Insights & advice
What is covered by health insurance in Canada?
April, 2022 – 15 min read
Some medical services are covered by your province/territory.
Workplace benefits coverage varies depending on the plan.
Depending on your health and wellness needs, you may want to purchase individual health insurance.
What’s in this article?
What is covered by government health insurance in Canada?
To fill the gaps in healthcare needs, some Canadians may have additional health and dental coverage through their employer, an individual health insurance plan, or even out-of-pocket.
Having supplementary health insurance can provide a safety net during times of illness, injury, or accident. Not to mention, it can help save you money when you need new glasses or get that root canal you’ve been putting off.
But how do you know what’s covered by your provincial/territorial health insurance - Opens in a new window and what’s not? We can help.
What does provincial/territorial health insurance cover?
In Canada, provinces and territorial governments provide coverage for medically necessary hospital, physician, and surgical-dental services (where required to be performed by a dentist in a hospital) provided to eligible residents.
Generally, each of the provinces and territories provide medical services - Opens in a new window to residents that may include:
Universal health care (provincial/territorial)
- Emergency services
- Doctor visits Referrals to specialists
- Referrals to and coordination with hospital and specialist care
- Primary mental health care
- Palliative and end-of-life care
- Healthy child development
- Primary maternity care
- Rehabilitation services
- Some prescription drugs (coverage varies by province/territory)
What may not be covered by provincial/territorial health insurance coverage?
- Some prescription drugs
- Dental care outside of a hospital
- Vision care (with exceptions based on age)
- Medical equipment and appliances (prostheses, wheelchairs, etc.)
- Other health professionals’ services such as physiotherapists or massage therapists
Provinces and territories may provide coverage for some of these supplementary health services - Opens in a new window, although coverage may be limited to certain groups (e.g., seniors, children, and low-income residents). Those who don’t qualify for provincial/territorial coverage (or have medical expenses not covered by government healthcare) will have to pay for these services out-of-pocket or through group or individual health insurance plans.
Many Canadians have health insurance coverage either through their employers or on their own - Opens in a new window. The level of coverage provided varies according to the plan purchased.
What is covered by workplace benefits?
It depends on the plan. But workplace benefits, also known as group benefits, look to fill in the gaps from provincial/territorial coverage. Workplace benefits plans generally include coverage for things like:
- Dental care
- Vision care (eyeglasses and contact lenses)
- Prescription drugs
- Specified medical services that are not covered by provincial healthcare (chiropractors, physiotherapists, podiatrists, osteopaths, optometrists, massage therapists, etc.)
- Semi-private or private hospital rooms
- Special nursing services
- Ambulance services
- Emergency medical expenses incurred outside of Canada
- Artificial limbs, prostheses and medical appliances
- Wheelchairs and other equipment
- Certain mental health care services
What is covered by individual insurance?
Individual health insurance is often purchased when benefits are not provided through your workplace, or most commonly, when people are self-employed - Opens in a new window. In rare cases, individual health insurance might be purchased in addition to your workplace benefits plan with coverage specific to your and your family’s needs.
Who does your individual health insurance policy cover?
If your policy is in your name, you are covered by that plan.
Your spouse or partner and children may also be eligible for coverage under your insurance policy. As well, children between 19-25 who are still in school or are disabled may be eligible for coverage under your policy.
Is it worth it?
Ultimately, the choice to buy individual health insurance - Opens in a new window is yours and the question of whether it’s worth it is one that we can help answer.
Consider what kind of additional insurance coverage you need and if it’s already covered by your workplace benefits plan. Knowing your own health needs as well as your family’s and how you would benefit most from individual health insurance coverage is important.
What if my employer doesn’t provide workplace benefits?
If your workplace doesn’t provide a benefits plan at all, purchasing an individual health insurance policy may be worth it. It may help cover the gaps in your provincial/territorial plan.
If you are a Quebec resident, individual health and dental insurance provides supplemental coverage to the prescription drug coverage provided under the Régie de l’assurance maladie du Québec (RAMQ) basic prescription drug insurance plan.
Individual health and dental insurance doesn’t remove your obligation to have drug coverage through the RAMQ drug public plan, through your employer or an association you are a member of or through the employer of your spouse.
What if my workplace benefits plan is limited?
While having workplace benefits is a great step in protecting you and your family, sometimes there are gaps that your specific health and wellness needs can fall through. The time you spend now considering what you and your family need is time (and money) you can save down the road.
There are lots of other reasons that make purchasing individual health insurance worth the cost, such as:
- You’re retiring - Opens in a new window
- You’re losing group coverage - Opens in a new window
- You’re not eligible for group benefits
- You’re self employed
Whatever your reason is, get a quote - Opens in a new window to get an idea of what you can expect from what Canada Life has to offer, including pricing. The more armed with knowledge you are, the better decisions you’ll make.
Now that you understand more about what is covered by health insurance in Canada, you may want to:
Check how much coverage you need and how much it could cost by getting a quote online. - Opens in a new window
Provincial government health plans pay for some of your healthcare services and needs. Select your province to see an overview of the provincial healthcare coverage - Opens in a new window that may be available to you.
When you’re covered by more than one benefits plan, they work together to pay your claims. This is called coordination of benefits - Opens in a new window and we’ve got answers to your questions.