How much is health insurance per month for a single person?

The cost of health insurance for a single person can vary depending on various factors, including your age, location, desired coverage, and the insurance provider. Monthly premiums can range from around $80 to hundreds a month depending on the person’s needs. To get the best quote for health insurance, get in touch with one of our advisors. Our expert advisors can go over your unique situation to find a health insurance solution that fits your situation best.

Is health insurance tax-deductible in Canada?

Yes. It is possible to deduct your health insurance premiums on your tax return in Canada. However, you must be the sole proprietor of your business and your business income must be your only source of income.

Can I get health insurance for my business?

Yes, you can consider offering affordable health insurance as part of your business benefits package. Many self-employed individuals choose to set up a small business health insurance plan to provide coverage for themselves and their employees, if applicable. The options available can vary, including group health insurance plans or Health Spending Accounts (HSAs). It’s recommended to consult with an insurance broker or advisor who specializes in small business insurance to explore the best options for your specific needs.

Find out more about group health insurance. 

What if I’m newly self-employed, but had health insurance with my previous employer? 

If you recently left a job that had a company group plan, many insurance companies will allow you to apply for guaranteed issue health insurance. Because they covered you before, you can skip the medical questions and keep your coverage—as long as it’s within 60-90 days of your employee benefits ending. This might be a great option if you have health issues, however, it is always best to shop around to find the best rate. Sometimes skipping the health questions will cost you extra! The less underwriting required, the more expensive the health benefits plan may be.

Can a self-employed person get group benefits?

No. If you are self-employed, you are likely not able to access group benefits unless you are a dependent on a spouses plan or have coverage through professional group association. To make sure your health care needs are met and your expenses are covered, we recommend buying personal health insurance. If you are a small business owner, you may choose to get a group plan for your employees that you can also participate in.

What other insurance should I have if I’m self-employed? 

To fully financially protect yourself and your employment income as a self-employed individual, you should also consider disability insurance, critical illness insurance, life insurance, liability insurance, and more.

You can find out more information about these insurance products on our blog post: Insurance for the self-employed: what coverage do entrepreneurs need?

What are the different private medical insurance plan tiers?

Supplemental health care is usually put into a tiered system, with each tier increasing its coverage at higher costs. The plans are usually separated into basic, standard, and enhanced tiers.

Coverage tiers and costs may look like*…

Every tier of plan will also have:

• Different deductible amounts
• A set waiting period before you can claim coverage
• Its own process for claims

What are the types of private medical insurance available in Canada?

In general, there are 3 types of personal health insurance plan offered in Canada:

1. Medically underwritten
2. Guaranteed acceptance
3. Replacement health insurance

These are different from the 3 tiers mentioned in this article. We’ll explain the different types.

1. Medically underwritten health insurance

Standard health insurance is medically underwritten. This means that during the application process, the insurance company will ask you about your health and lifestyle and use your answers to determine your eligibility and price for your insurance.

For this type of health insurance, insurers may exclude any pre-existing conditions. But you still have options for health insurance if you have a health issue.

2. Guaranteed acceptance health insurance

Guaranteed acceptance health insurance is usually a no-questions-asked kind of policy. There are no or very few medical questions or medical underwriting, and pre-existing conditions are generally covered.

Most companies will have the 3-tiered options — basic, standard, and enhanced — for medically underwritten policies, but just basic or standard options for guaranteed acceptance policies.

3. Replacement health insurance plans

The third most common type of personal health insurance in Canada is a replacement plan that’s meant for people who already had coverage through a group plan, such as through their work.

If you’re leaving your job or retiring, you can get health insurance without having to pass the usual medical requirements. But you must make the switch within 60-90 days of your work benefits ending.

Replacement plans can be especially useful for people who may have medical issues and may not get the best rates from a regular medically underwritten health policy, such as people who are older.

What is the difference between public and private health insurance in Canada?

The main difference between public and private health insurance in Canada is what they cover — public health insurance generally handles the immediate, urgent care needs while private health insurance covers a portion of the costs related to recovery.

Public health insurance covers basic and emergency medical services such as hospitalization, surgeries, and doctor’s visits.

Private health insurance covers health care services and other medical expenses such as prescription medication, paramedical services (chiropractic services, physiotherapy, massage), and other medical equipment (CPAP machines, crutches, nebulizers, etc.).

For example, if you had a car crash…

• Public health insurance will cover the ambulance services to get to the hospital and the cast for your broken leg.
• Private health insurance will provide physiotherapy coverage so you can walk and run normally again.

Canadians may coordinate this coverage so that all of their medical expenses are paid for under either their universal health plan, provincial health plan, private health insurance, or travel medical coverage.

Public healthcare plans in Canada include…

Universal health insurance

The “Medicare” system in Canada is a universal health system that is publicly funded through taxpayer dollars. It allows all Canadians to access essential medical care such as hospital visits and emergency surgery.

The federal government also provides some national-level health care such as the Universal Dental Benefit, which provides children from low-income families access to regular dental treatments.

