Personal Health Insurance in Canada
What is Personal Health Insurance?
Personal health insurance is a type of health insurance plan that you can purchase to cover yourself, spouse, and other dependents against the healthcare costs that are not normally covered in Canada’s provincial health system.
These healthcare services include physical therapy services such as physiotherapy, professional massages, chiropractic, acupuncture, chiropody, etc.
For the purposes of this article, we are going to outline what are some different types of personal health insurance plans that you can purchase in Canada and their pros and cons.
Personal health insurance is for people who currently don’t have health insurance, are losing health insurance due to a career change or retirement, are awaiting group health insurance coverage, or someone looking to top up their group health benefits.
Understanding Canada's Universal Healthcare Insurance
Canada has one of the best Universal Healthcare Insurance in the world. Part of the taxes we pay goes toward our share in funding provincial health insurance that benefits everyone living or working in Canada.
Canada’s universal healthcare system, however, does not cover all healthcare costs that’s why it’s a good idea to have a group or personal health insurance in place to have coverage against healthcare costs that aren’t usually covered on provincial health insurances.
As mentioned above, group health or personal health insurance covers personal care therapy services as these aren’t covered by our provincial health insurance. It’s also noteworthy that dental and vision products and services are also not covered by the universal health care system, as such it’s of vital importance to implement personal health insurance so as not to shoulder the entire costs of these services out of pocket since dental and vision services are quite expensive here in Canada.
How Does Personal Health Insurance Work in Canada?
Personal health insurance aims to extend your personal health coverage beyond what’s already covered by Canada’s universal healthcare system. As you may know, Canada’s universal healthcare system offers basic coverage under provincial health insurance, but for the most part, there are many essential areas of health coverage that do not make the cut, including prescribed medications, routine dental care, corrective vision care, and physical therapy.
Insurances such as health insurance help you minimize your financial risks – a simple dental filling may end up costing $400, without health insurance, you’re going to absorb 100% of this cost out of pocket. A personal health insurance plan helps you shoulder this cost, thereby minimizing your risk by sharing it with an insurance company.
Personal health insurance can be acquired either through your employer group insurance, if your company offers it as a benefit, or by purchasing an individual plan for yourself and your family.
Whether you purchase a personal health insurance plan or get it through your employer, it can be broken down into two categories: group and individual.
Group plans are set up by employers to cover all employees at the same price, which represents tremendous discounts for everyone involved. Individuals can also choose to take advantage of this offer if they wish to, but they can also opt to purchase an individual health insurance plan.
Understanding Group Insurance Benefits for Employees
Group health insurance is health insurance you usually can get through your employer, your union, or your professional association. It gives you access to health services in exchange for a monthly premium deducted from your paycheck.
Group health insurance typically includes coverage for certain services that are not part of the basic medical services we get through the universal healthcare system, including eye exams, dental work, prescription drugs, and physiotherapy. For most Canadians.
If you’re employed, you probably already have access to a group health insurance policy through your company (employer). Workers who are considered self-employed like massage therapists, hairdressers, or self-employed contractors usually don’t have access to group health insurance because they’re technically not employees of the companies they do work for but are considered their own employers.
Group health insurance and personal health insurance have a similar purpose, in that they lessen or minimize the financial impacts of health services that are not covered by the provincial healthcare system as mentioned in the previous sections.
This is what’s called “risk-sharing”, instead of shouldering 100% of the costs, you share it with a health insurance company that shoulders between 70% to 90% of the costs depending on which plan you have or plan to implement.
How Much Does Personal Health Insurance Cost?
The monthly cost of personal health insurance varies depending on which plan you choose, and the age group you belong to.
If you’re between 18 to 34 years old, a basic individual health insurance plan can cost you as low as $8 a month, that of course, does not include dental and prescription coverage – adding dental benefits increases your monthly contribution to $64.25 a month.
This computation is based on a very basic coverage that only covers 70% of health services costs to a maximum of $250.00 per year.
Each health insurance company has different offerings, so costs vary on the type of coverage, really. Individual health insurance can cover up to 90% of your health services cost but will of course require a higher premium contribution.
Why Do You Need Personal Health Insurance?
You need personal health insurance if you don’t have coverage from work, are self-employed, retired, or you’re awaiting coverage from your group plan. Another case is if when you want to extend your coverage beyond what’s already covered on your group policy.
If we are to pay for basic medical and hospital services, you’ll realize how high the costs of health services are in Canada. Most of the time, we don’t even have to think about the costs of extended health services since most Canadians have some form of group health insurance from work, when you retire or go on your own as a small business owner or self-employed, this benefit goes away since you’re no longer part of a group to benefit from group health insurance.
We all need extended health services, as well as vision, dental, and prescription drugs. If you don’t visit your dentist every six months, for example, your dental health will slowly deteriorate, which could lead to various dental problems.
