Am I Covered? When is Supplemental Health Insurance Necessary?

According to the Canadian Life and Health Insurance Association (CLHIA), 25 million Canadians have supplemental health insurance. Canadians may receive supplemental health insurance through their employer, or they can buy their own coverage to suit their needs.

Health plans in each province pay for basic medical care and hospital costs, but not every health-related cost is covered by your province's health plan. For example, OHIP won't pay for cosmetic surgery, dental, or chiropractic services. The province will only cover part of the costs for some procedures like eye exams, and will pay for some, but not all, prescription medications.

What expenses can supplemental health insurance cover?

Depending on your provincial health plan and its policies, you may need services that the plan doesn't cover. According to the CLHIA, in 2018, private supplemental insurance paid $29.2 billion in claims. The payments covered dental costs, medical and hospital costs not covered by provincial plans, and prescription drugs.

Some costs that supplemental health insurance can cover include prescription eyewear, dental procedures (not only cosmetic), and registered therapists and specialists. If you require emergency healthcare and transportation, supplemental health insurance will cover these costs, which are generally not covered under provincial health plans. You may also use the supplemental insurance for upgrades, like a semi-private hospital room or insurance coverage while you're traveling.

What do I need to know about specialty drugs and supplemental health insurance?

Specialty drugs are drugs which are not yet covered by provincial health plans. Specialty drugs are generally newer drugs that may be prescribed for chronic and/or complex health conditions. Many of them are biologics, which are a newer form of drug that often require special handling or controlled temperatures.
While many drug companies offer patient assistance programs (PAPs) for new drugs while they are going through provincial approval, these programs don't cover all necessary costs. Supplemental health insurance may be able to cover the cost of specialty drugs when necessary.

When is supplemental health insurance necessary?

Not every Canadian employer offers a group benefits plan that includes supplemental health insurance, and some employers may offer share-of-cost plans which may not offer the benefits you want or need. Or, you may be about to retire and will no longer have supplemental health coverage through your employer.

An increasing number of Canadians are self-employed. According to the Globe and Mail, more than 3 million Canadians were self-employed in 2018, and by 2020, 45 percent of Canadians are expected to be earning self-employment income, either part- or full-time. If you're self-employed, getting supplemental health insurance makes good sense. You can receive coverage for unexpected medical costs that aren't covered by your provincial health plan. You can also receive coverage for dental, eye, prescription, and paramedical services.

Learn more about your options and compare the best health insurance plans that will fit your needs through Kanetix.com.