- What do supplementary health and dental insurance cover?
A: Supplementary health insurance covers medical treatments and supplies that the Ontario Health Insurance Plan (OHIP) doesn’t cover. This may include things like prescription drugs, dental hygiene cleanings, private hospital rooms, vision care, and medical services like chiropractors, physiotherapists, podiatrists, massage therapists, and many others. Supplementary dental insurance covers things like dental hygiene cleaning and braces. For more information about what supplementary health and/or dental insurance policies cover, visit Types of Supplementary Health and Dental Insurance.
- How do supplementary health and/or dental insurance work?
A: Supplementary health insurance and dental insurance, like all types of insurance, work by spreading the financial risk among a large group of people, who pay into a pool or fund. Spreading risk in this way minimizes the costs associated with unexpected events like medical treatments. If you have supplementary health and/or dental insurance through your employer, the employer may pay the premiums, and you get the benefits. If you purchase individual insurance, you pay the premium yourself. For more information on how insurance works, visit Supplementary Health and Dental Insurance 101: Getting Started.
- Can I replace OHIP with supplementary health insurance?
A: If you’re a resident of Ontario, you can’t completely replace OHIP with private insurance, but you can buy supplementary health insurance that covers the medical expenses that OHIP doesn’t cover. If you are a newcomer to Ontario, or are returning to Canada after a prolonged absence, you may not yet be eligible for OHIP. In that case, you may want to purchase supplementary health insurance until your OHIP takes effect (usually 3 months). To learn more about purchasing supplementary health insurance, visit Shopping around for Supplementary Health and Dental Insurance.
- Does supplementary health insurance and/or dental insurance cover 100 per cent of my medical expenses?
A: Most supplementary health insurance and dental insurance policies don’t cover 100 per cent of your expenses. You probably have to pay some of the expenses at the beginning of the year (deductible), as well as a percentage of medical expenses on top of the deductible (co-insurance). You may also have dollar or percentage limits placed on the amount of benefits you can receive (maximums). To learn more about deductibles, co-insurance and maximums, visit Supplementary Health and Dental Insurance 101: Getting Started.
- I have health benefits through my employer. Should I get my own health insurance?
A: The amount of insurance you need is a highly personal decision. You need to know exactly what your employer’s group plan covers, and what it doesn’t. If you have medical needs that are not met by your combined OHIP and employer’s plan, you might want to speak with an insurance agent or company about buying your own supplementary health or dental insurance. For example, if your employer’s health benefits only cover a certain percentage of your chiropractic visits, you may want to consider your own supplementary health insurance plan.
- I am healthy and have OHIP coverage. Do I need supplementary health insurance?
A: The amount of insurance you need is a highly personal decision. OHIP is great for most basic medical needs, but there are a lot of things that OHIP doesn’t cover. If you need vision care (eyeglasses, contacts, and laser eye surgery), prescription drugs, orthotics, dental care or medical appliances, you will have to pay for them yourself. The costs can really add up. To learn more about what OHIP covers, or doesn’t cover, visit Supplementary Health and Dental Insurance 101: Getting Started.
- What is the difference between a group health and/or dental insurance plan and an individual plan?
A: Group insurance is usually offered through an employee benefits package or membership in a professional association. If your employer offers coverage, they will likely pay the premiums. If you get supplementary health insurance through an association, you will have to pay the premiums yourself. Everyone covered under these plans receives the same basic coverage. If you purchase your own individual health insurance, you can choose the features that are important to you, depending on how much you need and how much you can afford. For example you could just buy a supplementary dental care plan. You will pay the premiums, deductibles, and co-insurance yourself. For more information about different policy types, visit Types of Supplementary Health and Dental Insurance.
- Does my age affect my supplementary health insurance premiums?
A: Yes. Buying private insurance when you are younger can reduce your premiums because younger people usually present a lower risk to the insurance company. For more great questions to ask about your supplementary health insurance, visit Questions to Ask about Supplementary Health and Dental Insurance.
- My partner has health insurance through his employer, and I am covered as well. Should I get my own supplementary health insurance?
A: Make sure you check your partner’s plan carefully to understand exactly how much coverage you have. If you feel that you need more coverage than the plan offers, you should speak with an insurance agent or company about purchasing a supplementary plan. They can tell you how you can ‘coordinate benefits’ and which plan pays first. For more information visit Working with an Insurance Agent or Company.
- How do I get supplementary health and/or dental insurance?
A: You may have health and/or dental insurance through your employer or association or you can purchase them directly from an insurance company or agency, or through an insurance agent. If you are buying your own individual plan, review the information on selecting an insurance agency or company in Working with an Insurance Agent or Company.
- I have supplementary health insurance, but I am confused about my policy. What should I do?
A: If it is a Group policy through your employer we recommend calling your Human Resources representative. If an individual plan is confusing you, call your insurance agent or company with any questions you may have. They should be able to provide you with answers in plain language so you can understand your policy. Consider using FSCO’s Questions to Ask About Supplemental Health and Dental Insurance to help guide your conversation.
You may also want to review FSCO's Nine Tips on How to Read Your Supplementary Health or Dental Insurace Policy. This will guide you through your policy and help you know what to look for.
You may be interested in...
Supplementary Health and Dental Insurance 101: Getting Started: learn more about the common features of supplementary health and dental insurance plans.
Financial Literacy Portal: your one-stop shop for links to other great financial information.
Types of Supplementary Health and Dental Insurance: make sure your policy is the right one for you.
Questions to Ask About Supplementary Health and Dental Insurance: use our checklist to ask the right questions about your policy.
Supplementary Health and Dental Insurance Glossary: to better understand common supplementary health and dental insurance terms, refer to this glossary.