is adjusted family net income?
Your family net income (line 23600 of your tax return plus line 23600 of your spouse's or common-law partner's tax return)

(-) Any universal child care benefit (UCCB) and registered disability savings plan (RDSP) income received (line 11700 and line 12500 of your or your spouse's or common-law partner's tax return)

(+) Any UCCB and RDSP amounts repaid (line 21300 and line 23200 of your or your spouse's or common-law partner's tax return)

(=) Adjusted family net income

Consent(Required)

You’re a Canadian resident for tax purposes(Required)

If you have dental coverage through a provincial, territorial or federal government social program, you can still qualify for the CDCP. If you qualify, your coverage will be coordinated between the plans to make sure there are no duplication or gaps in coverage.

Before continuing, you must confirm that you meet all four eligibility criteria. You should only proceed to the next step if you fully qualify.
If you continue and complete the application while not meeting one or more of the required criteria, you are providing false information.

If you provide false information on your application, you and your family may be removed from the plan.

If you were not eligible for the CDCP, you may be required to repay the full cost of any services received.

Initial information

Do you already have Canadian Dental Care Plan coverage and want to renew it?(Required)

Yes

Have you, and if applicable, your spouse or common-law partner, filed your tax return for 2024 in Canada and received your Notice of Assessment?(Required)

Yes

You are not eligible to apply for the Canadian Dental Care Plan at this time

Type of application

Who are you applying for?(Required)

I am applying for myself

I am applying for my child(ren)

I am applying for myself and my child(ren)

Applicant information

Please provide your legal name as indicated on your Social Insurance Number (SIN) card or letter. We'll use the information you provide to verify your identity. Any information that does not match the information on your SIN record may cause a delay in the processing of your application.

If you have one legal name:

If using one legal name, please enter that name in BOTH the first name and last name fields.

First name(Required)

Last name(Required)

Date of birth (mm/dd/yyyy)(Required)

Month

Day

Year

(month-day-year)

Social Insurance Number (SIN)(Required)

Enter the 9-digit SIN

Marital status

What is your current marital status?(Required)

Single

Married

Common-Law

Separated

Divorced

Widowed

Spouse or common-law partner information

Provide information on your current spouse or common-law partner as indicated on their Social Insurance Number (SIN) card or letter.

The information is required to calculate your adjusted family net income. Your spouse or common-law partner must submit their own application for the Canadian Dental Care Plan.

Social Insurance Number (SIN)(Required)

Enter the 9-digit SIN

Date of birth (mm/dd/yyyy)(Required)

Month

Day

Year

(month-day-year)

Consent(Required)

I confirm that my spouse or common-law partner is aware and has agreed to share their personal information.(Required)

Mailing address

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Include apartment number (if applicable), street number, street name. For example: 123 Main St. Suite 4B

Is your mailing address the same as your home address?(Required)

Yes

Home address

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Include apartment number (if applicable), street number, street name. For example: 123 Main St. Suite 4B

Phone Number

Adding a phone number helps the Government of Canada contact you if there is an issue with your application. Otherwise, we'll contact you by mail.

Phone number (optional)

Alternate phone number (optional)

Communication

Email(Required)

Enter Email Confirm Email

What is your preferred official language of communication?(Required)

English

French

Access to private dental insurance

What does it mean to have access to private dental insurance or coverage?

It means you do not have access to any type of dental insurance or coverage through:

your employment benefits or a family member's employment benefits, including health and wellness accounts
a professional or student organization
Note: If you're eligible for dental coverage through your employment benefits or through a professional or student organization, you're not eligible for CDCP. This is true even if:
- you decide not to take it
- you have to pay a premium for it
- you don't use it
your pension benefits or a family member's pension benefits
- this includes federal, provincial and territorial government employer pension plans
- Exception: You may be eligible for the CDCP if you're retired and:
  - you opted out of pension benefits before December 11, 2023, and
  - you can't opt back in under the pension rules
coverage bought by you or a family member or through a group plan from an insurance or benefits company
- if you purchased your current dental insurance policy privately (and not as part of any of the coverage described above), you're not eligible for the CDCP while that coverage is in effect.

