Individual Health Insurance
and
Private Health Insurance
The Canadian Way
Individual health insurance must be provided to every person living in Canada under the
Canada Health Act.
Private health insurance plans are used to provide extra coverage for services not insured under
each province's individual health insurance plan and are most often a part of a benefits package negotiated by a
labor union.
Once residency and immigration requirements are met everyone in Canada is eligible for insurance coverage under the provincial health insurance plan.
Ability to pay and previously existing medical conditions cannot be used as a reason to withhold
insurance from an individual. The insurance plans in all provinces and territories must be
comprehensive and administered by a public authority on a non-profit basis.
If the 13 provinces and territories in Canada
do not provide individual health
insurance under the conditions set forth in the Canada Health Act they run the risk that the federal government will not
transfer money to them to run the health care system.
Here is how individual health insurance and private health insurance plans work in Canada.
Individual Health Insurance
- Every province or territory must have a health insurance plan in place and they are allowed to
charge an insurance premium but the plan must be "non-profit".
- The Canada Health Act says that all medically necessary services must be insured,
so variation between provinces will arise in how "medically necessary" is defined by each province's individual
health insurance plan.
- All people living in the province receive a "care card" which is an identification card for the provincial
health insurance plan. This card must be presented when accessing insured services.
- It is a requirement that every resident of the province carries health insurance.
You cannot "opt-out" of the health insurance plan and pay privately
for insured services. If you do not pay the required health insurance premiums and you
need health care you will receive the necessary insured services, however, you will
also receive a bill for all the missed insurance payments.
If this bill is not paid and your insurance is not
brought up to date, the insurance plan will collect the debt through debt collection services and
garnishee of wages if necessary.
- If you cannot afford the monthly insurance premium, you must apply to the government and provide proof of your inability to pay
through income tax records and once your are approved for financial assistance the insurance premium will be paid for you by
the government.
Your income will be monitored through the
income tax reports that are filed annually and when your income is sufficient to support payment of the health insurance premiums the government will
notify you that the financial assistance has been withdrawn.
- Many workers that belong to a union have the individual health insurance premium paid by their employer
if this has been negotiated through a labor union agreement. When you leave
that employer either your new employer pays or you must continue paying the insurance premium on your own.
Private Health Insurance
Private health insurance is available for services that are not insured under the provincial plan. These plans are often called
extended health and will cover such things as:
- prescriptions
- chiropractic and/or naturopathic care
- physiotherapy
- massage therapy
- acupuncture
- orthotics
- vision care, glasses, and contact lenses
- private nursing care if ordered by a doctor
Dental insurance can also be purchased through a private health insurance plan.
These private plans are highly variable in their coverage and are often paid for by the employer as a benefit
negotiated through a labor union agreement.
Typically a private health insurance plan has a deductible that must be satisfied for each insurable
service.
Provinces may also have plans in place to provide health care benefits to populations who may be considered
vulnerable to certain health challenges. Such populations may include seniors, children or
social assistance recipients.
Additional benefits to these populations may include prescriptions, dental care, wheelchairs or mobility devices,
and assisted living premiums and certain vaccinations, but it is highly variable from province to province.
Go from this article on
individual
health insurance plans in Canada to the article that describes the
Canadian health care system