Provincial health insurance

Our universal healthcare system here in Canada is provincially administered. Each provincial or territorial health insurance will have different rules to qualify for “free” universal healthcare.

In order to access public coverage with the provincial plan, some provinces require you to be a permanent resident for at least three months, while others will require longer.

Private healthcare plans in Canada include…

Private health care insurance

Many Canadians buy additional health insurance coverage through their employers or purchase private health insurance policies to cover gaps in the public healthcare system.

Private plans can vary in coverage and cost, depending on the provider, the specific policy, and your own health history.

Travel health insurance

Emergency travel medical insurance covers unexpected medical events and treatment when you’re traveling. You can buy it when you’re traveling outside of Canada or if you’re a visitor to Canada.

This is a form of private insurance, and those who buy it have many options for travel insurance providers.

Check out our travel insurance quoting tool to shop for the best travel insurance rates.

Is it worth getting health insurance in Canada?

Yes, private health insurance is worth it in Canada. It can help you get the medical care you need without paying extremely high costs.

Even if you have access to provincial health care, it will not cover all the medical costs required for you to recover from an injury or illness. And, it doesn’t always pay for  preventative healthcare. An extended health care policy supplements your public coverage so you get the treatment you need to stay healthy in the long-term.

Just imagine trying to pay this medical bill below after a car accident, without private health insurance to cover you.

How to choose a health insurance plan

To choose the health insurance plan that works best for you, start by thinking about your insurance needs. Ask yourself:

• Do I have health insurance coverage through my employer?
• Do I have health insurance coverage through my spouse’s employer?
• Do I have dependents who need more coverage?
• How much can I afford to spend on health insurance each month? 

The answers to these questions will help you determine which plan is the best for you and your family.

Which health insurance tier should I choose?

Still having trouble figuring out which personal health insurance plan is best for you? Here is a list of plan types and the scenarios in which they might be right for your insurance needs. 

You might choose a…

• If you are on a tight budget
• If you are using it to supplement other plans (employer or group plans)

• If you are looking for a primary plan with decent coverage
• If you want it for combined coverage with other plans (employer or group plans)

• If you have no other health insurance through your work, through your spouse’s work, or other group benefits and you intend to use this as your primary plan
• If you want it for combined benefits with other plans (employer or group plans)
• If you are looking for your expenses to be 100% covered through the coordination of benefits
• If you want to coordinate benefits with other plans because your family has high medical costs (i.e. lots of kids with braces, glasses, medications)

• If you have any pre-existing conditions or health issues
• If you don’t want to go through medical questionnaires

• If you are retiring and may have health issues that would prevent you from getting standard health insurance
• If you’re leaving a job with regular benefits

Who are the leading Canadian private health insurance providers?

There is no single “best” health insurance provider because everyone’s coverage needs are different. Each provider has something different to offer.

At PolicyAdvisor, we work with exceptional health insurance providers that all have great coverage options, depending on what kind of coverage you’re looking for.

We offer health insurance from the following providers:

• Blue Cross
• Canada Life
• Desjardins
• GMS
• GreenShield
• Manulife
• Sun Life
• And more!

Additionally, we offer guaranteed acceptance plans through Edge Benefits.

Apply for private health insurance

If you’re looking for a great price on personal health and dental insurance, PolicyAdvisor can help! We have a team of licensed insurance experts to help you go through health plans from Canada’s best insurance providers.

Book a quick call with one of our advisors today and let us help determine your health insurance needs.

Private Health Insurance
Frequently Asked Questions

What if you’re leaving your job with benefits?

If you have a job with benefits and you’re leaving that job, your private health coverage will likely come to an end.

But you can get replacement or guaranteed acceptance health plans with most insurance providers when you leave. This means that when you transition to your new plan, you don’t have to go through any medical questionnaires — your new individual policy is guaranteed to be accepted.

However, you must apply for the new coverage within the first 60-90 days of your employer benefits ending.

Isn’t health insurance in Canada free?

Some parts of healthcare are free in Canada. With universal healthcare, you don’t have to pay for basic medical expenses like seeing a doctor, surgery, non-private hospitalizations, etc.

But it does not cover costs associated with recovery, such as prescription medication, paramedical expenses, vision care, dental care, or medical equipment that may be needed to recover from injury or illness. Private insurance can cover these expenses and more.

Is private health insurance tax deductible in Canada?

In some cases, private health insurance can be tax deductible. For example, if you are self-employed or a business owner, it may be written off as a business expense.

Individuals may be able to include premiums as part of their medical expenses when calculating tax credits as well.

What if I’m covered under my spouse’s plan?

If you have private medical coverage through your spouse, that’s great! We’re glad that you have some sort of health insurance coverage to keep your financial wellness in check while you rest and recover. However, employer benefits may not have the most comprehensive plan.

You may consider buying your own individual plan to supplement your spouse’s employer’s plan to fit all your family’s needs. You can use both plans to get close to 100% coverage for your medical costs by coordinating your benefits. 

Connect with a licensed insurance advisor

Still unsure which plan would be best for you? Schedule a call with one of our expert insurance advisors for one-on-one advice.

