Health Insurance

Canada's publicly funded healthcare system, known as Medicare, provides essential medical coverage to all Canadian residents. However, Medicare does not cover everything. Many Canadians rely on supplemental or extended health insurance to fill the gaps in public coverage and access a wider range of health services.

Provincial health plans typically cover hospital stays, physician visits, and medically necessary procedures. However, they generally do not cover prescription drugs (outside of hospitals), dental care, vision care, physiotherapy, mental health services, medical equipment, and semi-private or private hospital rooms. This is where supplemental health insurance becomes invaluable.

Extended health insurance is commonly provided through employer-sponsored group benefit plans. However, self-employed individuals, freelancers, part-time workers, and those between jobs may need to purchase individual health insurance plans to ensure they have adequate coverage.

Understanding what is and is not covered by your provincial health plan is the first step in determining whether you need supplemental health insurance. With healthcare costs rising and an increasing emphasis on preventive care, having comprehensive health coverage is more important than ever for Canadians and their families.

Supplemental health insurance in Canada can include a variety of coverages:

Extended Health Care (EHC): This is the most common type of supplemental coverage. It typically includes prescription drug coverage, paramedical services (physiotherapy, chiropractic care, massage therapy, acupuncture), medical equipment and supplies, ambulance services, and out-of-province or out-of-country emergency medical coverage.

Dental Coverage: Dental plans cover preventive care (cleanings, exams, X-rays), basic restorative services (fillings, extractions), major restorative services (crowns, bridges, dentures), and orthodontics. Coverage levels and annual maximums vary by plan.

Vision Care: Vision coverage typically includes regular eye exams, prescription eyeglasses or contact lenses, laser eye surgery (in some plans), and other vision-related expenses.

Disability Insurance: This coverage replaces a portion of your income if you become unable to work due to illness or injury. Short-term disability covers temporary conditions, while long-term disability provides coverage for extended periods.

Critical Illness Insurance: Pays a lump-sum benefit upon diagnosis of a covered critical illness, such as cancer, heart attack, or stroke. This money can be used for any purpose, including treatments not covered by public health plans.

Health Spending Account (HSA): An employer-funded account that can be used to cover a wide range of health and dental expenses not covered by other benefits. HSAs offer flexibility in how funds are used and are tax-advantaged.

When selecting a supplemental health insurance plan, consider the following factors:

Coverage Needs: Assess your family's health needs. Do you require regular prescription medications? Do your children need orthodontic treatment? Do you use paramedical services regularly? Choose a plan that aligns with your actual usage patterns.

Group vs. Individual Plans: If your employer offers a group benefits plan, this is typically the most cost-effective option. However, if you are self-employed or your employer does not offer benefits, individual plans are available from many private insurers.

Waiting Periods: Most individual health insurance plans have waiting periods before certain coverages take effect. Dental coverage may have a waiting period of 3 to 6 months for basic services and up to 12 months for major services.

Annual Maximums: Plans have annual maximum limits for each type of coverage. Ensure these maximums are sufficient for your anticipated needs.

Co-insurance and Deductibles: Understand what percentage of each expense the plan will cover (co-insurance) and any deductibles you must pay before coverage kicks in.

Provider Networks: Some plans require you to use specific healthcare providers or pharmacies. Check whether your preferred providers are included in the plan's network.

Portability: If you change jobs or move to a different province, ensure your plan can be transferred or converted without loss of coverage.