The Ontario Cleft Lip and Palate/  Craniofacial Dental Program

 

Description:

This program provides financial assistance for the specialized dental needs of children with cleft lip/palate, craniofacial anomaly or other severe dental dysfunction. Children need to be registered in the Program before their 18th birthday.

 

Region of Administration:

Provincial

 

Government / Department:

Ministry of Health and Long-Term Care

 

Eligibility:

To determine eligibility for financial assistance through the program, an individual must contact, or be referred to, one of the designated centres for a screening assessment.  An individual's eligibility for registration with the program is determined by the Dental Director and the assessment team at each designated centre.

 

Coverage:

The Ontario Cleft Lip and Palate/Craniofacial Dental Program covers up to 75% of the pre-approved dental specialist treatment costs not covered by private dental insurance.

These costs may include

  • Dental infant orthopaedics
  • Orthodontic treatment
  • Some restorative dentistry
  • Dental prosthetics
  • Dental implants and oral surgery not funded by OHIP

The program will not cover the cost of regular dental check-ups, some procedures that are not deemed eligible and long-term follow-up care.

The program will reimburse 75% of dental treatment costs remaining after private dental insurance. If there is no private insurance in place, the program will reimburse 75% of the approved estimate. A funding limit applies to treatment for clients registered with diagnoses other than Cleft Lip and Palate and/or Craniofacial syndromes. 

 

Providers:

Dentists

 

Therapeutic Responsibility:

Dentists

 

Compensation:

Fee-for-service

 

How it Works:

Some procedures may need to be completed by a certified dental specialist in Ontario.

A treatment plan and fee estimate must be forwarded to, and approved by, the Dental Director of a designated centre prior to the initiation of any dental treatment.

Use of private dental insurance and coverage provided by The First Nation and Inuit Health Branch, Ontario Works, Ontario Disability Support Program or The Children in Need of Treatment Program must always precede any funding through the Cleft Lip and Palate/Craniofacial Dental Program.

The program will reimburse 75% of dental treatment costs remaining after private dental insurance.

If there is no private insurance in place, the program will reimburse 75% of the approved estimate.

A funding limit applies to treatment for clients registered with diagnoses other than Cleft Lip and Palate and/or Craniofacial syndromes.

All requests for reimbursement (e.g. orthodontic bills) must be sent to The Hospital for Sick Children, the designated provincial paymaster for the program.

 

More information