The conversation has no obligations to buy—let’s just start with a conversation about your insurance needs. Our health and dental insurance agents will ask you a few questions then shop Canada’s best insurance companies to get you the best price on health insurance.

How much does long-term care insurance cost?

You can expect to pay around $100/month for long-term care insurance. However, the cost of long-term care insurance depends on a number of factors:

• Your age at the time you apply 
• Your health status
• The type and amount of coverage you choose 
• The waiting period that you select 

While this may seem steep now, the cost of care can add up quickly. Consider that the average cost of retirement homes can range from $900 – $8,000 a month, depending on the facility and care you need. You could be paying upwards of $60,000 in “rent” for the support you need to live.

Is long-term care covered under my health insurance plan? 

Sometimes. Some health insurance plans will include coverage for in-home nurses or care homes. However, most plans will have lower coverage limits.

A health insurance policy might say: “$2,500 annual maximum for care homes & in-home care and a $20,000 lifetime maximum combined with medical equipment and services.”

When considering that care homes and care aides can cost upwards of $20-$30,000 a year, you can see why having this extra insurance is important. Health insurance is there to provide recovery and preventive costs—long-term care is there to help you field the ongoing cost it takes for long-term care.

What is the difference between long-term insurance and life insurance?

Long-term care insurance is designed to cover the costs of your care if you cannot perform basic activities of daily living by yourself such as feeding, bathing, toileting, or moving on your own. This insurance covers the cost of nurses, care aids, and facilities required for your daily support. 

Life insurance is a lump-sum payment, paid to your beneficiaries (usually your family) after you pass away. Some policies have “living benefits” that allow you to use your policy’s value to borrow or loan against. Some life insurance companies have riders that tack onto your life insurance policy—these riders let you use some of your death benefits to pay for your care needs. 

What is a long-term care annuity?

A long-term care annuity is a financial product that combines two things: a way to save money for the future (like an investment) and a way to pay for long-term care if you need it. With this annuity, you put money into it, and it grows over time. If you ever need help with things like bathing or eating because you’re sick or old, you can use some of the money you put into that annuity to pay for that care. But, using this money for care can reduce how much income you get from the annuity later on. So, it’s like having a backup plan for both saving and paying for long-term care.

When to buy long-term care insurance

As soon as possible! The younger you are, the less expensive the premiums are. Many companies offer a limited pay plan, meaning that you can pay for your coverage now, during your high-earning years, and get the benefits for free later if you should require it—for example, you only pay premiums for 10, 15, or 20 years and get coverage until you’re 65 or older.

What companies offer long-term care insurance?

At PolicyAdvisor, we work with over 30 of Canada’s best insurance companies. While we don’t provide long-term care insurance ourselves, we’re happy to connect you with one of our licensed partners that do!

The following is a list of our insurance partners that offer long-term care insurance: 

• Sun Life 
• Canada Life 
• Manulife  
• GMS 
• RBC

Speak to one of our licensed insurance advisors today to find out if a long-term care policy is right for you and your financial goals!

Get a quote for long-term care insurance

Again, we don’t directly sell this product, but we have some great partners that do! Give one of our expert insurance advisors a call! First, we’ll have a quick conversation about your insurance needs. This conversation will help us assess exactly what kind of coverage you’re looking for and point you to the best company to work with. We know how frustrating it can be to call around to a bunch of companies, so let us use our years of insurance expertise to help you find the exact coverage you need to achieve financial protection.

Schedule a call with one of our expert insurance advisors for one-on-one advice.

Is there an app to see a doctor?

Some telehealth platforms have an app while some require you to have a desktop computer for your virtual visit. When choosing a telehealth app, consider factors such as the availability of doctors, the ease of scheduling appointments, the variety of medical services offered, and the compatibility with your insurance coverage. It’s important to ensure that the app is reputable, secure, and compliant with privacy regulations to protect your personal and medical information. Take a look at the reviews in the app store for that particular telehealth app—it may provide insight into the best provider for your healthcare needs. 

Can a virtual doctor see me if I’m out of the country/province?

Whether you can see a virtual Canadian doctor while you’re out of the country depends on a few factors.

Telehealth Platform’s Availability: Some telehealth platforms might have restrictions based on geographic locations. They may only offer services within certain countries or regions. Before traveling, check with the telehealth platform you intend to use to see if their services are available in the country you’ll be visiting.

Licensing and Regulations: Healthcare providers, including virtual doctors, are often licensed to practice within specific jurisdictions. If you’re out of the country, a virtual doctor’s ability to provide medical care might be limited by their licensing and the local regulations of the country you’re in. Some telehealth platforms might have partnerships with international providers to offer services across borders, but this can vary.

Insurance Coverage: If you’re using telehealth services that are covered by your health insurance, it’s important to understand whether your insurance will extend to virtual appointments while you’re abroad. Some insurance plans might have limitations on coverage outside of the country, while others might have provisions for emergency medical care only. Contact your insurance provider to clarify the extent of your coverage for telehealth services while traveling.