Do you have access to private dental insurance or coverage?(Required)

Yes, I have access to dental insurance or coverage

No, I do not have access to dental insurance or coverage

Access to other government dental benefits

Access to dental coverage through a provincial, territorial or federal government social program will not impact your eligibility for the Canadian Dental Care Plan. If you meet all the eligibility criteria, your coverage will be coordinated between the plans to ensure there are no gaps or duplication in coverage.

Do you have other dental benefits through a federal, provincial or territorial social program other than the Canadian Dental Care Plan?(Required)

Yes, I have federal, provincial or territorial dental benefits

No, I do not have federal, provincial or territorial dental benefits

Access to other federal, provincial or territorial dental benefits

Federal benefits

Do you have other dental benefits through a federal social program other than the Canadian Dental Care Plan?(Required)

Yes, I have federal dental benefits

No, I do not have federal dental benefits

Please select which social program you are covered under. If you have more than one, please select the one you use most.(Required)

Correctional Service Canada Health Services

First Nations Health Authority (FNHA)

Interim Federal Health Program for asylum seekers or refugee claimants

Non-Insured Health Benefits Program by Indigenous Services Canada

Veterans Affairs Canada (VAC) Dental Services Program

Provincial or territorial benefits

Do you have other dental benefits through a provincial or territorial social program other than the Canadian Dental Care Plan?(Required)

Yes, I have provincial or territorial dental benefits

No, I do not have provincial or territorial dental benefits

If yes, through which province or territory?(Required)

Please select which social program you are covered under. If you have more than one, please select the one you use most.(Required)

Alberta Adult Health Benefit

Alberta Child Health Benefit

Assured Income for the Severely Handicapped (AISH)

Child Intervention Services

Dental and Optical Assistance for Seniors

Family Support for Children with Disabilities

Income and Employment Supports

Supports for Permanency (Orthodontic)

Please select which social program you are covered under. If you have more than one, please select the one you use most.(Required)

At Home Program

BC Employment and Assistance (BCEA) Program, including Disability Assistance and Income Assistance

Children in Care and Youth Agreements – Post Majority

Healthy Kids Program

Please select which social program you are covered under. If you have more than one, please select the one you use most.(Required)

Dental services for Employment and Income Assistance (EIA) and Manitoba Supports for Persons with Disabilities (MSPD)

Please select which social program you are covered under. If you have more than one, please select the one you use most.(Required)

Health Services Dental Program

Healthy Smiles Clear Vision

Please select which social program you are covered under. If you have more than one, please select the one you use most.(Required)

Adult Dental Program

Children’s Dental Health Program

Income Support Program

Low-income (Access) Program

Please select which social program you are covered under. If you have more than one, please select the one you use most.(Required)

Extended Health Benefits

Métis Health Benefits

Please select which social program you are covered under. If you have more than one, please select the one you use most.(Required)

Children’s Oral Health Program

Cleft Palate-Craniofacial Program

Disability Support Program (DSP)

Employment Support and Income Assistance (ESIA)

Individuals with Special Needs Oral Health Program

Maxillofacial Prosthodontics Program

Oral and Maxillofacial Surgery Program

Please select which social program you are covered under. If you have more than one, please select the one you use most.(Required)

Extended Health Benefits (EHB)

Please select which social program you are covered under. If you have more than one, please select the one you use most.(Required)

Healthy Smiles Ontario (HSO)

Ontario Disability Support Program (ODSP)

Ontario Seniors Dental Care Program (OSDCP)

Ontario Works (OW)

Please select which social program you are covered under. If you have more than one, please select the one you use most.(Required)

Cleft Palate Orthodontic Funding Program

The Provincial Dental Care Program

Please select which social program you are covered under. If you have more than one, please select the one you use most.(Required)

Quebec Health Insurance Board (QHIB) - Dental services - Children under age 10

Quebec Health Insurance Board (QHIB) - Dental Services - recipients of a financial assistance program with claim slip and their dependants

Please select which social program you are covered under. If you have more than one, please select the one you use most.(Required)

Family Health (FH) Benefits

Supplementary Health (SH) Benefits

Please select which social program you are covered under. If you have more than one, please select the one you use most.(Required)

Extended Health Care Benefits for Seniors

Yukon Children’s Dental Program

Yukon Dental Program

Child(ren)'s application

In this section you will add your child(ren) to the application.

