Jeremy’s Guide to the Canada Dental Benefit (Part III)

In this last blog post kicking off the Canada Dental Benefit, we are going over some Frequently Asked Questions. These questions were from a webinar held by the Federal Government for dental offices across Canada. Here they are, sorted with the most popular questions at the top! (In my opinion, that means the most interesting questions are at the bottom, because they are more unique!)

During this webinar, government representatives did note that these questions are helping them think about how they are designing the long-term dental program in Canada. The Canada Dental Benefit really is a cash-in-hand benefit to parents with children under the age of 12 (who meet the eligibility criteria).

And if you are just joining us now, feel free to jump back to Part I or Part II for the basics of the program.

(Q01) Will the Federal Canada Dental Benefit change eligibility for any of the provincial dental programs? Is there any co-ordination of benefits between them? Which program will be the payor of last resort?

(A) There is no impact of the Canada Dental Benefit on existing provincial programs. Should a parent have to pay out-of-pocket expenses that are not covered by a provincial program, they can apply for the benefit (if they meet the eligibility criteria).

(Q02) What is required by the dental office for patients who receive benefits from this plan?

(A) The benefit is really putting money in the hands of parents, allowing them to pay for oral health care for their child. It doesn’t really change anything for the dental office.

(Q03) Does this benefit have its own fee guide, or does the office continue to charge the regular provincial fee guide?

(A) This benefit puts money directly in the hands of parents. Nothing changes on the office side of things. Offices maintain their regular fees.

(Q04) Can the dental office take assignment directly from the CRA, or does it accept payment upfront from the patient?

(A) No, this is a benefit for eligible families, to benefit their children’s oral health. To make it easier, families are able to apply for the benefit first, receive the payment, and then get treatment done by the dental office.

(Q05) How will this benefit affect those who are already on a provincial program (like Healthy Smiles in Ontario)?

(A) The Healthy Smiles program remains in effect. If parents have any additional out-of-pocket expenses, they can apply for the Canada Dental Benefit program as well.

(Q06) Is there a way for an office to check eligibility after the family/child has applied?

(A) The Federal Government has taken ownership of validating eligibility. Dental offices don’t have any further requirements. This is a direct benefit to the taxpayer, and any eligibility verification is between the CRA and the applicant, not with the oral healthcare provider.

(Q07) What documentation will parents have for providing the dental clinic with proof of eligibility? Will they receive a benefits card?

(A) There is no benefit card or proof of eligibility. Parents receive direct payment from the Federal Government to pay for oral health expenses.

(Q08) Will patients be expected to pay upfront and be responsible for reimbursement on their own? Or are we expected to allow patients to walk away with their bill and apply for this benefit, then return to pay the clinic?

(A) The eligible parent has the choice whether to apply for the benefit before or after the appointment. If they choose to, the parent can apply for the benefit, receive it, and then take the child in for treatment and pay at the time of service. Receiving payment for the benefit can take up to 10 business days by cheque (or 5 business days if the parent is registered for direct deposit).

(Q09) Is there a brochure the dental practice can provide to patients for this, showing where to apply for the benefit?

(A) Yes, there is a toolkit.

Jeremy’s note: We added the toolkit to the website in Part II of this series. Click here to access it.

(Q10) Can the money be used at any office for any type of treatment?

(A) The money can be used by parents to pay for treatment for their child at any regulated oral health professional.

(Q11) Will the federal plan co-ordinate with Ontario and other provinces to allow co-ordination of benefits on covered procedures?

(A) This is a temporary, interim benefit for a period of 2 years, until the government develops a more long-term program. It’s a fixed benefit, provided to parents. It doesn’t affect provincial programs. As long as the parent has out-of-pocket expenses, they can apply for the Canada Dental Benefit.

(Q12) How does this impact indigenous individuals who are eligible for dental benefits through the NIHB program? What considerations have been given to ensure that this program is not increasing the oral health inequity gap that already exists in Canada?

(A) Any families who have out-of-pocket expenses not covered by the NIHB program can apply for the Canada Dental Benefit, so long as they meet the eligibility criteria.

(Q13) Can a qualifying family with more than one child pool the total benefit allocated for each child, and utilize the benefit to the children whose dental needs are greatest?

(A) No, the benefit is intended to be used per child, per period.

(Q14) Patients pay us for their dental treatment. How long until the patient gets reimbursed from the government? What if the patient does not have the funds to pay up-front?

(A) As long as services are being done during the benefit period, parents can apply for the benefit prior to attending the appointment. There is flexibility for parents. If they have a treatment plan, they can get the benefit before having the treatment done.

(Q15) What is specifically covered under this dental plan? Specifically, are crowns, braces, or other treatments which are sometimes considered “cosmetic” covered?

(A) Any treatment covered by a regulated oral health care professional is covered. It really is cash in the hand of parents for oral health care services of a child under 12.

(Q16) What about new immigrants or refugees who have not filed income taxes? How can they apply?

(A) You must be a recipient of the Canada Child Benefit (CCB) in order to be eligible for the Canada Dental Benefit. We recognize that some newcomers or immigrants might not be eligible. They can apply for the CCB and provide a statement of income. It will be a bit of a process for them to go through before applying for the benefit.

(Q17) Will the dental benefit be extended to seniors and teens in 2023?

(A) The Canada Dental Benefit is an interim benefit, while we are waiting to build a longer-term program. The Federal Government wants to make that available to Canadians earning less than $9,000 in income by 2025. The legislation for the Canada Dental Benefit is only for kids under age 12.