Legal and Regulatory Considerations: Different countries have varying laws and regulations related to telehealth and the practice of medicine. Some countries might have restrictions on providing medical services across borders, while others might have specific requirements for virtual healthcare providers operating within their jurisdiction. It’s advisable to research the legal and regulatory landscape of the country you’re visiting to ensure you’re compliant.

When to see a doctor in person

While telehealth doctor services offer unparalleled convenience, there are certain limitations to consider. Telehealth is most effective for non-emergency medical situations, such as minor illnesses, prescription refills, and routine follow-ups.

You should see a doctor in person:

• In emergency situations
• In cases requiring physical examinations
• If you don’t have a reliable internet connection or access to the telehealth platform

Additionally, telehealth consultations may vary in quality based on factors such as the patient’s internet connection, the clarity of communication, and the effectiveness of the digital platform being used. Some medical conditions might require more comprehensive assessments that can only be conducted in person. It’s crucial for both patients and medical professionals to recognize these limitations and use telehealth appropriately.

Can I get medication without seeing a doctor in person?

Generally, yes, but there are considerations. Telehealth doctors, like in-person physicians, can prescribe a wide range of medications, including those for chronic conditions, allergies, and common illnesses. However, the ability to prescribe medications depends on various factors, including the doctor’s assessment of your condition, your medical history, and the specific laws and regulations in your state or country. Some medications, particularly controlled substances, may have stricter regulations for prescription via telehealth. In such cases, doctors might require an in-person visit or additional documentation before prescribing certain medications.

• What can a virtual doctor diagnose?
  Virtual doctors, also known as telehealth or telemedicine doctors, can diagnose and treat a wide range of non-emergency medical conditions and health concerns. Here are some examples of conditions that virtual doctors can diagnose:
  1. Common Illnesses: Virtual doctors can diagnose and provide treatment recommendations for common illnesses such as colds, flu, sinus infections, strep throat, and urinary tract infections.
  2. Skin Conditions: Skin issues like rashes, eczema, acne, and minor allergic reactions can often be diagnosed through virtual appointments. You might be asked to describe the appearance and location of the skin problem.
  3. Mental Health Concerns: Many virtual doctors include mental health professionals who can diagnose and provide support for conditions like anxiety, depression, stress, and mood disorders.
  4. Allergies: Virtual doctors can discuss your symptoms and medical history to diagnose allergies and recommend appropriate treatment or management strategies.
  5. Respiratory Infections: Conditions like bronchitis, mild asthma issues, and other respiratory infections can often be diagnosed based on symptoms and medical history.
  6. Gastrointestinal Issues: Virtual doctors can help diagnose and provide advice for conditions like acid reflux, indigestion, mild food poisoning, and gastroenteritis.
  7. Minor Injuries: For minor injuries like sprains, strains, minor burns, and small cuts that don’t require immediate attention, virtual doctors can provide guidance on treatment and recovery.
  8. Prescription Refills: If you have an ongoing prescription for a chronic condition, a virtual doctor can often refill your prescription after assessing your medical history and current condition.
  9. Women’s Health Concerns: Virtual doctors can provide advice and guidance on issues related to women’s health, such as menstrual cycle irregularities, contraception, and urinary tract infections.
  10. Follow-Up Appointments: Virtual doctors are well-suited for follow-up appointments to discuss treatment progress, review lab results, and make adjustments to your care plan.

Do I have to pay to see a virtual doctor?

It depends, but usually, you don’t. Many health insurance plans now offer coverage for virtual doctor appointments as part of their telehealth services. The extent of coverage can vary depending on your insurance provider and the specific plan you have. Some plans might fully cover virtual appointments, while others might require a deductible for that service. It’s important to review your insurance policy or contact your insurance provider to understand the telehealth benefits available to you.

Connect with a licensed insurance advisor

Looking for a better health insurance plan that covers online doctor’s appointments? Schedule a call with one of our expert insurance advisors for one-on-one advice. The conversation has no obligations to buy—let’s just start with a conversation about your insurance needs. Our health and dental insurance agents will ask you a few questions, then shop with Canada’s best insurance companies to get you the best price on health insurance.

What can I do if I’m 25 and no longer covered under my parents?

Some health insurance plans will allow you to stay on your parent’s health plan, even as an adult. You might be allowed to stay on your parent’s plan: 

• Until age 18 or 21
• Until age 25 if you are a full-time student

If you get married, you may no longer be eligible for your parents’ plan. Once it’s official that you can no longer mooch those sweet free benefits, you’ll have to get your own plan. 

When you need to set up your own health insurance, you can go for two options. 

Option 1: Tap into your school’s health insurance plan 

Sign up for your student group health insurance plan that’s administered through your student government (most cost-effective)

Option 2: Buy your own health insurance

Apply for private extended health insurance that is personalized to your needs (most comprehensive coverage).

You may choose both options if you have complex health needs and require more coverage. In either case, premiums for the “student” age group are generally inexpensive because when you’re young, you have fewer health expenses in comparison to older age groups. 

Should I opt out of my student health plan?

