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How health insurance works

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Personal health insurance helps people who don’t have group benefit coverage. This insurance may cover the cost of things provincial health-care plans may not pay for.

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We offer a choice of plans to suit your needs and budget.

What is personal health insurance?

Personal health insurance is coverage that can help Canadians or those living in Canada cover the cost of eligible preventative care or medical bills due to an illness.

It’s also known as individual health insurance or dental insurance. This insurance helps Canadians or those living in Canada cover the cost of preventive care or medical bills due to an illness. It can help pay for several health-related expenses, including:

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Personal health insurance

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A beginner’s guide to health insurance - 2023

Navigating the world of health insurance can be daunting, but it's an important aspect of maintaining your overall well-being. Most people invest in Personal Health Insurance (PHI) not just as a safety net for unexpected health challenges, but primarily to afford regular health services such as dental, vision, Registered Massage Therapy (RMT), physiotherapy, and psychology services, among others.

These services are crucial for maintaining one’s well-being and can quickly add up without insurance.

This guide will walk you through the ins and outs of health insurance, helping you understand how it works, what it covers, and why it's an essential investment for your well-being. Let's dive deeper into the importance and benefits of personal health insurance.

What is health insurance?

Personal health insurance is a coverage plan designed to help cover the cost of covered medical and health-care expenses. Beyond this basic definition, it represents a shield that safeguards our health and financial stability.

Example : Julia, a self-employed individual, invests in personal health insurance for comprehensive coverage. She breaks a leg, needs ambulance to emergency, needs pain medications and a walker after surgery and hospital stay. She also needs physiotherapy after the cast is removed. In this case the plan may cover ambulance, semi-private hospital room, prescription medications, walker and physiotherapy.

It can help pay for eligible health-related expenses, including:

  • Prescription drugs to treat a chronic or serious health condition
  • Dental treatments such as teeth cleanings, braces, dentures and crowns
  • Vision-care needs such as eye exams and prescription glasses
  • Emergency travel medical services when you travel to another country
  • Physiotherapy to help with injury recovery
  • Medical equipment to help with your mobility

Why choose health insurance?

When considering health coverage, the question of necessity often arises. Why choose personal health insurance? 

Financial protection against health hazards

The financial impact of medical expenses can still be considerable, even with personal health insurance. With the rising health-care expenses, insurance cushions the blow, making it feasible to access necessary medical services.

Comprehensive health coverage

A significant benefit of personal health insurance is its broad coverage. It includes hospitalization, emergency services, prescriptions, and sometimes even dental and eye care. Such coverage ensures that you're protected against a range of health issues.

Do I need personal health insurance even with government health-care?

Yes, even with government health-care, personal health insurance can be beneficial. Government-provided health-care often covers basic medical services, but it may not include specialized treatments, certain medications, or preventive services. Personal health insurance fills these gaps, providing comprehensive coverage that ensures access to all necessary health-care services.

Types of health insurance plans

The beauty of personal health insurance lies in its diversity. There are multiple plans available to cater to various needs such individuals and families, and from young professionals those entering retirement.

Individual health insurance plans

Individual health insurance plans can help cater to the health needs of a single person. They offer a range of coverage options, ensuring that every individual can find a plan that suits their unique needs and lifestyle.

Family health insurance plans

Family health insurance plans can help cover the entire family under a single policy. It provides a holistic coverage approach, protecting all members and offering peace of mind.

How do I choose the right health insurance for me?

Choosing the right health insurance involves a careful analysis of your health needs, lifestyle, and financial capacity. Here's a guide to help you make an informed decision.

Evaluate your health-care needs

Start by evaluating your health-care needs. Consider factors such as your age, current health status, potential genetic risks, and any ongoing treatments or medications. If you have a family, consider their health needs as well.

Understand your financial capacity

Your financial capability plays a crucial role in choosing a health insurance plan. Assess how much you can afford to spend on premiums, deductibles, copayments, and out-of-pocket maximums.

Explore different plan options

Health insurance plans come in various forms, including individual, family, and senior plans. Understand the benefits and limitations of each type to determine which one suits your needs best.

Review the coverage

Review the plan's coverage details carefully. Ensure it covers the health-care services you anticipate needing, such as hospitalization, prescription medications, preventive services, and potentially mental health services.

Consult a professional

If you find it challenging to navigate health insurance options, consider consulting with a professional. An insurance broker or agent can provide valuable insights and help you find a plan that fits your needs and budget.

Frequently asked questions (FAQ)

What services are typically covered by personal health insurance?

While coverage can vary by policy, typical services covered by personal health insurance include:

  • Prescription drugs to treat a chronic or serious health condition
  • Optional dental benefits may cover treatments such as teeth cleanings, braces,
dentures and crowns
  • Vision-care needs such as eye exams and prescription glasses
  • Some plans include emergency travel medical services when you travel to another country
  • Covers a wide range of paramedical services for your well-being
  • Medical equipment to help with your mobility

Who can personal health insurance cover?

Personal health insurance plans cater to various situations:

  • Single person: Individual health insurance
  • Family: Family health insurance

How can I apply for personal health insurance?

The process of applying for personal health insurance typically involves deciding on the type of plan, filling out an application form, undergoing medical underwriting, and awaiting policy approval.

How does personal health insurance contribute to wellness?

Personal health insurance plays a critical role in promoting wellness. It allows you to access necessary medical services without worrying about costs, encourages preventive care, and provides peace of mind, all of which contribute to overall well-being.

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