Similar to Group Health plans, Individual plans are designed to help offset the cost of medical expenses that are not covered by provincial health care plans.
Individual plans typically have lower reimbursement levels and more restrictive coverage limits. The benefits may include:
Prescription Drug Coverage:
Often reimbursed at 70% or 80%, with an annual maximum.
Coverage for massage therapists, chiropractors, physiotherapists, acupuncturists and other paramedical practitioners. Often covered at $300/year/practitioner/insured, with per visit limits.
Often covered at $200/2 years/insured.
Ambulance expenses, hospital rooms, home nursing, foot orthotics, etc.
Benefits often have a coinsurance to reduce cost and share the responsibility of dental health. Diagnostic, Preventative, and Minor Restorative are often reimbursed at 70%-100% up to an annual maximum of between $500 and $1,500. Major restorative claims are often reimbursed at 50% up to an annual maximum of $500 – $1000. Orthodontic claims are often reimbursed at 50% up to a lifetime maximum of $500 – $1,000.