It depends. The bottom line is, you should arm yourself with some kind of coverage so you’re not stressing over exams AND medical expenses. Health insurance gives you that peace of mind, knowing that if you have even a small accident (like falling off an electric scooter after one too many at the student pub), your expenses will be covered.

Am I covered if I go to school out of province?

If you are a Canadian and go to school outside of your home province, your provincial coverage will extend for the usual emergency services. However, you may have to pay upfront and submit the receipt later on to get your money back. Additionally, each province has a standard of what they will reimburse for each emergency service. For example, one province may have a $75 fee for ambulatory services, whereas another charges $300. 

If you have extended medical insurance, each company has different rules about out-of-province services. Your health insurance provider may decide: 

• You are NOT covered for any out-of-province medical procedures, services, or treatment.
  Ex. Your regular teeth cleaning wouldn’t be covered.
• You ARE covered for but only up to the limit dictated in your home province.
  Ex. BC has a standard dental cleaning price, whereas Alberta dentist’s prices vary. If you are from BC and get your teeth cleaned in Alberta, your dental coverage limit will be the limit set for BC, meaning you could have to pay for the difference.

It’s always best to check your extended health insurance policy documents to see exactly what it covers and where. If you are not sure how to access that information, reach out to your broker or one of our agents.

Am I covered if I go to school out of the country?

When you are going to school on an exchange or just out of your home country, your health coverage may vary. Some countries provide health care free of charge to anyone, including international students. Other countries may charge thousands for medical services.

If you are a Canadian going to school in another country, you may receive medical coverage in a number of ways:

1. Provincial health care plan
The provincial health insurance plan of your home province may reimburse you for emergency medical costs, but that’s not always the case. In some provinces, like Alberta, you will be reimbursed for some emergency services like hospital stays, but only at the standardized rate it would cost if you were hospitalized in Alberta.

For example, the standard in-patient hospital stay in Canada is $100 CAD per day, and so your provincial coverage will only reimburse up to that amount. This can cause a lot of financial strain if you had to stay in the hospital in a place like the United States. In some states, a single day in the hospital can land you with a $4,000 USD bill—leaving you to pay the thousands of dollars difference out of pocket.

2. Extended health plan
Many extended health insurance plans include coverage for emergency travel medical. This part of the health insurance policy covers you for unexpected medical emergencies when you are out of the country, as well as coverage for prescription medication and other services. Coverage may be limited, so it’s best to check your policy wordings. Student group health insurance may not have this coverage on their policies. 

3. Travel medical insurance
Any Canadian traveling outside of Canada should purchase travel medical insurance. It helps to cover the cost of medical care if you become sick or injured while traveling. Travel insurance can also protect you from financial loss if you have to cancel or interrupt your trip. Travel medical coverage makes up for any shortfalls in your provincial or extended health plan. Read more about the difference between travel medical and trip interruption insurance. 

Many countries, including Canada, will make sure that you have some sort of international student health insurance plan in place before entering the country and beginning your studies.

How much does health insurance for students cost?

If you are a student, chances are you are young and healthy and that means you’ll get a great rate for health insurance. Each plan will vary depending on your individual circumstances, but you can expect to pay about $50-$100 per month for a private health insurance plan. If you have coverage through your school or student union, you should expect to pay less as group plans have cheaper rates. This is why it’s usually best to stick with your student plan if you are eligible—it’s the most cost-effective option for students.

Factors that affect the price of health insurance include: 

• Medical history 
• Age
• Province of residence/location 
• Policy plan details

Get a quote for student health insurance 

To get an accurate price, it’s best to get a personalized quote. At PolicyAdvisor.com, we have a great, instant, online tool that can help you shop the best rate for health insurance policies. We know that as a student you’re likely on a tight budget, so let us help you save every penny you can on your policy! Book a call with one of our friendly expert insurance advisors today to chat about protecting your personal and financial health today!

Am I covered if I go to school out of province?

Your province may cover some out-of-province doctor visits and emergency medical care, but they do not usually cover things like ambulance services. You may have to front some of the cost and you may be reimbursed by your provincial health care plan at a later date. Your private, extended, or group plan may not cover you outside of your home province. 

Am I covered if I go to school outside of Canada?

If you are traveling outside of the country, your provincial or private health insurance will not cover your medical expenses. You must purchase travel medical insurance. This might be included in extended health insurance automatically, but not always. Check your coverage details. If it does not come included in your existing health insurance policy, we can help you shop for the best emergency travel medical insurance on the market! 

How do I file a health insurance claim?

Some health insurance plans pay the service provider (doctor, pharmacist, physiotherapist, etc.) directly, while others pay you back later. Imagine you need medicine from the pharmacy. If your insurance covers it directly, the pharmacy sends the bill to them. You pay only a part of the cost. But if they don’t cover it directly, you pay the full price and then send the receipt to your insurance company. They give you some money back for the medicine. If you have to file a claim, contact your insurance company’s claims submission page.

Read our Step-by-Step Guide to Filing a Health Insurance Claim.

How do I get a hold of my insurance company?

If you have questions about claims or specific coverage details, you can contact your insurance provider directly. 

What will they ask about my business on a group health insurance application?