At least, you should have some form of personal health insurance, ideally one that works for your entire family. By extending the benefits of your current group coverage to include these types of individual services, it can save you money and protect your family members from certain medical conditions or accidents.
What Are the Benefits of Personal Health Insurance in Canada?
Personal health insurance is a valuable addition to your current group health plan or a stand alone plan if you’re not covered already.
In general, when you have health coverage from work, you may no longer need personal health insurance but if you’re retired or you work for yourself, you definitely should have your own personal health insurance.
On the other hand, you can also extend your group health insurance coverage by topping it up with a personal health insurance.
How Do I Choose the Perfect Personal Health Insurance Plan?
The best way to ensure that you get the appropriate coverage for you and your family is by consulting with an independent insurance broker (like us).
Independent insurance brokers are licensed professionals who can help you select the right plan for your individual needs. They will also let you know if your current group health plan is providing the coverage that you need or how to improve it so that it better meets your personal and family health care needs.
How Do I Pay for My Personal Health Insurance?
Just like most insurances in Canada, premium payments for personal health insurance policies can be arranged through pre-authorized payment contributions where your contributions are automatically debited from your account on your preferred draw date so you need not worry about missing or making payments as long as there’s enough funds on your bank account on your chosen draw date.
What Does Personal Health Insurance Usually Cover?
Unlike other personal insurance plans which covers the insureds against unforeseen circumstances such as premature death, a serious illness, or prolonged injury, personal health insurance provides insurance coverage for health services that we may need on an ongoing basis such as therapeutic massages, chiropractic, and physiotherapy as well as dental and vision care.
Say you need a pair of new prescription glasses, for example, if you don’t have health insurance with vision coverage, you’ll have to pay the full amount out of pocket which can range between $300 to thousands of dollars depending on the eyewear brand you choose.
Below is a list of the usually covered services in a personal health insurance plan, note that some services such as dental and vision care may need to be added as a top-up on the base plan, depending on the kind of coverage you’re going to select and from which company:
- Health Supplies & Equipment
- Casts & Crutches
- Emergency Medical Services when Traveling
- Hearing Aids
- Air Ambulance
- Speech Pathologist/Therapist
- Counseling Services
- Health Practitioners (Acupuncturist, Chiropractor, Chiropodist/Podiatrist, Massage Therapist, Naturopath, Dietitian, Osteopath, and Physiotherapist
- Vision Care
- Prescription Drugs
- Dental Care
- Hospital Cash
Best Private Health Insurance Canada
The best private health insurance plan for someone else may not be the best for you, likewise, the best health insurance policy for you may not be the best for someone else.
As you may know, the word best is subjective. A person may choose a health insurance policy with all the benefits and high coverage limits but may not be able to afford the monthly contribution.
The best health insurance plan meets your needs and budget. Ideally, we should have enough coverage for the services we need annually.
If you love going to massages, you need something that provides enhanced coverage for RMT services. On the other hand, if you’re someone who has maintenance medications, you may want enhanced prescription coverage so you avoid overspending on prescription drugs.
There are a lot of health insurance options in Canada, and from different companies. We can help you explore your options to land a plan that’s best for your needs, and one that fits your budget!
Top Health Insurance Companies in Canada
In Canada, there are a number of health insurance carriers, and below are the top ones:
GMS or Group Medical Services was founded in 1949 and has been servicing the Canadian market since then.
When Canada’s universal health insurance was introduced, GMS started providing health insurance for medical expenses that the government would not cover, such as prescription drugs, ambulance services, and private duty nursing. The major benefits of these plans have remained the foundations for today’s policies.
Manulife Health Insurance
Manulife offers health insurance in addition to other insurance products. Manulife is one of the largest Canadian insurance companies offering health insurance plans.
Edge Benefits specializes in providing health benefits as well as living benefits like critical illness and disability insurance for the self-employed market. Since starting over 35 years ago, they continue to grow their coverage options with the goal of meeting customer needs. Edge Benefits is one of Canada’s leading providers of health insurance plans.
Blue Cross Health Insurance
Blue Cross offers a wide range of health insurance plans and is one of the most recognized health insurance brands in Canada since most group health insurance are covered through Blue Cross.
Health Insurance Canada: Ontario and Manitoba
If you’re looking for health insurance in the provinces of Ontario and Manitoba, we can help you implement a health insurance policy that best meets your needs and budget.
Health insurance is an important part of your financial risk management strategy. It protects you from unnecessary overspending when you can share the spending with an insurance company.
If you have health insurance, you can keep your mind and body in the best possible condition through regular care and health services without shouldering the costs on your own.
Please book an appointment below, and we’ll help you get set up with a quality personal health insurance plan for yourself and your family.