March 2019

9.7 Dental Benefits

Summary of Legislation

An ODSP recipient and their spouse 18 years of age or older can receive coverage for dental services provided they meet the criteria and income support is being paid on their behalf.

Legislative Authority

Section 44(1)1.ii.1 of the ODSP Regulation

Summary of Directive

Who is Eligible for ODSP Dental Benefits?

ODSP recipients and their spouse 18 years of age or older are eligible for dental benefits.

Who is Not Eligible for ODSP Dental Benefits?

Dependent adults are not eligible for ODSP dental benefits. They may receive dental services as a discretionary benefit through Ontario Works. In most cases, coverage is for emergency dental care or dentures.

Children 17 or younger are not eligible for ODSP dental benefits. They are eligible for dental benefits through the Healthy Smiles Ontario Program of the Ministry of Health and Long-Term Care.

The spouse of an ODSP recipient who is under 18 will also receive dental benefits from the Healthy Smiles Ontario Program.

Information about Healthy Smiles Ontario is available at: http://www.ontario.ca/healthysmiles.

ODSP Recipients Living in Residences Providing Specialized Care (listed in s. 32(2) of the ODSP General Regulation)

If the dental services the person requires are provided by the institution, they are not eligible for ODSP coverage for those services. However, if there are services in the MCCSS dental schedule that are not covered by the institution or by any other source, the ODSP recipient or spouse 18 years of age or older would be eligible for ODSP coverage for those services.

The same principle applies for the services in the MCCSS dental hygiene schedule.

Starting April 1, 2019, ODSP recipients and spouses 18 years of age or older, will use their Ontario health card or other government identification such as their daily or monthly statement of assistance or driver’s license, to access dental benefits. A paper dental card will no longer be provided with the daily or monthly statement of assistance.

A complete list of acceptable government identification.

A manual paper dental card may also be provided in exceptional circumstances.

MCCSS Dental Schedules

The MCCSS Schedule of Dental Services and Fees and the MCCSS Schedule of Dental Hygiene Services and Fees outline the services, fees and plan limitations covered under the MCCSS dental benefit.

The MCCSS schedules are available to ODSP staff, dentists and dental hygienists, municipal Ontario Works Administrators, Regional Directors and to clients on request.

Clients can also ask their dentist/dental hygienist about the services available under the schedule and any limitations with respect to the services they may require.

Dental Special Care Plan

In addition to basic dental services, recipients and eligible spouses may receive services under the Dental Special Care Plan. The Dental Special Care Plan provides additional dental services for those whose disability, prescribed medications or prescribed medical treatment affects their oral health.

Examples include:

  • Radiation of head/ neck
  • Diuretics
  • Diabetes
  • HIV/AIDS
  • Developmental disabilities (such as Down Syndrome)

A dentist or dental hygienist can apply for the Dental Special Care Plan on behalf of the client by submitting a pre-determination to AccertaClaim Servicorp Inc. (Accerta). Accerta administers the ODSP dental benefit on behalf of the MCCSS.

Dental Special Care treatment plans are valid for five years as long as the client continues to be eligible for the ODSP dental benefit. Should the client require additional services within the five-year period, a new pre-determination is required to authorize those services.

Further information about the Dental Special Care Plan and instructions on how to apply are in the MCCSS dental and dental hygiene schedules.

Intent of Policy

To ensure that dental benefits are provided to eligible members of a benefit unit.

Application of Policy

The following persons are eligible for dental benefits:

  • ODSP recipients and their spouse 18 years of age or older
  • Former ODSP recipients and their spouse 18 years of age or older who are receiving Extended Health Benefits
  • Former ODSP recipients and their spouse 18 years of age or older who are receiving the Transitional Health Benefit, and
  • ODSP recipients (or their spouse 18 years of age or older) who live in residences providing specialized care (listed in s. 32(2) of the ODSP General Regulation) where the residence does not cover the costs for dental services

Accessing Dental Services

Starting April 1, 2019, ODSP recipients and spouses 18 years of age or older, will use their Ontario health card or other government identification such as their daily or monthly statement of assistance or driver’s license, to access dental benefits. A paper dental card will no longer be provided with the daily or monthly statement of assistance.

A manual paper dental card may be provided in exceptional circumstances.

An acceptable piece of government identification allows the dental office to verify the person’s identity. The dental provider must verify eligibility for dental services using the AccertaWorX Dental Portal (an online tool). A separate piece of identification for each person is required, unless the statement of assistance is presented.

If a dental office does not have access to the AccertaWorx Dental Portal, the statement of assistance is proof of eligibility for dental benefits. It is important to note that if a ‘D’ appears beside the name of a benefit unit member on the statement of assistance, they are a dependent adult and not eligible for ODSP dental benefits.

The manual paper dental card is proof of eligibility for dental benefits, in all cases.

The Ontario health card or other acceptable government identification should be presented to the dental office prior to treatment. The client should ensure that the dentist/dental hygienist is participating in the ODSP Dental Plan.

Acceptable government identification

  • Ontario Health Card (i.e., photo, non-photo or temporary card)
  • Social Assistance (ODSP) Statement of Assistance
  • Health card issued by another province or territory in Canada
  • Other official document showing the health number (i.e., letter from the Ontario Ministry of Health and Long-Term Care or Citizenship and Immigration Canada (CIC))
  • Valid driver’s licence or temporary driver’s licence (issued by Ontario or another jurisdiction)
  • Ontario Photo Identification Card
  • Birth Certificate from a Canadian province or territory
  • Statement of Live Birth
  • Confirmation from the Registrar General of birth registration
  • Ontario Outdoors Card
  • Age of Majority Card
  • Secure Certificate of Indian Status (Status Card)
  • Indian Band records
  • Valid passport - Canadian or other country
  • Canadian Citizenship Card
  • Canadian Immigration Identification Card
  • Permanent Resident Card
  • Record of Landing
  • Refugee Protection Claimant Document (CIC Form 1442)
  • Determination of eligibility for refugee status (CIC form IMM1442 or IMM5292)
  • Temporary Resident Permit (CIC form IMM 1442 or IMM 1263)
  • Firearms Possession and Acquisition Licence
  • Military record

If a dental office has questions regarding claims processing and payments, or if the AccertaWorX dental portal is out of service, they can be directed to Accerta at 1-800-505-7430 or 416-922-6565

Cleft Lip and Palate Program of the Ministry of Health and Long-Term Care

Dependent children of ODSP recipients may be eligible for benefits under the Cleft Lip and Palate program of the Ministry of Health and Long-Term Care.

Related Directives:

2.1 Who is Eligible: Dependent Adults
2.3 Who is Eligible: Spouse
9.10 Extended Health Benefit
9.19 Transitional Health Benefit