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SUPPLEMENTARY HEALTH AND DENTAL INSURANCE 101: GETTING STARTED

The Greatest Wealth is Health

Considering supplementary health or dental insurance? There are things you need to understand/know. Watch our video to learn more.

Descriptive transcript: The Greatest Wealth is Health open new window

What is Supplementary Health and Dental Insurance?

If you live in Ontario, you are probably covered under the government-funded Ontario Health Insurance Plan (OHIP). When you are approved for OHIP, you’ll get an Ontario health card which enables you to go to a doctor, clinic, hospital or emergency room, and receive medical attention, tests and surgeries at no cost to you.

But OHIP only partially covers or doesn’t cover some medical services like prescription drugs and vision care, and it does not cover dental care. To pay for medical needs and dental care that OHIP doesn’t cover, you may want to consider purchasing supplementary health insurance; also known as extended health insurance, or private health insurance, and supplementary dental insurance.

You might have supplementary health and dental insurance through your employer, known as group insurance, or you may decide to buy your own policies, known as individual insurance. Supplementary health and dental insurance is a way to get the medical services you need, at an affordable price. To find out more about the different types of supplementary health and dental insurance, visit Types of Supplementary Health and Dental Insurance.

How does it work?

Supplementary health and dental insurance policies are contracts between you and an insurance company. You agree to pay a yearly or monthly fee called a premium, and the company agrees to pay the benefits which are covered under your policy. Your policy will outline what is included and what is not.

Here are some common features of supplementary health and dental insurance:

  • Most policies do not cover 100 per cent of your medical expenses. You may have to pay some of the medical expenses you and your dependants incur. This is known as the deductible. Each policy is structured differently and you might have family deductibles (e.g., the first $75 in eligible expenses for any two covered family members at the beginning of each year) or per service deductibles (e.g., $5 per drug prescription).
  • Some plans have a co-insurance feature in addition to the deductible. That means you have to pay a percentage, or co-insure, the medical expenses on top of your deductible. It could be 10 per cent of the eligible medical expense, or higher, and it may depend on the type of medical service required.
  • You may also have dollar or percentage limits, or maximums placed on the amount of benefits that you can receive. Maximums can apply to specific health benefits like eyeglasses or massage therapy sessions in a specified period; typically a year, or during your lifetime.

Deductibles, co-insurance and maximums can affect the amount that you have to pay. To reduce costs, you may be able to coordinate benefits with your spouse or partner if they have supplementary health or dental insurance. Read your policy carefully to understand the expenses you are expected to cover yourself and which policy will pay first.

What OHIP Covers and What it Doesn’t

Before you can decide whether or not you need supplementary health and dental insurance, you should have an idea about the kinds of services OHIP does and doesn’t pay for. The basic expenses covered by OHIP include:

  • Visits to doctors
  • Hospital visits and stays
  • Travel for health services for residents of Northern Ontario

For a full list visit What OHIP Covers open new window.

What OHIP doesn’t typically cover:

  • Prescription drugs/medicines provided outside of hospitals such as antibiotics, painkillers, and some cancer drugs
  • Specified elective medical services such as chiropractors or massage therapists
  • Semi-private or private hospital rooms
  • Some medical exams, tests and vaccinations
  • Dental care

Do you need Supplementary Health or Dental Insurance?

If you are young and healthy, you might not need to buy supplementary health or dental coverage. It depends to an extent on what you are covered for under OHIP, a group plan or a parent’s group plan. For example, starting in 2018, OHIP will provide prescription drug coverage to youth 24 and under. Children and youth will be able to get more than 4,400 prescription medicines for free by showing their health card and prescription. Coverage will be automatic, with no up-front costs. Read the news release to find out more open new window. Check what you are covered for, take a look at your individual situation, and make a decision on whether what you have now is sufficient.

How Much Supplementary Health or Dental Insurance Do you Need?

There are a wide variety of supplementary health and dental insurance plans, each with their own level of coverage, but the amount of health insurance you need is a highly personal decision. Only you can decide how much is right for you, but an insurance agent or company may be able to help you make those decisions. Visit the “finding an insurance agent or company” section of Working With an Insurance Agent or Company to find someone who can help you.

Factors to consider when deciding how much coverage you need include:

  • How much can you afford to pay each month? Each year?
  • Do you have any other supplementary health insurance – through your employer, a parent’s group plan or a spouse/partner?
  • Do you require prescription drugs on an ongoing basis?
  • Are you willing to share a hospital room, or do you prefer a private room?
  • Do you wear glasses or contact lenses?
  • Do you receive medical services from professionals such as chiropractors or massage therapists?
  • Can you afford to pay out of pocket for ambulance fees?
  • Do you have a chronic illness that requires more extensive medical services than OHIP provides?
  • Do you have a pre-existing medical condition? Some supplementary health insurance plans do not cover this. Be sure to shop around to find an insurer who might.

Where do you buy Supplementary Health or Dental Insurance?

It is important to note that supplementary dental insurance policies are offered separately from supplementary health insurance, but you can often purchase them together. You can purchase supplementary health insurance through:

For more information about shopping for supplementary health insurance, visit Shopping for Supplementary Health and Dental Insurance.

Life, supplementary health and dental insurance risk assessment questionnaire

Think you don’t need life, supplementary health or dental insurance, or that you’ve got enough already? You might need to think again. It’s worth the three minutes this questionnaire will take to assess your needs and make a financial decision that’s in your best interest.

#FSCOAskTheExperts: Ask the Experts Online Q&A.

Questions to Ask About Supplementary Health and Dental Insurance: consider these questions to ask your employer, human resources representative, insurance agent or company about your health and dental insurance policy.

Financial Literacy Portal open new window: your one-stop shop for links to other great financial resources.

Working With an Insurance Agent or Company: understand what to expect when working with an insurance agent or company.

Types of Supplementary Health and Dental Insurance: learn what the different policy types are and what options you have.

Supplementary Health and Dental Insurance Glossary: to better understand common supplementary health and dental insurance terms, refer to this glossary.

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ABOUT FSCO

FSCO's legislative mandate is to provide regulatory services that protect the public interest and enhance public confidence in the sectors it regulates. FSCO regulates the mortgage brokering sector; insurance sector; pension plans; loan and trust companies; credit unions and caisses populaires; co-operative corporations in Ontario; and service providers who invoice auto insurers for statutory accident benefits claims. FSCO is accountable to the Minister of Finance.