Supplementary health insurance

Supplementary health insurance plans typically cover a range of expenses, including prescription drugs, dental care, vision care (e.g., eyeglasses, eye exams), paramedical services (like physiotherapy, massage therapy, chiropractic care), medical equipment and supplies, and sometimes out-of-province or out-of-country emergency medical expenses.

You can obtain supplementary health insurance through various avenues. Many Canadians have access to it through their employer's group benefits plan. If not available through an employer, you can purchase individual supplementary health insurance directly from insurance companies. Group plans may also be available through professional associations, unions, or other organizations.

Yes, there are different types of supplementary health insurance plans. Group plans, often provided by employers, offer benefits to a group of people. Individual plans are purchased directly by individuals. Coverage and costs can vary significantly between different plans and providers.

When choosing a supplementary health insurance plan, consider your individual or family's healthcare needs and budget. Look at the types of services covered, the extent of coverage (e.g., deductibles, co-pays, maximum limits), the cost of premiums, and any restrictions or exclusions. It is recommended that you compare different plans and get quotes.

These are common terms related to how you share the cost of healthcare with your insurance provider.

A deductible is the amount you must pay out-of-pocket before your insurance coverage begins.

A co-payment is a fixed amount you pay for a covered healthcare service after you've met your deductible.

Coinsurance is a percentage of the cost of a covered healthcare service that you pay after you've met your deductible.

When you receive a healthcare service covered by your supplementary insurance, you typically submit a claim to your insurance provider for reimbursement. This may involve submitting receipts and claim forms. Some providers offer direct billing, where they pay the healthcare provider directly for their portion of the cost.

In some cases, particularly with individual plans, pre-existing medical conditions may affect your ability to obtain coverage or result in limitations or exclusions related to those conditions.

Group plans typically have fewer restrictions regarding pre-existing conditions, especially during initial enrollment periods. It's important to disclose any pre-existing conditions when applying for insurance.

Understanding the cancellation provisions of your supplementary individual health and dental insurance policy is crucial because it protects you from unexpected issues and potential financial loss. Knowing these terms helps you avoid dangerous gaps in your coverage if you switch plans or your circumstances change, ensuring you don't face significant out-of-pocket expenses for necessary medical or dental care. It also informs you of any potential fees, penalties, or impacts on your ability to get future insurance coverage, especially if your health status has changed.

The cancellation provisions provisions outlines how and when the policy can be cancelled, including the required notice period and whether you're eligible for any premium refunds. They also detail the conditions under which the insurance company can cancel your policy, typically related to non-payment or fraudulent activity.

Familiarizing yourself with these details, including any initial "free look" or rescission period, empowers you to make informed decisions about your coverage and manage your policy effectively throughout its term.

Your age and health status are significant factors when applying for supplementary health insurance in Canada because they directly influence both your eligibility and the cost of your premiums. Insurance companies use this information to assess the potential risk of paying out claims.

Generally, older applicants or those with pre-existing health conditions may face higher premiums, have certain conditions excluded from coverage, or have waiting periods before coverage for those conditions begins. Being younger and in good health typically allows access to more plan options at lower costs.

Glossary of Key Terms:

Supplementary health insurance: Private insurance that covers health care expenses not fully covered by provincial government health plans.

Provincial health plans: Government-funded healthcare programs in Canadian provinces that provide basic medical coverage.

Waiting period: A set amount of time after a policy begins during which certain benefits are not available.

Deductible: A fixed amount that the policyholder must pay out-of-pocket before the insurance company starts covering eligible expenses.Co-payment: A fixed fee paid by the policyholder for a specific service.

Policy maximum: The maximum amount that the insurance company will pay for eligible expenses within a specific timeframe or for a specific service.

Premiums: The regular payments made by the policyholder to the insurance company to maintain coverage.

Exclusions: Specific services or conditions that are not covered by the insurance policy.

Cancellation provisions: The terms and conditions under which an insurance policy can be cancelled.

Eligibility: The requirements that must be met to qualify for supplementary health insurance coverage.

According to the Canadian Life and Health Insurance Association (CLHIA)'s guide to supplementary health insurance, while government plans cover core services like hospital stays (ward level) and physician services, they generally do not fully cover "non-core" services.

These often include expenses for prescription drugs, semi-private or private hospital rooms, special nursing services, ambulance services, medical costs incurred outside of Canada, artificial limbs and medical appliances, and various paramedical services such as those provided by chiropractors, physiotherapists, and optometrists. Dental services and vision care expenses like eyeglasses and contact lenses are also typically not fully covered by government plans and are commonly addressed by supplementary insurance.