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self employed health benefits canada

Health Benefits for Self-employed in Canada

As a self-employed business owner or a full-time freelancer, you get to enjoy a lot of perks that are otherwise not available when you’re working for someone else.

You get to choose how many hours you work, who you work with, and when. These and many more are benefits of self-employment in Canada.

As a self-employed professional, what I like most about working for myself is time flexibility, of course, in no way whatsoever an indication that I work less. In fact, I work long hours for my business compared to when I was working a regular job, and if you’ve been self-employed for a little while, I know you can relate.

With all its perks, choosing the self-employment path, however, comes with its share of challenges. As you may know, we lose our group health benefits when we leave the comforts of a traditional 9 – 5 job. We also lose the perks of working with other people on a day-to-day basis but self-employment in Canada is so lucrative that more and more Canadians have switched to this career path in the last couple of years. In fact, self-employed Canadians now represent 16% of the total working population in the country, most of whom don’t have health benefits coverage.

A lot of freelancers, professionals, and business owners, who belong to the self-employed demographics are forced into paying health services that are not covered by provincial health insurances out of pocket.

I remember not too long ago when our then 5-year-old was experiencing a toothache, the dentist said that he needed a couple of crowns to protect the affected teeth from further deterioration. The bill was around $3,500.00, even with health insurance coverage, we would still have to pay a portion of the amount out of pocket since we didn’t have enough room in our health insurance to cover the whole amount.

This is the true cost of dental care in Canada, and it’s sad that most self-employed usually pay for their and their loved ones’ health and dental care out of pocket.

health benefits for self employed canada top imgIf you’re self-employed and reading this, know that you don’t have to shoulder all of these costs on your own. You don’t need to stay at a job you don’t like just so you don’t lose your group health benefits. As a self-employed professional, freelancer, or business owner, you can implement health benefits for self-employed coverage, which is technically individual health insurance to protect yourself and loved ones against unexpected costs of dental, health, and vision services whenever the need arises.

As we’ve experienced ourselves, dental services alone easily cost you thousands of dollars in one event. Instead of paying for health services out of pocket, as most self-employed Canadians do, you can share this risk with a health insurance carrier such as ManulifeGMS, and Edge Benefits to minimize your out-of-pocket expenses.

Depending on whether you have employees, you can either get group health insurance or individual insurance. If you have two employees who are not family members or relatives, you can qualify for a group health coverage with three non-familial employees, which includes you. If you operate your business under a corporate entity, with no employees, you may be better off implementing a health spending account, instead.

Health Insurance for Self Employed

Individual health insurance coverages are perfect for self-employed individuals who operate as a sole-proprietor or as a freelancer. You don’t need any employees to qualify for individual health insurance, in fact, you can buy individual health insurance even if you’re not employed, such as the case of many retirees who lose their group health benefits upon retirement.

As a business owner (or freelancer), you may be able to claim your health insurance costs as a business expense, since the main reason you’re implementing one is the fact that you’re self-employed and are not covered by a group health plan. Notice, I said “may”, and not “will” since this is a subject that you should discuss with your CPA.

Individual health benefits usually cover between 70% to 90% of your health and medical expenses, depending on the plan package. The most affordable health insurance offers the most basic health insurance, which often does not include vision and dental care, depending on the insurance company, these benefits can be added as riders or are available in a higher tier plan option.

Most health insurance companies have 3-tier options for their health insurance offers, starting with a basic 70% (health insurance only), mid-tier 80%, and top tier 90% plans. Which types you choose depends on the benefits you need, how much of the cost you would want to pass to the insurance company on each claim, and of course, your monthly budget.

Health insurance for self-employed is usually a month-to-month deal, so when you’re just starting out on your own, you can start by implementing an individual health plan, you can later switch to a group plan when you hire two employees since a group plan is usually a more cost-effective option when you have people working for you.

Health Benefits Plan, and Carrier Options

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As mentioned, individual health benefits are sold in packages, and each insurance carrier has its own unique packages on each plan offer.

Manulife Health and Dental Coverage Options

FlexCare Health and Dental Insurance

Manulife’s FlexCare health and dental insurance coverage are designed for the independent, you can implement this policy whether you work as an employee or as a self-employed. For the seasonal employees, this means that you don’t lose coverage whether or not you’re on or off work. This solves the health benefits need for most self-employed. If you’re just starting out as a self-employed and you’re coming out of a group plan, Manulife has launched a specific program for this demographic, which they call the FollowMe Health Plan.

