Dental Insurance and CDCP in Hamilton, Ontario

Direct insurance billing at our Hamilton clinic

We submit insurance claims directly to your provider on your behalf. You only pay your portion (deductible plus any co-insurance) at the visit. There is no waiting weeks for reimbursement and no claim form for you to mail. Bring your insurance card or a photo of it to your first visit and we will set up your file in our practice-management system before treatment begins.

Canadian dental insurers we bill directly

We bill all the major Canadian carriers, including but not limited to:

• Sun Life (also administers the federal Canadian Dental Care Plan)
• Manulife (group benefits and individual plans)
• Canada Life (the merged Great-West Life, London Life, and Canada Life brand)
• Green Shield Canada (GSC)
• Desjardins Insurance
• Equitable Life of Canada
• Industrial Alliance (iA Financial Group)
• SSQ Insurance / Beneva
• Empire Life
• Blue Cross (Ontario Blue Cross and other provincial Blue Cross plans)
• RWAM, ClaimSecure, and other third-party administrators

If your carrier is not in this list, ask us when you book. We can almost always bill your plan directly.

Canadian Dental Care Plan (CDCP)

The Canadian Dental Care Plan is a federal program administered through Sun Life that helps Canadian residents without private dental coverage afford routine and restorative dental care. Eligibility expanded significantly through 2024 and 2025 to include most adults under 65 in addition to seniors and children, subject to an adjusted family net income threshold.

Hamilton Care Dental Centre is an accepting CDCP provider. We submit claims directly to Sun Life, confirm any co-pay before treatment, and explain pre-authorization for services that require it. For full details, see our CDCP page and the official Sun Life CDCP information.

Our fees follow the Ontario Dental Association (ODA) fee guide

The Ontario Dental Association publishes an annual suggested fee guide that lists a recommended fee for every dental procedure code in Ontario. Most insurance plans benchmark coverage against this same guide. Because we follow the ODA fee guide, your insurance plan typically covers the published amount and your out-of-pocket portion is predictable. For broader clinical guidance we also follow the Canadian Dental Association standards and are regulated by the Royal College of Dental Surgeons of Ontario.

What is typically covered

Coverage varies by plan, but the standard breakdown for most Canadian dental insurance plans looks like this:

• Preventive / Diagnostic (usually 80 to 100 percent coverage): Exams, professional cleanings, X-rays, fluoride, pit and fissure sealants, oral cancer screening.
• Basic / Restorative (usually 70 to 80 percent): Tooth-coloured composite fillings, simple extractions, scaling and root planing for gum disease, basic root canal therapy.
• Major (usually 50 percent): Crowns, bridges, inlays, onlays, dentures, complex extractions, surgical wisdom-teeth removal.
• Orthodontic (varies, often a lifetime maximum): Traditional braces, SureSmile® Aligners, and Invisalign for eligible patients (often children and dependants).
• Implants: Dental implants are increasingly included under major coverage. The crown portion is usually covered. Surgical placement varies by plan.

Annual maximums in Canada commonly range from CAD $1,000 to $2,500 per person per year, with the most popular tier sitting around $1,500. Orthodontic coverage usually carries a separate lifetime maximum, often $1,500 to $3,000.

How to get the most from your dental benefits

• Use your benefits before they reset. Most Canadian dental plans reset on January 1. Unused benefits do not roll over. Book preventive visits and any planned restorative work early in the year.
• Split major treatment across two calendar years. If you need $3,000 of restorative work and your annual maximum is $1,500, we can plan one phase in December and a second in January so you use two annual maximums.
• Ask for a pre-authorization. We can submit your treatment plan to your insurer in advance. They respond with what is covered, what is not, and any expected out-of-pocket cost before treatment starts.
• Combine insurance with Beautifi financing. Insurance covers the medical share, Beautifi 0 percent financing covers the rest with predictable monthly payments.
• Use a Health Spending Account (HSA) for the gap. Many employer plans now include an HSA that can be applied to dental balances. Ask your HR or benefits administrator.

No insurance and not CDCP-eligible? You still have options

If you do not currently have private dental insurance and do not qualify for CDCP, you can still access full-service dental care at our office. We offer Beautifi financing with 0 percent options on qualifying treatments, terms from 6 to 60 months, instant decisions, and no penalty for early repayment. We also accept cash, debit, Visa, Mastercard, American Express, and e-transfer.

Before any major treatment we give you a written estimate that lists the procedure codes, the fee for each, what insurance is expected to pay (if applicable), and your share. No surprises at checkout.

What to bring to your first visit

1. Photo ID. Driver licence, Ontario photo card, or passport.
2. Insurance card or details. Carrier name, group/policy number, certificate/ID number, and policy holder's date of birth. A photo of your insurance card is perfect.
3. CDCP member ID (if applicable). Issued by Sun Life after your CDCP application is approved.
4. Medication list. Anything you take regularly, with doses.
5. Recent X-rays (optional). If you saw another dentist within the past year and have digital copies, we can use them and avoid new imaging.

Authoritative resources (external)

Some helpful third-party resources if you want to dig deeper into Canadian dental coverage:

• Government of Canada, Canadian Dental Care Plan (eligibility, applying, what's covered)
• Sun Life CDCP information (claims, provider network)
• Ontario Dental Association (ODA) (annual fee guide, patient information)
• Canadian Dental Association (CDA) (oral health information for the public)
• Royal College of Dental Surgeons of Ontario (RCDSO) (the regulator of dentists in Ontario)