How to Choose Private Health Insurance in Canada Based on Your Healthcare Needs

By Your Health Magazine Contributor

Your Health Magazine Contributor

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How to Choose Private Health Insurance in Canada Based on Your Healthcare Needs

Private medical insurance can offer great support to you and your family however you will want to understand what medical costs you may be facing as well as what coverage your provincial/territorial plans may already provide. While your provincial/territorial healthcare plan can cover many essential medical costs you may still need to pay for prescription medication, dental treatment, eye treatment and certain paramedical treatments. By understanding your current medical requirements and comparing policies you can find an ideal plan to suit your current situation without paying for unnecessary coverage.

Assessing Current Healthcare Needs

A good way to start is to look at what medical costs you faced last year. By looking at your receipts you can see where you may want extra coverage. If you are regularly paying out of your own pocket for certain treatments you will want to look for policies that cover those. You can also get a realistic idea of how much you are paying for your medical treatments so you can compare it to your premium. This can help when looking for coverage to suit your needs.

Your medical requirements may change depending on age, family, work etc. For example, you may not visit the dentist regularly now, however in the future you may need more extensive treatment. If you have a long term condition you may rely on regular prescriptions and specialist appointments. It is important to consider these however try to be realistic with what you may need in the future. This will help you find a policy that will suit your needs going forward however try to avoid overestimating and paying for unnecessary coverage.

Understanding Provincial Healthcare Coverage

Provincial/territorial health insurance will generally cover necessary medical treatments in hospitals and from doctors. However prescription medication, dental treatments, eye treatments and paramedical treatments can vary a lot. By understanding what coverage you already have you can identify what areas you may want extra coverage. If you don’t have prescription coverage from your employer you may be facing high costs for ongoing prescriptions. Whereas if you do have extensive prescription coverage from your province you may not need it from a private policy. By looking at what coverage you already have from the government you can avoid paying for duplicate coverage.

Work can impact the type of private insurance you may need. If you have work based insurance you may already have prescription coverage, dental reimbursement, eye allowance and paramedical professionals. However there may be annual limits, percentage reimbursement and certain restrictions on what you can claim. Look at your insurance booklet to see what coverage you have and if you have coverage while you are changing jobs/retiring. You may also have the option to convert your group insurance to an individual policy if you leave your job. Knowing what coverage you have will help you find additional coverage.

Comparing Available Insurance Benefits

If you are regularly purchasing medication or require ongoing treatment it is important to look at what coverage is offered. Medication may vary between policies, with different amounts of reimbursement, annual limits, deductibles and requirements to use generic medication. Some policies may not cover certain medications and you may need approval for certain prescriptions. Compare what coverage you have to what you are currently paying for medication. If possible look at the medication list provided by the insurance company. If you are paying a low premium however you aren’t getting much coverage for expensive medication it may not be worth it. Look at what restrictions you have before taking out coverage so you know what you may be paying for.

Look at how often you will be using these and what the costs are. Some dental coverage may include regular check ups, cleans, fillings and more expensive treatments such as crowns/root canals. There can be limits on how much you can claim. Eye coverage may include reimbursement for eye checks, glasses and/or contact lenses up to a certain amount within a certain time frame. Look at the annual limits, waiting periods, percentage reimbursement and exclusions. If you only require basic dental treatments however your plan doesn’t provide much for extensive treatments it may be suitable for you.

Choosing Coverage for Individuals and Families

Look at what medical requirements you have as a family. Children may need regular dental check ups, orthodontics, prescription glasses and ongoing treatment. Adults may be more reliant on prescriptions, physio and specialist treatments. Family insurance can provide you with coverage for multiple people in your family. However look to see if everyone has the same limits, dependants may have age requirements and family deductibles. Compare what you need as a family to ensure you have coverage that will provide you with real benefits.

Marriage, having children, separation and changing jobs can affect your insurance requirements. If you are expecting a new child look at what prescription coverage you have, what medical equipment you are eligible for and what non-public treatments you have coverage for. If you have older children look at dependent requirements. When children reach adulthood or go to post secondary they may no longer qualify. Those nearing retirement may need to replace their work based coverage. Look at what policies you have to ensure you don’t have any gaps in your coverage. Look to see if there are any deadlines for adding dependants.

Evaluating Costs and Policy Restrictions

While the monthly premium is important to consider, you should also look at what you will be paying annually and how much you can expect to be reimbursed. If you have high prescription costs a policy with a higher premium may be worth it. Whereas if you only need occasional dental and eye treatments a low premium may be better. Take into account deductibles, co-payments, limits and what you will be responsible for paying. While you can’t be 100% sure how much you will be paying in the future you can look at a few realistic scenarios to see what policy will give you the best value for money.

Important terms will be included in your policy documents. Look at what waiting periods you have for certain treatments. There may be exclusions for certain treatments, medications and pre-existing conditions. Some policies may have limits on expensive treatments and annual limits for individual treatments. Read through what you can and can’t claim. Ask the insurance company to clarify anything that you don’t understand. Look to see if there are any medical requirements. This will help you avoid paying for coverage that won’t suit your needs.

Selecting a Suitable Insurance Provider

The quality of service you receive from your insurance company can make claiming your coverage easier. Look at how easy it is to claim, how easy it is to get reimbursement and if there are online tools to view your coverage. Some companies will offer direct billing so you don’t have to pay the full cost of eligible treatments. This can depend on the company, treatment and policy. Clear communication is important if you are denied a claim or asked for extra documentation. Look at what customers say about their experience and how the company deals with complaints.

Look for a policy that will allow you to make reasonable changes to your coverage without putting pressure on your budget. Look at what upgrades you can make, adding dependents and changing your coverage. Look at renewal terms, premium changes, cancellation and any conditions. Some policies have more flexibility however there may be new underwriting requirements. Ask the insurance company what you can do to ensure your policy will be useful in the future. Flexibility can be a great feature if you are experiencing changes in your family.

Conclusion

Choosing private medical insurance in Canada can be done by considering your current medical costs, future requirements, existing coverage and affordability. Start by identifying what gaps you have in your public and work coverage. Compare what prescription, dental, eye and other eligible treatments you have. Consider your family situation, policy restrictions, claiming and renewal terms. This will help you find a policy that will provide you with realistic financial support. By carefully comparing your premiums, coverage and restrictions you can ensure you have coverage that will help you with your healthcare priorities.