Health Insurance FAQ

What do supplemental health and dental policies cover?

Supplementary health insurance covers treatments and supplies not covered by the Ontario Health Insurance Plan (OHIP). This can include prescription drugs, oral health cleanings, private hospital rooms, vision. It can also include ancillary care givers like chiropractors, physiotherapists, podiatrists, and massage therapists. Supplemental dental insurance usually handles cleanings and braces.

How do supplementary health and/or dental insurance coverages work?

Supplementary insurance is just like other insurance coverage in that it spreads the risk over a large group of people, who have paid premiums into a fund. If your supplementary insurance is provided through your employer, it will probably pay the premiums. If you have purchased individual coverage, you are responsible for the premium payments. If you pay the premiums, this can be used as a deduction when you file your taxes at the end of the year.

Can I replace OHIP with supplementary health insurance?

As a resident of Ontario, you cannot completely replace OHIP with private insurance. However, you can purchase supplementary health coverage to bridge the gap that OHIP doesn’t cover. Existing OHIP coverage is required prior to the purchase of supplementary coverage. New residents of Ontario can purchase emergency travel insurance to cover any emergency medical expenses until OHIP becomes active.

Does supplementary health and/or dental insurance cover 100% of my expenses?

Depending on the provisions of the plan, it can cover between 60% and 100% of the charges. There may also be maximum allowables shown as percentages or dollar amounts.

Since I have health benefits through my employer, should I get my own health insurance too?

This depends on your circumstances. You need to review what your employer’s plan covers and what it does not. If you have a coverage gap between OHIP and your employer’s plan, you may want to consult an insurance agent about purchasing supplemental coverage.

I am healthy and have OHIP, should I consider supplementary insurance?

That depends on your needs. OHIP covers the basics but does not cover vision, prescriptions, dental or medical appliances. Since these costs can accumulate quickly, you need to review your situation and possibly visit with an insurance agent.

What is the difference between group health plan and an individual plan?

Group insurance is generally offered through an employee benefits package or through membership in a professional association. Everyone under these plans are covered for the same basic expenses. Employers usually cover between 50% and 100% of the premiums. Coverage offered through a professional association usually means you are responsible for the entire premium payment.

When you buy your own insurance, you pick and choose the features that are important to you and how much you can afford. You are responsible for the entire premium payment yourself.

Does age affect the supplementary health insurance premiums?

Yes. If you are in an age group that reflect lower claim rates, your premium will be lower. Generally older ages are higher risk and the premiums are, in turn, higher. It is suggested that you discuss your options with an insurance professional to determine the rates.

My partner has health insurance through the employer and I am part of that coverage. Should I consider supplementary health insurance?

Plans vary. Review your partner’s employer’s plan to see exactly how much coverage you are entitled to. If you feel you need some supplement, speak with an insurance agent. The agent will also be able to advise how benefits are coordinated between the plans.

How do I get supplementary health and dental coverage?

You may be covered under health and/or dental through your employer or through a professional association. You can also purchase it directly through an insurance agent.

I don’t understand the policy for my supplemental health coverage. What should I do?

If it is a group policy through an employer, discuss it with Human Resources. If you have an independent policy, call your insurance agent or the company directly. Keep asking questions until you are sure you understand.