Coordination of benefits between the CDCP and Saskatchewan's provincial dental programs
November 2024
Version 2.0
For those individuals who are not enrolled in the Canadian Dental Care Plan (CDCP), Saskatchewan is maintaining a first payer approach to its provincial dental programs. As both the CDCP and Supplementary and Family Health Benefits are first payers for their programs, no coordination of benefits is required.
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.
How will the CDCP and Saskatchewan coordinate benefits?
- At this time, coordination of benefits between the CDCP and the province of Saskatchewan's dental programs — Supplementary Health and Family Health Dental Benefits — is not required.
- The CDCP will be the only payer for those who are enrolled in the CDCP. Saskatchewan will continue to act as first payer for Supplementary and Family Health Benefit clients who are not enrolled in or eligible for the CDCP.
- 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.
What if services require preauthorization under the CDCP?
- Some services under the CDCP will require prior approval through preauthorization before the treatment is confirmed for coverage under the plan. Certain services always require preauthorization, and services above CDCP frequency limitations can also be requested through preauthorization.
- CDCP is accepting preauthorization requests effective November 1, 2024.
- Providers should refer to the CDCP Dental Benefits Guide for services covered by the CDCP and the policies, including criteria, guidelines and limitations, as well as the CDCP Dental Benefit Grids for the list of services that always require preauthorization - under “Schedule B” or identified with a “P”. This also includes treatment for services available without prior approval, but that would be above established frequency limits.
- Oral health providers need to submit all required and relevant documentation available to support the request directly to Sun Life. Please refer to the CDCP Dental Benefits Guide for documentation requirements.
- If a service requires preauthorization under the CDCP, the preauthorization request for that service must always be submitted to the CDCP, regardless of whether the service is covered or has been preauthorized by another federal or provincial dental program.
Resource:
For more guidance on the claims submission process for CDCP, including preauthorization, post-determination, and reconsideration steps, please refer to the Sun Life claims submission information resource.
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