You are probably already covered by the government-sponsored OHIP if you live in Ontario. Once admitted, you get an Ontario health card that allows you to go to a doctor, clinic, hospital, or emergency room, get medical care, and undergo tests and procedures. Free surgeries.
However, OHIP only covers some medical services, such as prescription drugs and vision care, or not at all. It does not cover dental care. To pay for medical and dental care not covered by OHIP, you might consider purchasing extended medical care insurance, comprehensive health care insurance, a private health insurance plan, and supplementary dental care insurance.
You could get additional health and dental insurance through your employer called coinsurance, or choose to purchase individual insurance policies. Supplemental health and dental insurance allow you to get the medical services you need at an affordable price.
How does extra insurance work?
Supplemental health and dental insurance policies are contracts between you and an insurance company. You agree to pay an annual or monthly fee called a premium, and the company agrees to pay the benefits that are insured under the policy. The policy will specify inclusions and exclusions.
Here are some standard provisions of supplementary health and dental insurance:
- Most policies do not cover all medical expenses. You may have to pay part of the medical costs for yourself and your dependents. This is called the deductible. Each policy is structured differently and may have family deductibles (e.g., the first $75 of eligible expenses for two insured members at the start of each year) or service deductibles (e.g., $5 per drug prescription).
- Some plans have coinsurance conditions in addition to the deductible. Thus, you must pay a percentage of medical expenses or coinsurance and the deductible. Coinsurance can be set at 10% of eligible medical expenses or higher and can vary depending on the type of medical service needed.
- In addition, dollar or percentage limits, or maximums, could be set for the number of benefits received. Maximums can apply to specific health care benefits, such as eyeglasses or massage therapy sessions, for a given period, usually within a year or life.
Deductible, coinsurance, and maximums can affect how much you pay. To reduce costs, you may be able to coordinate benefits with your spouse or partner if they also have extended health and dental insurance. Read your policy carefully to understand what fees you must pay yourself and which policy will pay first.
What is and is not covered by OHIP
Before you decide if you need supplemental health and dental insurance, you need to know what kind of services OHIP covers. Essential services covered include the following:
- Visits to the doctor;
- Hospital visits and stays;
- Health care travel for residents of Northern Ontario.
In general, OHIP does not cover the following:
- Prescription drugs prescribed in a non-hospital setting, including antibiotics, pain relievers, and certain medications to treat cancer;
- Special non-emergency medical services, including those of a chiropractor or massage therapist;
- Single and double bed hospital rooms;
- Specific medical examinations, tests, and vaccinations;
- Dental care.
Do you need supplementary medical or dental insurance?
If you are young and healthy, you may not need supplemental insurance. It depends on whether you have coverage through OHIP, a group plan, or a parent’s group plan. For example, since January 2018, OHIP has offered prescription drug coverage to youth 24 and under who do not have private insurance coverage. These children and youth can receive over 4,400 prescription drugs free of charge by presenting their health care and the prescription. Coverage is automatic, with no initial cost to pay. Only you can decide what amount is right for you; however, an insurance agent or company can help you make these decisions.