Applications for group health insurance are a little different from individual plans. With private health insurance, the insurance provider is concerned about the individual’s health history and age. With group insurance, they don’t do as much individual underwriting. Instead, they’ll want to know more about the general employee demographics.

Employees will notice that when they sign up for their group employee benefits, they won’t be asked as many health questions that normally come with individual insurance applications. Instead, the underwriting factors are more heavily weighted on your business’s claims history and industry claims history. If your employees claim a lot, the insurance company will price their premiums accordingly.

What is a pooled insurance plan?

The two biggest factors in determining the price of your group health insurance is your claims history and industry. But what if it’s your first time? Or what if your business is in a high-risk industry? If you don’t have any history, an insurance company might put you in a pooled insurance plan. They pool your business with others so that they can collect the premiums from everyone and use that to cover any claims. Pooling the risk like this allows the higher costs of the less healthy to be offset by the relatively lower costs of the healthy.

Once you have a few years of claims history under your belt, you may qualify for your own individual pricing. This is because the insurance underwriter has a better idea of how often they’ll be paying out for your employee’s claims.

Having health insurance means more than financial protection—it provides peace of mind. Your quality of life is directly linked to your health care. Having health insurance allows you to focus on your well-being without worrying about potential expenses. And that is priceless!

How much does a small business employee benefits package cost in Canada

The cost of a group insurance plan for a small business owner will really depend on their employee demographics, claims history, and plan details. In general, the larger the employee base, the cheaper the cost per employee. This is because the insurance company can spread the risk out—the employees that don’t claim a lot make up for the ones that do. For a small business, the price will be more contingent on industry type and claims history.

Who pays the group insurance premiums?

It depends on the company. Some companies will provide their health and dental plans to their employees completely free. This means the business owner will cover all the health insurance premiums. Other businesses will charge a small fee to their employees to participate—usually deducting this premium directly from the employee’s paycheck. Some small businesses will offer free participation for standard plans and if the employees want more comprehensive coverage, they can opt for additional deductions from their pay.

Are group benefits tax deductible in Canada?

Yes, group benefits provided by an employer are generally tax-deductible in Canada. Employers can deduct the cost of providing group benefits, such as health and dental insurance, from their business income when calculating their taxable income.

Get quotes for group health and dental insurance 

If you’re looking for an affordable group benefits plan for your small business, or business of any size for that matter, our licensed insurance experts at PolicyAdvisor are here to help. We’ll ask some questions about your business (like the ones listed above) and shop around to find you the best rate for health benefit plans for your employees.

Book a call with one of our friendly expert insurance advisors to chat about protecting your personal and financial health today!

Are employee benefits mandatory?

No. Employee benefits, such as health insurance, are not mandatory. However, providing insurance for your employees may provide that competitive edge your business needs to maintain employee retention. The premium costs may seem like another additional expense to take on, but ultimately having a healthy and consistent employee base will save you money in high turnover costs. Plus, insurance premiums can be claimed as tax-deductible business expenses.

What is the cheapest group health insurance for small businesses?

Some plans offer group benefits for as low as $25-75 per employee, but it depends on the plan. Cheap plans usually mean minimal coverage—just basic medical expenses with no dental, vision, and/or minimal paramedical expense coverage. However, cheaping out on benefits can leave your employees high and dry when they need the coverage the most. Having a healthy employee base means they’re able to work and having adequate coverage to pay for health expenses is an important aspect of this.

What is an HSA?

An HSA is short for “Health Spending Account.” This is an additional benefit sometimes included in group health insurance plans that a lot a certain dollar amount each year for an employee to spend on health-promotional or recreational products. For example, you might use your health spending account to pay for part of your gym membership, an exercise bike, or an Apple watch. It’s designed to offer flexible coverage for services and items that still promote healthy living but don’t necessarily fit.

How much do benefits cost per employee?

The cost of group benefits really depends on your group plan. Generally, it can range from $50-$300 per month per employee. Some employers will have their employees contribute a fraction of this premium to help cover the cost. Business owners can also count these premiums as a deductible business expense on their tax return.

Do certain small businesses get discounts depending on their industry?

It’s not a discount, per se. But industry type is one of the more weighted factors in determining the price of group insurance. If historically, that industry has more claims than others, businesses in that industry would have higher premiums for their group insurance.

Can you insure dentures or false teeth?

The cost of a dental appliance or prosthetic itself is usually covered under your dental insurance. However, if you have a particularly expensive set of dentures, false teeth, or other medical equipment, you may be able to cover that through your personal home insurance up to a specified limit. For example, some home insurance providers have additional coverage for hearing aids, motorized mobility devices, and more.

How much does it cost to clean teeth?

The cost of teeth cleaning and scaling depends on your province. Some provinces have a “fair guideline” that dentists may have to adhere to for general dental services. For example, in Alberta, the guidelines state that polishing should be around $69, scaling should be $77, and a fluoride treatment should be $33, all of which are included in standard teeth cleaning. Moreover, the approximate cost for just a cleaning may be around $180, depending on your province (not including the dentist consultation cost—just having the dentist examine your teeth will cost extra).

