Supplemental Health Insurance

Even though all citizens of Canada are provided with access to medical care by the Canadian government’s federal and/or provincial programs, these programs do not provide coverage for every health condition or situation.

Why should I buy supplemental health insurance?

Vision and dental coverage under the various provincial plans range from comprehensive coverage to no coverage at all. Prescription drug costs are usually covered up to a specified percentage, depending on the province of residence. Children, seniors, and social assistance recipients are provided with additional coverage by the government healthcare system for health services such as vision and dental care, prescription drugs, medical equipment, and treatment provided by specialized medical professionals. Those individuals that are not part of these three groups must provide for themselves. Additional coverage can be obtained by purchasing supplemental health insurance.

Since coverage for the health services listed above vary by province/territory, it is important that you determine what your government plan covers, what it does not, and what types of coverage might be worth obtaining through supplemental health insurance. Without supplemental health insurance to offset the often high costs of health services not covered by the government programs, you can end up with potential financial concerns.

What should I look for in a supplemental health insurance plan?

Most supplemental plans will pay from 40% to 80% of the cost of healthcare needs such as dental and vision care, psychologists, podiatrists, chiropractors, hearing aids, certain medical equipment, and health coverage while traveling outside of Canada. When researching supplemental health insurance, asking the right questions will ensure that you get the coverage your family needs at a price you can afford.

Below are some pertinent questions you should ask a potential insurance provider:

• Can I obtain coverage for my children, and what is the cost per child?
• Is coverage available for family members with special needs, and if so, what type of coverage is provided?
• Is coverage effective immediately upon approval of my application? If not, how long is the waiting period?
• Will I be covered in the event of an emergency prior to my waiting period ending?
• Does the plan cover preexisting conditions, and what is considered to be an existing condition?
• What exactly does the plan cover and what does it exclude?
• Does the plan provide coverage outside of Canada?
• Must I notify my insurance provider if I leave Canada for vacation or business purposes?
• How does the plan provide coverage over and above the government plan?
• How does my group health insurance coverage through my employer compare to the coverage of supplemental health insurance?
• Does the plan cover visits to specialists or special procedures, and what steps do I have to take prior to consulting with a specialist?
• Does the plan cover prescription eye glasses/contacts, and if so, up to what amount?
• Does the plan cover dental care, and if so, what is the coverage?
• How do I file a claim, and how and when do I receive reimbursement for my claims?
• What type of prescription drug coverage is provided by the plan, and are there instances whereby a prescription drug would not be covered?
• What will be the monthly cost of the plan, and what methods of payment are accepted?
• What happens if I accidentally miss a payment?
• Are there co-insurance or co-payments that I should be aware of?
• Is there a deductible that applies to the plan, and if so, how much is it?
• How do I know when I have met the deductible?

While the process of researching and purchasing supplemental health insurance may seem tedious and time-consuming, the effort is worthwhile. It will ensure your family’s well-being and alleviate potential financial difficulties in the event of serious illness or injury. It may be one of the wisest decisions you will ever make.

Adriana Stefania is a freelance writer for www.canada-health-insurance.com. For more information on health insurance for Canadians please visit www.canada-health-insurance.com.