If you’ve been self-employed for a while, you can take a look at their FlexCare Health Plans. As an individual health benefits provider, they offer 7 different health insurance tiers with their FlexCare Plans as follows:

FlexCare Plans

Prescription Drugs

Dental

Vision Care

Extended Health Care

DrugPlus Basic

$5,000.00

Not covered

$250/2 years

$250,000.00 lifetime maximum

DrugPlus Enhanced

$10,000.00

Not Covered

$250/2 years

$250,000.00 lifetime maximum

Dental Plus Basic

Not Covered

Year 1 $575

Year 2: $750/year

 

$250/2 years

$ 250,000-lifetime maximum

 

Dental Plus Enhanced

Not Covered

Year 1: $840

Year 2: $920/year

$250/2 years

$250,000 lifetime maximum

Combo Plus Starter

70% of first $750 (up to $525/year)

70% of first $575 ( up to $400/year)

$150/2 years

$250,000 lifetime maximum

Combo Plus Basic

70% of first $750, and 90% of next $4,972 (up to $5,000/year)

80% of first $400, and 50% of next $860 (up to $750/year)

$250/2 years

$250,000 lifetime maximum

Combo Plus Enhanced

90% of first $2,222, 100% of next $8,000 (up to $10,000/year)

100% of first $500, 60% of next $700 (up to $920/year)

$250/2 years

$250,000 lifetime maximum

Optional Add-ons:

The following optional add-ons can be added to any Manulife Health and Dental Insurance plans:

Manulife Vitality

Manulife Vitality is a rewards program that offers Manulife clients the opportunity to earn rewards and save on their monthly insurance contributions by accumulating Vitality Points through a more active lifestyle that improves the client’s overall health.

Hospital Benefits

The Hospital basic add-on covers a semi-private hospital room, while the Hospital Enhanced Plan covers a semi-private or private hospital room.

Additional Vision Care

You can get an additional Vision Care benefit as an add-on on all plans listed above, except Combo Plus Basic.

Travel Insurance

All Manulife Health and Dental plan come with a $5,000,000 worth of emergency health coverage for the first 9 days of each trip. This is especially beneficial if you’re a frequent traveler, you can purchase additional 8 and 21 days coverage as add-ons depending on your average travel length.

Accidental Death and Dismemberment

Accidental death and dismemberment cover a total of $50,000.00 for adults younger than 65 years of age, $20,000 for those who are aged 65 and older, and $20,000.00 for children. Note that to get the dismemberment benefit, the loss should be a combination of at least a hand, foot, or sight for 1 eye.

 Catastrophic Coverage

Manulife’s Catastrophic health insurance has two plan options, both cover all drug costs after you pay a certain amount in a year.

  1. After you pay $10,200
  2. After you pay $4,500

Stand-Alone Coverage:

As named, Manulife’s Stand-Alone Coverages allows you to implement specific health benefits on a la carte basis, you just get what you actually feel is important to you. In a way, this helps you fill gaps if you already have existing health insurance coverage. Say for example if you’re spouse is a full-time employee and you and the kids are covered through their work but you want to jack up your prescription coverage, you can get a stand-alone Catastrophic coverage.

They offer the following stand-alone health benefits:

  1. Catastrophic – After you pay $10,200
  2. Hospital Basic Plan
  3. Catastrophic – After you pay $4,500
  4. Hospital Enhanced Plan

FollowMe Health and Dental Benefits Plans

FollowMe Health is specifically designed for people who are losing their group benefits from work. There are two groups of people who usually qualify for this program:

  1. Freelancers and Self-employed, who are leaving work to go on their own.
  2. The soon-to-be-retired. As a retiree, you still need health benefits, you don’t want to pay for those dentures out of pocket, do you?

FollowMe is a guaranteed issue health and dental benefits plan, which means, you’re guaranteed to be approved for coverage with no medical questions asked when you apply and pay your first contribution within the 90 days of your employee benefits’ expiration.

It comes in four different Coverage Options:

Coverage

Basic

Enhanced

Enhanced Plus

Premiere

Prescription Drugs

80% up to $500/year

80% up to $1,300/year

80% up to $1,300/year

80% up to $2,600/year

Dental

Not Covered

Not Covered

80% up to:

Year 1: $700

Year 2: $850

Year 3+: $1,000/year

80% up to:

Year 1: $800

Year 2: $1,000

Year 3+: $1,500/year

Vision

$150 every 2 years

$200 every 2 years

$200 every 2 years

$300 every 2 years

Extended Health

No lifetime maximum

No lifetime maximum

No lifetime maximum

No lifetime maximum

Hospital

50% for the first 150 days (up to 87.50 every day)

100% for the first 60 days (up to $175 every day), and 50% for the next 90 days (up to $87.50 every day)

100% for the first 60 days (up to $175 every day), and 50% for the next 90 days (up to $87.50 every day)

100% for the first 100 days (up to $200 every day), and 60% for the next 90 days (up to $120 every day)

Contact us to get a Manulife health benefits quote.

Or, book an appointment here.

GMS Health and Dental Insurance [GMS Quote]

Another option we recommend to our self-employed clients is GMS Health and Dental Insurance, which is also a great option when you’re looking to implement health benefits coverage for the self-employed. As you’ve seen in the previous section, Manulife has a robust health benefits offering, and if it’s within your budget, it’s one of the best health benefits you can implement.

