What Healthcare Needs are Covered by Supplemental Health Insurance in Canada Beyond Public Health Insurance

Canada's public health insurance system, often referred to as Medicare, provides coverage for a wide range of medical services but leaves some healthcare needs uncovered. Supplemental health insurance, such as Blue Cross, fills these gaps by covering additional services and expenses that are not typically included in public health insurance plans. In this article, we will explore the specific healthcare needs that are covered by supplemental health insurance in Canada.

Differences in Provincial Coverage

The specifics of what is covered by supplemental health insurance can vary significantly by province. However, there are certain common services that are not covered by the provincial healthcare systems, although some exceptions exist based on age, income, or specific circumstances. Below is a list of some of the most common healthcare needs that are typically covered by supplemental insurance.

Common Items Not Covered by Provincial Healthcare Systems

Ambulance Transportation Services: Unless deemed medically necessary, supplemental insurance often covers the cost. Routine Eye Examinations: For individuals aged 20 to 65, these are usually not covered. Glasses and Contact Lenses: The cost of these is generally not covered by public health insurance. Dental Care in a Dentist's Office: Beginning here, supplemental insurance usually covers this. Prescription Drugs: Typically, prescription drugs obtained outside of hospitals are not covered. However, there are exceptions based on age and income. Physiotherapy: Many supplemental plans cover this type of treatment. Paramedical Services: This includes services provided by chiropractors, massage therapists, naturopaths, acupuncturists, and osteopaths. Semi-Private and Private Hospital Rooms: Supplemental insurance can cover the cost of these, although availability is not guaranteed. Necessary Emergency Medical Treatment Outside Canada: Depending on your plan, this may be covered. Birth Control Pills and Contraceptives: These are often covered by supplemental insurance.

Understanding the Ontario Health Insurance Plan (OHIP)

For those living in the most populous province, Ontario, the situation can be a bit more detailed. The Ontario Health Insurance Plan (OHIP) covers a broad range of healthcare services, but there are some notable exclusions. The following are some of the key points related to OHIP in Ontario:

Dental Care: OHIP covers preventative care and some routine dental treatments, but not all. For more comprehensive coverage, a supplemental plan like Blue Cross is recommended. Optical Services: OHIP covers some vision care services, but supplemental insurance can provide full coverage. Prescription Drugs: OHIP covers some prescription medications, but there is a deductible to be met. Supplemental insurance can help cover the costs after the deductible is reached.

How Supplemental Health Insurance Works in Ontario

Supplemental plans in Ontario, such as Blue Cross, work by covering a portion of the costs after a lower deductible. This can be particularly beneficial for those facing higher healthcare expenses. Here’s how it works:

Prescription Medication Coverage: Typically, individuals must pay full price for prescriptions until a deductible is reached, which is usually 2-3 times their prior year's income. After this deductible is met, the supplemental plan kicks in and covers a significant portion of the remaining costs. Otical and Dental Care: Supplemental plans often cover a higher percentage of these costs compared to the limited coverage provided by OHIP. Hospital Stay Costs: Supplemental plans can cover the cost of a semi-private or private hospital room if available.

Conclusion

While Canada's public health insurance system provides a strong foundation for healthcare coverage, there are many gaps that can be addressed through supplemental health insurance. Understanding the coverage provided by your provincial health insurance plan and choosing the right supplemental plan can help ensure that you have the financial protection you need. If you're unsure about what your specific plan covers, it's a good idea to review the details or contact your insurance provider for clarification.