Health Insurance, Explained
Provincial health plans cover a lot, but not everything. Here’s what supplemental health insurance actually fills in, and how to figure out if you have a real gap.
What supplemental health insurance actually is
Everything to know about health and dental insurance
Who it is for
- Families without a workplace benefits plan
- Self employed people and contractors
- Newcomers whose employer plan has not started yet
- Retirees who have lost group benefits
How it works
- You pick a plan with drug, dental, vision and paramedical options
- You pay a monthly premium and may have a deductible or co-insurance
- You claim online, or the provider bills the insurer directly
- The plan works alongside your provincial health coverage, not instead of it
What affects the cost
- The level of drug, dental and vision cover
- Deductibles and annual maximums
- Age and family size
- Whether pre-existing conditions are covered
Common mistakes to avoid
- Assuming provincial plans cover dental and prescriptions fully
- Not checking annual maximums for dental and paramedical care
- Overlooking waiting periods on major dental work
- Buying more cover than you will use
A self employed family of four chooses a plan with drug and dental cover so orthodontic and prescription costs are predictable. Illustration only.
Questions people ask
Does health insurance replace my provincial plan?
No. It supplements it by covering things provincial plans usually do not, such as many prescriptions, dental, vision and physiotherapy, depending on your province.
Is there a waiting period?
Some plans have waiting periods for certain services such as major dental work. We check this before you apply.
Can I get coverage with a health condition?
Many plans accept applicants with health conditions, sometimes with exclusions. We compare options that fit your situation.
What’s typically covered, and what to check
| Category | Typical coverage | Watch for |
|---|---|---|
| Prescription drugs | 70 to 100% up to an annual max | Formulary, some plans exclude newer/brand-name drugs |
| Dental | Basic cleanings/fillings; major work often extra | Waiting periods before major/orthodontic coverage kicks in |
| Vision | Set dollar amount every 1 to 2 years for glasses/contacts | Frequency limits, not full replacement cost |
| Paramedical | Physio, massage, chiro, psych, per-practitioner annual caps | Caps are often per practitioner type, not one pooled amount |
| Hospital | Semi-private or private room upgrade | Only pays the room upgrade, not the hospital stay itself (already covered provincially) |
Quick coverage-gap check
Common mistakes
- 01 Buying a duplicate plan without checking what a spouse’s workplace plan already covers.
- 02 Not checking the drug formulary before assuming a specific medication is covered.
- 03 Letting coverage lapse between jobs, which can trigger new waiting periods or health questions on the next application.
- 04 Ignoring per-practitioner paramedical caps and being surprised when a $2,000 “paramedical” limit turns out to be $500 per type of therapy.
- 05 Assuming provincial coverage includes dental or vision, in almost every province, it doesn’t for working-age adults.
Frequently asked questions
Can I get supplemental health insurance if I’m self-employed?
Yes, this is one of the most common reasons self-employed Canadians buy an individual health plan, and premiums may be tax-deductible as a business expense in some structures. Talk to your advisor and accountant about how your specific business is set up.
Is there a waiting period before I can make a claim?
Many individual plans have a waiting period (commonly 30 to 90 days) before certain benefits like dental or paramedical claims are payable, especially for major dental work. Emergency and drug coverage often start sooner. Always check the specific policy’s effective dates for each benefit category.
Do pre-existing conditions affect my application?
Depending on the plan (guaranteed-issue vs. medically underwritten), a pre-existing condition can lead to an exclusion, a higher premium, or in some cases a decline. Guaranteed-issue plans accept everyone but usually have lower benefit maximums.
What happens to my coverage if I retire?
Most employer health plans end at retirement unless your employer specifically extends retiree benefits. This is one of the most common times people buy an individual health plan, ideally arranged before your group coverage ends to avoid a coverage gap.
Can I cover my whole family on one plan?
Yes, most individual health plans offer family rates that cover a spouse and dependent children under one policy, usually at a lower combined cost than separate individual policies.
Not sure what gaps you actually have?
Manpreet can review what you’re covered for today and show you exactly where a supplemental health plan would help.
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