What is the most common type of dental insurance?

Many people have dental insurance provided through their employer benefits plan. For those that do not, they may opt for a basic plan as they are the least expensive. Basic plans cover preventative care like teeth cleaning. Standard plans include orthodontics or restorative care like braces or teeth replacement.

What if I can’t afford dental insurance?

If you cannot afford dental insurance, you may be eligible for the Canada Dental Benefit. This is a taxpayer-funded program for families that earn less than $90,000/year and whose children are under 12. Each province also may have dental care coverage available if you are a senior or are a family that needs income assistance.

Visit the Government of Canada’s website or contact them to find out if you’re eligible.

Is there a waiting period for dental insurance?

Some plans may have a waiting period for dental insurance. This is usually the case with basic or low-cost plans. Having a waiting period with dental insurance means that you can’t claim anything once the policy comes into effect until the waiting period is over. This is to prevent people from signing up for dental insurance when they already have pre-existing dental issues and then canceling the policy as soon as the treatment is done and paid for by insurance. Plans vary between 30-90 day waiting periods to no waiting at all.

What is a dental insurance predetermination?

An insurance predetermination is when your dental care provider requests a quote from your insurance provider to confirm which services and treatments will be covered by your plan. They will do this before the services are performed, to make sure that either the insurance fully covers it or that you can handle any remaining out-of-pocket expenses.

Do seniors get free dental coverage?

In some provinces, seniors with low or moderate incomes get financial assistance with basic dental care. However, that may not be the case in every province. By the end of 2023, the federal government is hoping to expand the Canada Dental Benefit to all individuals who are 18-years-old and under, seniors, and people living with disabilities.

Connect with a licensed insurance advisor

Looking for insurance to cover your dental health care needs? Schedule a call with one of our expert insurance advisors for one-on-one advice. The conversation has no obligations to buy—let’s just start with a conversation about your insurance needs. Our health and dental insurance agents will ask you a few questions, then shop Canada’s best insurance companies to get you the best price on health insurance.

Step Four: Fill out the claim paperwork

Now that you have all your information together, you will need to fill out a health insurance claim form. Depending on the company, you will complete the claim forms online or you will need to submit them by mail.

Online claims

In order to submit a claim online, you will likely need to sign up for an account with the insurance provider. Once you’ve created an account, you can access the online claims portal. This portal will walk you through the company’s claim submission process and ask you relevant questions and information about your claim. Some companies even have mobile apps for the claims process. 

Sometimes, companies won’t have an online claim portal, but they will have electronic PDFs that you can fill out and email to the claims department. 

Paper claims 

If your health insurance company does not have an online claim submission process or portal, they will need you to send a paper claim. You should be able to access the many types of claims forms online to print or you can phone your insurance company and ask them to mail you the forms with a return envelope. 

Claims on paper will ask you for the same information that an online claim form does. You will provide information about the paramedical services, dental services, prescription drug costs, your healthcare provider, your policy number, etc.

Some providers may also require that you send in the original receipts with your paperwork, while others will just ask you to hold onto them. If you do have to send in proof of payment and original documents, it’s always a good idea to make a copy of them, in case they get lost in the mail.

The coverage amounts and availability are all dependent on your insurance provider and what tier of coverage you select (more on that below). 

Additionally, insurance companies have a price list of what they think is a “reasonable amount” for any service, equipment, or medication within your particular province. For example, under your prescription drug coverage, your plan may feel that name-brand medication like Ozempic is overpriced, and will only approve coverage for a generic alternative with the same ingredients.

Step Five: Submit forms

Once you have everything together, you either submit the paperwork electronically or by mail. Some companies will want you to submit your original receipt with your claim form, while others will just ask that you hold onto them in case of a claim audit (more on that in step 7). 

Your claim will be reviewed by the insurance company’s claims department to determine how much you are entitled to for reimbursement of your out-of-pocket expenses.

If you are submitting your claim online, your claim is reviewed by an automated service. You may receive an explanation of benefits and reimbursement right away, especially in the case of small claims. If you submitted your claim by mail, you may have to wait a few business days or weeks for a review.

Step Six: Receive a payout

Once your claim is processed, you will receive an explanation of benefits (EOB) from your insurance provider company. This will include a detailed explanation of your entire claim, the total amount that the insurance company will pay, and any remaining balance that you may be responsible for or that you can submit to your secondary plan. 

The insurance company will then send you the amount they are responsible for. They will either do this via cheque or direct deposit if you have that set up.

Step Seven: Hold onto your documents

Even if you didn’t have to submit your original receipts and medical documents because you submitted your paperwork online or your insurance company didn’t need to see it with the initial claims forms, it’s important to keep a record of your medical information.

If the claim is declined or your account is audited for any reason, the insurance provider may ask for those documents again. This includes any itemized bills, detailed invoices, healthcare provider statements, and other relevant documents.

How do you submit a claim if you are coordinating benefits? 

The process of submitting a claim is the same if you are coordinating benefits. Follow steps one through seven and wait for your explanation of benefits and reimbursement with your primary health insurance provider. Then, repeat the process with your secondary health insurance provider.