You can apply for your child if:

You're a parent or legal guardian
You're over 16 years old
Your child is under 18 years old

Provide the child's legal name as indicated on their Social Insurance Number (SIN) card or letter, or other government documentation.

Child First name(Required)

Child Last name(Required)

Child Date of birth (mm/dd/yyyy)(Required)

Month

Day

Year

(month-day-year)

Does this child have a Social Insurance Number (SIN)?(Required)

Yes, enter the child's 9-digit SIN

No, this child does not have a SIN

Child Social Insurance Number (SIN)(Required)

Enter the 9-digit SIN

Consent(Required)

I confirm that I am the parent or legal guardian of this child and I consent to this application being submitted.(Required)

Does your child have access to private dental insurance?

What does it mean to have access to private dental insurance or coverage?

It means the child has access to any type of dental insurance or coverage through:

a parent or legal guardian's employment benefits, including health and wellness accounts
a professional or student organization
Note: If the child is eligible for dental coverage through a parent or legal guardian's employment benefits, or through a professional or student organization, they're not eligible for the CDCP. This is true even if:
- you decide not to take it
- you have to pay a premium for it
- you don't use it
a parent or legal guardian's pension benefits
- this includes federal, provincial and territorial government employer pension plans
- Exception: The child may still be eligible if a parent or legal guardian is retired and:
  - opted out of pension benefits before December 11, 2023, and
  - can't opt back in under the pension rules
coverage bought by a parent or legal guardian through a group plan from an insurance or benefits company.
- if a parent or legal guardian purchased the child's current dental insurance policy privately (and not as part of any of the coverage described above), the child is not eligible for the CDCP while that coverage is in effect.

Does your child have access to private dental insurance or coverage?(Required)

Yes, this child has access to dental insurance or coverage

No, this child does not have access to dental insurance or coverage

Does your child have access to other government dental benefits?

Access to dental coverage through a provincial, territorial or federal government social programs will not impact the child's eligibility for the Canadian Dental Care Plan. If the child meets all the eligibility criteria, their coverage will be coordinated between the plans to ensure there are no gaps or duplication in coverage.

Does your child have other dental benefits through a federal, provincial or territorial social program other than the Canadian Dental Care Plan?(Required)

Yes, this child has federal, provincial or territorial dental benefits

No, this child does not have federal, provincial or territorial dental benefits

Does your child have access to other federal, provincial or territorial dental benefits?

Access to dental coverage through a provincial, territorial or federal government social program will not impact the child's eligibility for the Canadian Dental Care Plan. If the child meets all the eligibility criteria, their coverage will be coordinated between the plans to ensure there are no gaps or duplication in coverage.

Federal benefits

Does your child have other dental benefits through a federal social program other than the Canadian Dental Care Plan?(Required)

Yes, this child has federal dental benefits

No, this child does not have federal dental benefits

Please select which social program this child is covered under. If this child has more than one, please select the one you use most.(Required)

Correctional Service Canada Health Services

First Nations Health Authority (FNHA)

Interim Federal Health Program for asylum seekers or refugee claimants

Non-Insured Health Benefits Program by Indigenous Services Canada

Veterans Affairs Canada (VAC) Dental Services Program

Provincial or territorial benefits

Does your child have other dental benefits through a provincial or territorial social program other than the Canadian Dental Care Plan?(Required)