(Q18) Will children be eligible if they have private dental insurance which does not provide 100% coverage? For example, if coverage is 50% and parents are responsible for the other half?

(A) Within the eligibility criteria, if a child has private dental benefits, they would not be eligible for the Canada Dental Benefit.

(Q19) If a patient is eligible for a certain amount, and doesn’t utilize that full amount, what happens to that balance? For example, if they receive the full $650, but only have $400 of dental work needed?

(A) In that instance, we would encourage parents to seek additional oral health care for their child, or to invest in other oral health care products, such as a high-quality toothbrush.

(Q20) If a parent has a health spending account under which dental hygiene is only one of many services covered, is the child still eligible for the Canada Dental Benefit? If the other services (such as physical therapy, chiropractic, etc.) have used up the HSA, can the parent apply for the Canada Dental Benefit?

(A) A health spending account that is made available by an employer counts as insurance. The criteria that needs to be met isn’t “does my child have private dental benefits or not?” It’s “does my child have access to private dental benefits?” If, through your employer, you have access to a dental health spending account, then you should say no on that part of the application, and you would not be eligible for this benefit.

(Q21) It says on my dental office’s website that we have to book the appointment first, and then the patient’s family is asked to apply. Will the dental office be compensated if the patient does not show up to that appointment?

(A) The general answer here is no. Payment goes directly to the patient. The exception would be if the dental office has a policy in place where the patient must pay for an appointment if they fail to show up for their appointment. Either way, payment goes directly from the CRA to the applicant (not the dental office).

(Q22) If a child requires additional treatment beyond the amount given, is there a way to request additional funding?

(A) Parents and guardians can apply for a child once per benefit period. If a child requires additional oral health care, and if it requires two appointments (and if it can wait), then the parent could apply for that same child during the second benefit period (starting July 2023). If a family is in a bracket lower than $70,000 net income, then they could be eligible up to $650 per child for each benefit period. Because there is more confusion possible here, we would really encourage you to focus on the current benefit period now.

(Q23) What guarantees parents will actually use this money for dental benefits? Can parents cancel the appointment and use the money elsewhere?

(A) We do ask parents to attest that they will be using this money for dental care. Applicants should be prepared to provide proof upon request.

Jeremy’s note: These programs are all built on some level of trust. It’s true that in any system, someone (somewhere, sometime) will abuse the system. At the same time, I try to approach this from a perspective of compassion. These benefits are going to kids who really stand to benefit. Most parents care deeply about their children doing well.

(Q24) When and if private insurance carriers stop offering coverage for children as the Canadian Dental Plan rolls out fully, how does the government plan to deal with the dental care needs of those children previously covered by private insurance?

(A) This is one of those questions that is really focused on a long-term program. We want to make sure that any new program fits into the landscape of existing care. This is a temporary program, it’s directed at children under the age of 12. It’s providing an additional source of cash-in-hand for parents who are already accessing oral health care for their children and who are paying out of pocket. We don’t foresee that there will be any big changes to existing coverage because of this benefit. The government’s focus is on filling the gaps.

(Q25) What is the process for quick approvals for emergency care?

(A) This is really a benefit for the applicant. If you need emergency care for your child, we would encourage you to do that right away and then apply for the benefit. There is no emergency program in place for the benefit itself. If you are on direct deposit, you can see your payment within 5 days.

(Q26) Is the Canada Dental Benefit available for parents with a combined income of $90,000, or is it $90,000 per parent?

(A) The benefit is based on combined net income. For the vast majority of people, it is their individual net income plus the net income of their spouse of common-law partner.

(Q27) Is the benefit renewed automatically or do parents need to re-apply in July 2023?

(A) It does not renew automatically. Parents need to provide dental care for their children. If the child doesn’t need oral health care, then the parent wouldn’t apply. And the child will need to be under the age of 12 on July 1st, 2023 to be eligible for the second benefit period.

(Q28) There is a shortage of dental staff recently, which may cause a delay in treatment. If a child has work done in June and again in July, do they have to reapply because the program dates start again on July 1, 2023?

(A) In this case, the child would be eligible for the benefit during both periods, so long as they are under the age of 12 on July 1, 2023.

(Q29) Given that children of lower socioeconomic status are burdened with poor oral health compared to their cohorts of higher socioeconomic status, has the additional cost of more dental treatment been taken into consideration?

(A) The benefit was calculated based on the average cost of treatment, and is the first step of the Federal Government’s commitment to ensuring children get the oral health care they need. This is something we are considering for the Canada Dental Plan, which will be rolled out in the future.

(Q30) Does this benefit count as income? How is it taxed? Could receiving it cause some famillies to be over the income threshold for provincial programs (such as HSO CORE)?

(A) This is non-taxable, non-reportable income. The individual will not receive an income slip at the end of the year, and it will not be added to any other income.

(Q31) I am still confused about reimbursement. When would I need to reimburse the government? What if I don’t use the full amount? What if my child’s appointment goes slightly past the benefit period?

(A) If a patient receives $390 for their child’s dental care treatment, and only needs to pay $300, they would not be expected to reimburse the other $90. However, if they have applied for the benefit during the benefit period, and they have not taken their child in for treatment during that period, then they would be expected to reimburse the full $390.

(Q32) If parents are divorced and living apart, is the benefit based on one parent’s income? What if one parent makes more than $90,000.

(A) The answer is anchored in how we issue the Canada Child Benefit. In cases where there is a shared custody agreement, each parent is eligible for 50% of the benefit. They each need to be independently eligible. Each parent would need to apply on their own.