On the claims form, it will ask if you are coordinating benefits or have “dual coverage.” After selecting “yes”, they will ask for an explanation of benefits information from the primary insurance company. They will then use that information to determine how much of the remaining cost they will cover.

What are some reasons a health insurance claim may be denied?

If your claim is denied, you can file an appeal. Insurance companies usually have this process available online or you can call the company’s claims line directly to ask for an appeal. This process will require you to provide further documentation, such as confirmation from your doctor that the treatment was necessary. 

If you feel your claim was wrongfully denied and your appeal was not accepted, you have a final option to pursue legal action against the insurance company. This would only be in extreme circumstances as the legal fees usually outweigh the medical expenses being claimed.

Need help submitting a health insurance claim?

If you need assistance filing a health insurance claim, we can connect you with the claims departments of our partner insurance companies, depending on who you have coverage with. Our expert insurance agents can also advise you on your coverage details and help you shop around after your initial claim is taken care of, if you feel your coverage isn’t sufficient. 

If you’re looking to start a claim, you can find more details on our insurance partner’s websites.

What if my health insurance doesn’t cover all of the expenses?

If you have dual coverage, you can submit the remaining cost to your secondary health insurance provider. If you do not coordinate your benefits in this way, you’ll have to cover the remaining balance yourself. If you feel that your current coverage isn’t meeting your coverage needs, you can always shop around for better coverage by contacting our insurance experts at PolicyAdvisor.

How long does it take for a health insurance claim to be processed?

If you submit your claim online, you may have your claim processed instantly, within 24 hours, or within a week. This depends on the provider—some use automated claims portals for small and usual claims. For mailed-in claims, you can expect to wait longer to get your explanation of benefits and reimbursement simply due to the time it takes to process physical documents (uploading, manual reviewing, mailing times, etc.). If your claim is large or is flagged for whatever reason, you may wait even longer to receive your reimbursement.

Is there a time limit to submit a health insurance claim?

The time limit for submitting claims varies from company to company—generally, it is from 9 – 12 months from the point of service. Even if your policy is no longer in force, as long as you got the service during the active policy period, you can still make a claim. 

What is a health insurance claim quote?

If you want to find out whether your health insurance provider will cover your service before you actually go ahead with it, the service provider can ask your health insurance company for a quote for the claim. This quote will estimate how much the insurance will cover and how much you will have to pay out of pocket (or what your secondary insurance will also cover). Then you can decide if you want to proceed or make adjustments to the service.

Where can I find my health insurance policy number?

Your health insurance policy number can be found on your health insurance member ID card, on your policy documents, or in the online portal (if your insurance company has one). If you have misplaced your policy number or member number, you can call the claims helpline for the respective insurance company. See the above contact list for phone numbers and the websites for claims assistance.

Connect with a licensed insurance advisor

Looking for a better health insurance plan? Schedule a call with one of our expert insurance advisors for one-on-one advice. The conversation has no obligations to buy—let’s just start with a conversation about your insurance needs. Our health and dental insurance agents will ask you a few questions, then shop Canada’s best insurance companies to get you the best price on health insurance.

How much do contacts cost?

The cost of contacts can range from $125 – $1,000 a year, depending on your lens type. Some contacts are daily wear, while others are for more long-term use (making them more expensive). Additionally, your prescription type can affect the cost of your contacts. If you have a particularly strong or complicated prescription, it costs more to make.

How much do glasses cost?

On average, the cost for a single pair of glasses runs about $300. The cost of corrective eyewear has two different components: the frame cost and the lens cost. Frames can be relatively cheap—sometimes as low as $20 if you buy them online. The cost of the lens is the most expensive aspect of glasses cost. Single vision is the least expensive lens type. This means there is only one type of prescription in the lens. Single-vision lenses can cost $75 – $300. If your prescription calls for dual vision or progressive lenses (meaning two different types of prescription in each lens) it can be more costly. Dual-vision lenses can cost $250 – $700.

Does insurance cover blue light glasses?

If the blue light glasses are prescribed by your optometrist, they may be covered under your health insurance plan. Especially if you work at a computer all day, your eye doctor may prescribe this type of blue-light-blocking lens. However, if you want to buy them on your own accord, they may not be covered by your plan—they usually are not unless specified.

How much does it cost for an eye exam?

The average cost for an eye exam can range from $90-$160. The cost will depend on your province and the eye care professional you see. In some provinces (like Alberta and Ontario), if you are under 18 or over 65, you can get yearly comprehensive eye exams for free. If you are between 19 and 64, you can get coverage for eye examinations through your private health insurance.

Should I opt out of vision insurance?

It depends on your circumstances. If you have medical insurance elsewhere, like through your parent’s plan, you may consider opting out of vision care if it’s offered under your student plan. If you’ve already done eye exams in the past and know you have decent vision, you might also consider opting out. However, there may come a day when you need to see an eye doctor and find yourself paying hundreds in out-of-pocket expenses. Just like all insurance, vision insurance is there for your immediate needs and your “just-in-case” needs as well.