# Thursday, August 8, 2013
Health Insurance QuestionsHealthQuotes.ca is a nationally licensed Canadian health insurance brokerage, and as such we get many questions from Canadians regarding health insurance.

All Canadian citizens are eligible for a provincial health care plan which is specific to each Canadian province and each provincial plan differs in the types and amounts of healthcare offered. In addition these plans change, and the latest trend is an overall decrease in coverage.

Many Canadians don’t know what their provincial plan covers and also wonder what role private, individual health insurance plays in all of this.

This Question and Answer blog article covers the most common health insurance questions we are asked.

Why Might I Need Private Health Insurance?

Provincial healthcare plans such as OHIP and AHCIP do not cover all health costs. Doctor visits are usually covered as are necessary medical procedures. (For a summary of provincial plans use the links at the bottom-left of the main web site.)

Generally speaking the following costs are not covered by provincial healthcare plans but are covered by private health insurance:
  • Routine dental procedures such as examinations, cleanings and fillings.
  • Major dental such as orthodontics, periodontics, crowns and dentures.
  • Prescription drugs.
  • Paramedical practitioners such as naturopaths, chiropractors and massage therapists.
  • Vision care such as optometrist fees, prescription glasses and contact lenses.
  • Semi-private and private hospital rooms.
  • Extended travel medical benefits (many provincial plans do have short-term coverage).
  • Ambulance costs (land and air ambulance transportation).
  • Accidental death and dismemberment.

What are the Typical Benefits of Individual Health Insurance?

Typically a personal Canadian health insurance plan offers the following coverage:
  • Dental (routine and major procedures).
  • Prescription drugs.
  • Visioncare.
  • Hospital rooms.
  • Ambulance transportation.
  • Homecare and nursing.
  • Paramedicals such as massage therapists, psychologists and speech therapists.

Are Birth Control Pills Covered by Health Insurance Plans?

This depends on the insurance company and plan. Some plans do cover contraceptive costs, while others do not.

Here are just some plans that do cover birth control pill costs:

Can I Get Drug or Dental Only Plans?

It is possible to get a health plan that does not have dental or drugs, but this is dependent on the insurance company and specific plan. Some plans are more flexible than others and sometimes prescription drug and dental benefits are not optional.

Most individual health plans come with core health benefits that cover things like visioncare, paramedical practitioners, homecare and nursing, and accidental dental (only covers damage due to an accident).

What Prescription Drugs are Covered?

The following summarizes prescription drug eligibility:
  • Prescription drugs with a DIN # ( drug identification number) prescribed by a doctor.
  • Fertility drugs are generally excluded, except in the Manulife Flexcare Enhanced plans.
  • Some life style drugs and experimental drugs that have not been approved by the Medical Association are excluded.
  • Some mixed drugs that have an SN number but no DIN number are not covered.
  • Over the counter drugs are not eligible.
  • Oftentimes reimbursement of prescription drug costs is based on the lowest-cost generic equivalent if it is available (although this is plan dependent).

What About Pre-Existing Conditions?

If you have one or more pre-existing health conditions than you have two options available to you:
  1. Apply for a medically underwritten individual health insurance plan and see what happens with the underwriting. Usually the pre-existing conditions are excluded (e.g. not covered). In some cases an applicant may be deemed too high a risk and declined outright.
  2. Apply for a guaranteed health insurance plan that does not involve any medical questions. Acceptance is guaranteed and all pre-existing conditions will be covered. The drawback to no medical health insurance plans is that they offer less coverage for the same amount of premium as compared to medically underwritten plans.


We hope you found this article helpful! If you have any questions about Canadian health insurance please do not hesitate to call us toll-free at 1-800-474-4474.

RSS 2.0