Coordination of benefits between the CDCP and Nunavut's Extended Health Benefits program
April 2024
Version 1.0
This fact sheet is intended to provide information on the approach to coordination of benefits between the Canadian Dental Care Plan (CDCP) and Nunavut’s Extended Health Benefits (EHB) program, as noted below.
Note: Individuals with private insurance are not eligible for the CDCP, and therefore there would be no coordination of benefits with the CDCP. Should clients have dental benefits through a private plan, then providers must not submit claims to the CDCP.
| Program Name | Contact Information |
|---|---|
| Extended Health Benefits (EHB) |
Nunavut Health Insurance Programs Office |
| Administrator | Contact Information |
|---|---|
| Nunavut Department of Health |
Nunavut Health Insurance Programs Office |
What is the payer order between the CDCP and the Nunavut Extended Health Benefits program?
The CDCP will be the primary payer relative to Nunavut’s Extended Health Benefits program.
How do providers submit CDCP claims to Sun Life?
Submitting claims under the CDCP will be done in the same way you are doing now with other insurance plans, so the process will be very familiar and easy.
Claims and CDCP client eligibility verification can be submitted through CDAnet, CDHAnet and DACnet using oral health providers' existing Practice Management Software (PMS).
For more information on the claims submission process for CDCP, please consult the Sun Life claims submission information document.
Please note that before November 2024, the CDCP will only accept electronic claims submission through Electronic Data Interchange (EDI). If a provider does not have EDI capability, they will be unable to seek reimbursement from Sun Life until November 2024.
How will the CDCP and Nunavut coordinate benefits?
COB claims submission process — through EDI:
Where patients are eligible for the CDCP and dental benefits under the Extended Health Benefits program, providers will need to:
- Indicate in the patient's profile of their PMS that the CDCP is the primary payer and the Extended Health Benefits program is the secondary payer.
- Submit the claim through EDI:
- The claim will automatically go to Sun Life first. Sun Life will generate an Explanation of Benefits (EOB) that will show what amount is covered under the CDCP (Total Payable to Provider).
- Make sure to indicate Pay to Provider, Assignment of Benefits, or equivalent (depending on the software) in your PMS — otherwise, your claim submission will be rejected by Sun Life. You will have to choose to assign benefits in your PMS and resubmit your claim.
- CDCP clients will continue to be responsible for paying, directly to the provider, any applicable co-payment and any remaining amounts not covered by the CDCP.
- Members of the Extended Health Benefits program can seek reimbursement for any fees not covered by the CDCP, up to an annual limit of $1,000 per year, by submitting an invoice/receipts that include the amount not covered by the CDCP to the Extended Health Benefits program according to program policies.
More details concerning updates to the COB process effective November 2024 will be shared in the coming months.
What if services require preauthorization?
CDCP will start accepting requests for preauthorizations effective November 2024. There is no coverage under CDCP for services requiring preauthorization prior to November 2024 and there will be no coordination of benefits.
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