Working with an Insurance Agent or Company

Supplementary health and dental insurance should be there for you when you need them most, and it’s a good idea to get professional advice before you buy any policy that is protecting your most important asset: your health. Whether you get that advice from an insurance agent or direct from an insurance company, here are some things you should know before you purchase a supplementary health and/or dental insurance plan.

What is an Insurance Agent?

In Ontario, insurance agents are people who are licensed and regulated by the Financial Services Commission of Ontario (FSCO) to sell a variety of insurance products including life, health and dental insurance. Some agents represent one insurance company, while others represent several insurance companies. To see if someone you want to work with is licensed, visit FSCO’s Agents Licensed in Ontario database. Alternatively, ask an insurance company for the name of an agent authorized to sell their product.

What is an Insurance Company?

An insurance company issues and sells comprehensive financial products including individual or group insurance policies to individuals and employers, and promises to pay benefits to holders of those policies. In Ontario insurance companies are licensed and regulated by FSCO. For a list of licensed companies visit FSCO’s Licensed Insurance Companies in Ontario database.

FSCO's Role

FSCO licenses and regulates insurance agents and companies in Ontario to ensure consumers are protected and to enhance their confidence in the insurance sector. If an insurance agent or company is licensed and regulated by FSCO it means that safeguards are in place to protect your consumer rights. For more information about your rights as a consumer, visit Rights and Responsibilities.

As well as checking that the insurance agent or company you want to work with is licensed by FSCO, you should also check FSCO’s Enforcement Online  database to see if any enforcement action has been taken against them in Ontario. Enforcement actions like having their license suspended, or being fined (Administrative Monetary Penalty) means that there have been some issues in regards to compliance with the law that were remediated through these sanctions. If a life insurance agent or company has an enforcement action against them you should ask what it is and how they will remediate it. You might also want to check out the Canadian Insurance Regulators Disciplinary Actions  database that offers public access to regulatory decisions issued by insurance regulators across Canada.

Finding an Insurance Agent or Company

Finding a professional to work with is an important step. Ask friends and family for recommendations or referrals. Other trusted advisors like the family lawyer or your bank manager can help too. You can also check the Yellow Pages, professional associations, articles from the media and annual reports from insurance companies online. You could even do a search of one or more of FSCO’s databases as a start. Make sure you call at least two or three agents or companies to and see if you feel comfortable with them. Focus on getting sound advice rather than the lowest premium.

Insurance Agent and Companies Responsibilities

Insurance agents and companies have obligations and responsibilities to you, the buyer.

They are required to:

• be licensed by the Financial Services Commission of Ontario to sell life, health and dental insurance in Ontario;
• comply with the Ontario Insurance Act ;

• if an agent, disclose to you in writing the names of providers of financial products, services, and insurers that they represent;
• if an agent, disclose to you in writing any conflicts of interest that they may have; and
• have purchased errors & omissions insurance (E&O) so that you are protected if they are negligent or make errors selling you an insurance product.

In addition to legal requirements, insurance agents and companies should follow industry best practices. They should:

• document their recommendations to you;
• keep records of your discussions;
• ensure that a licensed agent is always available for consultation during business hours;
• provide their contact information, registration number, and other information that you request; and
• draw your attention to all relevant information before you buy a policy.

What to Expect When Working with an Insurance Agent or Company

The insurance agent or company you select should:

• discuss your health and dental care needs and make policy recommendations to you;
• answer your questions in language that you can understand;
• arrange the purchase of health and/or dental insurance for you; and
• provide post-sale services like policy reviews and updates.

When you have selected your insurance agent or company, you should discuss your health and life situation with them, and identify what coverage makes sense for you. Any information you provide is kept confidential. Your insurance agent or company will guide you through the following:

1. Completing a health questionnaire

You might not need to have a medical exam, but you will probably have to complete a detailed health questionnaire. Be prepared to answer questions about your age, medical history and your family’s medical history.

2. Reviewing insurance options

The agent or company should present you with options and clearly explain the benefits of each one to you. Don’t feel pressured to accept the first one you hear. In fact, don’t work with an insurance agent or company who tries to sell you a policy without offering alternatives.

3. Submitting the application

The application asks for your personal information such as your name, address, etc., and it describes the type of insurance policy for which you are applying.

The application is sent to the underwriting department, where it is reviewed, the risk you pose is assessed, and a decision is made on whether the policy can be issued on the terms that you requested.

When you sign your application form, you authorize the insurance company to contact your physicians, hospitals and possibly the Medical Information Bureau (MIB) . The insurer cannot decline your application based on the MIB report, but they can use it as a basis to set premiums or request further information from you.

It is your responsibility before you sign the form to make sure that all information on it is correct. Providing false or misleading information can invalidate your policy. Ask for a copy of the application form so you have a record.

4. Getting the health and/or dental insurance policy

When you receive your policy(s), check all information carefully against your application form and report any errors. Visit Nine Tips on How to Read Your Health and Dental Insurance Policy to learn what to look for when reviewing your policy.

If your insurance company provides you with an insurance card for claiming purposes, you will likely receive it in the mail within the first month.

5. Post-sale service

Your agent or company will provide you with contact information as well as the insurance company’s information. You should be able to access a licensed agent for advice during business hours. If you need to alter a policy or need help with making a claim, contact your agent or company.

What to Do if You Have a Complaint

If you have a question or complaint about a service or product that you purchased, you should speak with your agent or the insurance company first and see if they can resolve the issue.

If you want to file a complaint about any unresolved insurance business activity, you can follow the three steps on FSCO’s website: How to Resolve a Complaint about Insurance .