Yes, this child has provincial or territorial dental benefits

No, this child does not have provincial or territorial dental benefits

If yes, through which province or territory?(Required)

Please select which social program this child is covered under. If this child has more than one, please select the one you use most.(Required)

Alberta Adult Health Benefit

Alberta Child Health Benefit

Assured Income for the Severely Handicapped (AISH)

Child Intervention Services

Dental and Optical Assistance for Seniors

Family Support for Children with Disabilities

Income and Employment Supports

Supports for Permanency (Orthodontic)

Please select which social program this child is covered under. If this child has more than one, please select the one you use most.(Required)

At Home Program

BC Employment and Assistance (BCEA) Program, including Disability Assistance and Income Assistance

Children in Care and Youth Agreements – Post Majority

Healthy Kids Program

Please select which social program this child is covered under. If this child has more than one, please select the one you use most.(Required)

Dental services for Employment and Income Assistance (EIA) and Manitoba Supports for Persons with Disabilities (MSPD)

Please select which social program this child is covered under. If this child has more than one, please select the one you use most.(Required)

Health Services Dental Program

Healthy Smiles Clear Vision

Please select which social program this child is covered under. If this child has more than one, please select the one you use most.(Required)

Adult Dental Program

Children’s Dental Health Program

Income Support Program

Low-income (Access) Program

Please select which social program this child is covered under. If this child has more than one, please select the one you use most.(Required)

Extended Health Benefits

Métis Health Benefits

Please select which social program this child is covered under. If this child has more than one, please select the one you use most.(Required)

Children’s Oral Health Program

Cleft Palate-Craniofacial Program

Disability Support Program (DSP)

Employment Support and Income Assistance (ESIA)

Individuals with Special Needs Oral Health Program

Maxillofacial Prosthodontics Program

Oral and Maxillofacial Surgery Program

Please select which social program this child is covered under. If this child has more than one, please select the one you use most.(Required)

Extended Health Benefits (EHB)

Please select which social program this child is covered under. If this child has more than one, please select the one you use most.(Required)

Healthy Smiles Ontario (HSO)

Ontario Disability Support Program (ODSP)

Ontario Seniors Dental Care Program (OSDCP)

Ontario Works (OW)

Please select which social program this child is covered under. If this child has more than one, please select the one you use most.(Required)

Cleft Palate Orthodontic Funding Program

The Provincial Dental Care Program

Please select which social program this child is covered under. If this child has more than one, please select the one you use most.(Required)

Quebec Health Insurance Board (QHIB) - Dental services - Children under age 10

Quebec Health Insurance Board (QHIB) - Dental Services - recipients of a financial assistance program with claim slip and their dependants

Please select which social program this child is covered under. If this child has more than one, please select the one you use most.(Required)

Family Health (FH) Benefits

Supplementary Health (SH) Benefits

Please select which social program this child is covered under. If this child has more than one, please select the one you use most.(Required)

Extended Health Care Benefits for Seniors

Yukon Children’s Dental Program

Yukon Dental Program

Canadian Dental Care Plan assistance, management and processing service.

Credit or Debit Card(Required)

Cardholder Name

Card Details

Application type:	Canadian Dental Care Plan
Processing time:	Up to 30 business days
Total	$95 CAD ≈ $69 USD

ⓘ This price includes online application management, information preparation and full assistance throughout the process. Once your application has been submitted, no further action is required from you. The Government of Canada will send you a letter by post within the next 30 business days to inform you whether you qualify for the Canadian Dental Care Plan. You will also be able to check the status of your application online at any time using the application code that we will email to you once your request has been processed.

Consent(Required)

I have read, understood and accept the privacy policy and the terms and conditions. I also authorise acting on my behalf with the relevant authority to process my request(Required)

By proceeding with this application, you are agreeing to attest truthfully to the information provided.

If you provide false information on your application, you and others you applied for may be removed from the plan.

If you or your family members were not eligible to apply, you or your family member may have to repay the full cost of care received through the Canadian Dental Care Plan.