GMS offers two distinct health benefits coverages as follows:

  1. Personal Health
  2. Replacement Health

Personal Health Insurance

The GMS Personal Health Insurance is pretty much available to anyone looking to implement health benefits coverage. You can implement one of these plans even if you’re working as an employee if you feel that there’s a need for additional coverage than the one you already have at work. As a self-employed, however, you definitely need to get health insurance since you don’t have any group health plans.

Personal health comes in three different packages, as follows:

  1. Basic Plan
  2. Extenda Plan
  3. Omni Plan
Basic Plan

Basic Plan is the most affordable option, covering you for your most basic health insurance needs such as an ambulance ride, wheelchair service, naturopath, dietician, speech pathologist, and osteopath. This does not include vision care, and counseling services but do include coverage for basic health practitioners such as acupuncturists.

Extenda Plan

The Extenda health insurance plan covers more than what the Basic plan offers. In this mid-tier health insurance plan, you get a wider range of health benefits that include registered massage therapists, chiropractors, and vision care.

Omni Plan

Omni plan is GMS’s top tier coverage under their Personal Health Insurance plans. Think of it as their Model X (Tesla Motors), it has got all the bells and whistles, with 90% coverage for vision care, 90% for health practitioners (limit of $300 per practitioner/year).

GMS Personal Health Insurance Options

Coverage

Omni Plan

Extenda Plan

Basic Plan

Vision Care

90% to $250/2 years for frames and lenses

$90/eye exam/2 years

80% to $200/2 years combined

Not included

Health Practitioners

90% to $300 per health practitioner, per person, per policy year for Acupuncturist, Chiropractor, Chiropodist/Podiatrist, Massage Therapist, Naturopath, Dietician, Osteopath, and Physiotherapist

80% to $350 combined maximum for Acupuncturist, Chiropractor, Chiropodist/Podiatrist, Massage Therapist, Naturopath, Dietician, Osteopath, and Physiotherapist per person per policy year.

70% to $250 combined maximum for Acupuncturist, Chiropodist/Podiatrist, Naturopath, Dietician, and Osteopath, per person, per year.

Counseling (Psychologist, Psychotherapist, and Registered Social Workers)

A combined maximum of $65 per visit for 15 visits per person, per policy year.

A combined maximum of $65 per visit for 10 visits per person, per policy year.

Not included

Speech Pathologist/Therapist

A combined maximum of $45 per visit for 10 visits, per person, per policy year.

A combined maximum of $45 per visit for 10 visits, per person, per policy year.

A combined maximum of $45 per visit for 5 visits, per person, per policy year.

Ambulance

Unlimited

Unlimited

$2,000 / person / year

Air Ambulance

Unlimited

Unlimited

Unlimited

Hearing Aids

$800/5 years

$500/5 years

Not Included

Casts & Crutches

Unlimited

Unlimted

Unlimited

Health Supplies & Equipment (splints, braces, air casts, shoulder immobilizers & more)

$500 per person per year

$500 per person per year

Not included

Annual Travel (Emergency Medical Insurance while traveling

30 days coverage outside Canada

183 days within Canada

$2,000,000 annual maximum

$500,000 COVID-19 coverage within the policy’s annual maximum

48 or 63 days coverage outside Canada

183 days within Canada

$2,000,000 annual maximum

$500,000 COVID-19 coverage within the policy’s annual maximum

Not included

Diabetic Supplies & Equipment

$300 per person per year

$300 per person per year

Not included

Oxygen Equipment

$500 / person/year to a lifetime maximum of $2,500

$500 / person/year to a lifetime maximum of $1,500

Not Included

Blood Pressure Monitors

1 per policy per 5 years

1 per policy per 5 years

Not included

Custom Made Foot Orthotics

80% 1 per 3 years / adult; 1/year for children under 16

80% 1 per 5 years / adult; 1/year for children under 16

Not included

Orthopedic Shoes

$225 / person / year

$225 / person / year

Not Included

Mobility Aids

$300 / person / year

$300 / person / year

Not included

Ostomy Supplies

$300 / person / year

$300 / person / year

Not included

Preferred Hospital Room

45 days up to $3,500 / person / year

$1,000 / person / year

$500 / person / year

Private duty

80% to $5,000 / person / year for in-hospital or in-home nursing.

80% to $3,000 / person / year for in-hospital or in-home nursing.

80% to $1,500/ person / year for in-hospital nursing.

Accidental Dental

$5,000 / injury

$2,000 / injury

$500 / injury

Wheelchairs, Motorized Scooters & Adjustable Beds

$1,000 / person / 5 years

$750 / person / 5 years

$500 / person / 5 years

Prosthetic Appliances

Artificial limbs, eyes, breasts, and surgical bras

Artificial limbs, eyes, breasts, and surgical bras

Artificial limbs, eyes, breasts, and surgical bras

Patient Walkers

80% of purchase or rental to a maximum of $300 / person / 5 years

80% of purchase or rental to a maximum of $300 / person / 5 years

80% of purchase or rental to a maximum of $300 / person / 5 years

LifeWorks

Included

Included

Included

 

Click here to Get a GMS Health Benefits Quote

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