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Health and dental insurance explained Thumbnail

Health and dental insurance explained

Health insurance is designed to help pay your expenses for regular health and dental care, illness and accidents that may not be covered by your provincial or territorial health insurance.

Depending on your specific needs and circumstances, as well as budget, there are flexible options available that are easy to buy, and manage, and best of all, are easy to understand.

Comparing policies and eligibility

There are two main types of supplemental health insurance policies you can choose from. Both can help you pay for expenses that regular insurance doesn’t cover or share the cost with other insurance plans you might have. If you’re a gig worker, freelancer or self-employed – like approximately one in three Canadians – you might be considering supplemental insurance. Depending on the type of coverage you apply for, you may be required to answer a medical questionnaire.

If you were previously covered by a work policy but lost your benefits because you left (or lost) your job, or are retiring, then you may qualify for a policy that continues your coverage (not necessarily with identical benefits). This type of policy guarantees that you’ll get coverage and there are no medical questions at the time of application. You’ll want to apply and pay your first premium within a prescribed time frame after losing your work benefits.

There are certain eligibility requirements for health insurance. You need to be older than 18, a Canadian resident and covered by a provincial or territorial health plan. You can also cover your spouse and unemployed dependent children under the age of 21. You can’t buy insurance for someone else, but you can pay the premiums for them if you wish.


Pick a plan that’s right for you

You can tailor your coverage to suit your needs and your budget. For example, you may want coverage for prescription drugs but not dental work, or dental but not drugs — or you may be looking for a plan that covers both. Typically, insurance companies will offer multiple types of coverage bundled as a single plan. For example, some plans offer drug, dental, vision and travel coverage, while others offer drug, vision, hospital coverage for a semi-private room and extended health care.

Plans may include accidental death and dismemberment (AD&D) coverage and a survivor benefit, as well. With AD&D, the policyholder receives a payment if they’re dismembered in an accident. If an adult insured by the policy dies in an accident, a survivor benefit provides for one year of continued coverage with no premiums for the  other people covered by the policy. These types of plans can help protect loved ones in the event that something happens to you.

Standalone options

Some types of coverage can be purchased as standalone plans. For instance, if your plan doesn’t include travel, catastrophic drug coverage or hospital coverage, you may be able to purchase these as standalone plans. Catastrophic drug coverage offers unlimited drug coverage once you’ve paid a certain amount in annual drug expenses, while hospital coverage provides for a semi-private or private room if you’re hospitalized.

More than just coverage

Many policies also offer non-insurance perks, such as telephone or virtual health care services that provide round-the-clock, on-demand access to medical professionals who can provide prescriptions, mental health care, diagnoses and referrals.

Some insurers offer wellness programs along with their insurance plans, which can help put you and your family on a healthier path. For example, some programs allow you to earn points for doing healthy activities like walking the dog, going to the gym or completing online nutrition courses. The points can be exchanged for rewards or can even reduce your premiums.

Choosing the right plan or making changes

When determining the best coverage for you, you’ll want to consider a few things, such as:


  • Your medical history and any pre-existing conditions, which might require higher prescription or hospitalization coverage, or opt for a plan that doesn’t require a medical questionnaire
  • Your health – if you require specialized care, you might want coverage for home care or nursing care
  • The needs of your dependents – your children might require vision care or orthodontic treatment


You’ll want to balance your needs with your budget too – determine what percentage of expenses are covered versus the amount you pay out of pocket, as well as the types of expenses that are covered.

If your circumstances change you may want to adjust the coverage on your policy. You can increase it on an existing policy by submitting a written application with updated medical information. Or reduce it if you’ve been covered under the existing benefits for a certain amount of time. If you experience big life changes, such as getting married or having a baby, you can add your spouse or baby to your coverage.

Understanding your policy

It’s important to read and understand your policy and schedule of benefits so you’re aware of what is and isn’t covered and the coverage limits. Once you’ve reached your coverage limit for an expense, you will need to pay out of pocket until the benefits reset. It’s important to understand when your benefits reset, as it can vary. Some expenses reset annually, some reset every 2 years, and some are subject to lifetime maximums – maximum dollar amounts your insurance company would pay out over your lifetime.

Many benefits reset on the anniversary year of the policy, not calendar year – so if your policy began in March, your benefits run until the following March. This is important to remember, so you can get the most out of your health insurance, especially benefits for preventive health care. Set reminders to book regular appointments to visit your doctor and dentist, as well as other health service providers. Wellness programs that offer virtual health services can save you time and hassle.

What happens when you have multiple policies? Since you may not have more than one private health policy from the same insurer, some of your expenses could be covered by another company’s health insurance policy, your spouse’s policy or your auto or credit card insurance. In this case, the amount of  eligible expenses covered by the province or territory will be paid first, and payment of the remaining eligible expenses will be coordinated between the other insurers. Your policy will outline how that works.

Speak with your advisor

Health and dental insurance can be an effective and affordable tool that helps lessen the burden of out-of-pocket expenses. Your advisor has the expertise to help you choose the best plan that fits your needs and budget. You might be pleasantly surprised at how affordable it is to help protect yourself and your family.


Source: https://www.coverme.com/blog/health/health-and-dental-insurance-explained.html

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