How Does Health Insurance Work?

If you are self-employed or your employer doesn’t offer benefits, you might be stuck paying for your own health costs. In Canada, we are fortunate to have a Pharmacare, but it does not pay for all health expenses. That’s where personal health insurance comes in.

What does it cover?

Health Insurance covers a variety of different expenses, depending on the plan you choose. Generally, they cover a percentage of:

  1. The cost of prescriptions after Pharmacare’s benefit
  2. Basic dental costs like X-rays, cleanings, and fillings
  3. Eye exams and glasses
  4. Certain professional or registered services like massage and chiropractic
  5. Selected medical supplies

Each of these categories will pay a maximum amount of money each year. For example, your prescription drug coverage might cap out at $1,000 per year.

Many plans will also have travel insurance built-in, coverage for hearing aids, and other, smaller benefits. So be sure to shop around!

What does it cost?

These plans vary quite a bit in cost. However, dental coverage is usually what makes one plan more expensive than another. Plans that offer less dental coverage or none at all are typically more affordable.

A plan with all of the coverages listed above and more would cost an individual ~$80/month. With the option to have coverage for the whole family for a higher, set price.

What type of health questions do they ask?

While much less invasive than life or disability insurance, a health insurance application will still ask a number of questions. Including but not limited to:

  1. Whether anyone going on the plan is on medications or receiving treatment currently, like regular massage therapy
  2. If you’ve just left or are about to leave a group plan (this may give you more options)
  3. About any health conditions you have experienced in the last number of months or years, depending on the Insurer

The Insurance Company will want to know when symptoms started, what the cause was, if there was a resolution, and about prescriptions.

What if I already take medications or receive treatment for pain?

Medications you already take will be considered a pre-existing condition and typically so will treatment you are already receiving.

Insurance Companies will not usually cover pre-existing conditions and specify in your policy what, if any, the exclusions are.

The exception is with a non-medically underwritten policy.

In these policies, the Insurer does not ask questions about your health nor do they exclude pre-existing conditions. The trade-off for this extra coverage is typically less coverage for more money.

How do I buy it?

You can buy health insurance from an Insurance Advisor or Broker, select companies have applications on their website, or you can call the Insurance company and have one of their agents sign you up.

We will always recommend that you work with a Broker as they can show you options from multiple companies, getting you the best fit for no extra cost.

At Iron & Pearl Financial, we can offer coverage through four different Canadian carriers. Get Started Here.