A Simple Breakdown of Health Insurance Plans in Ontario

Posted on December 26, 2018

In Ontario, one-third of employees don't get dental and medical benefits through their employer.

And while Ontarians are covered for many medical costs by the government-funded insurance plan, there is still a big, expensive gap.

Read on to learn all about personal health insurance plans in Ontario so you can make an educated choice for your family. 

Why Do You Need Health Insurance in Ontario?

In Ontario, all residents have access to the Ontario Health Insurance Plan (OHIP) paid for by the government. But OHIP doesn't cover everything you may need.

OHIP covers many health services such as doctor appointments, emergency room visits, and medical tests and surgeries. It does not cover prescription medication, dental clinic services, optometrist visits, and prescription eyewear nor cosmetic surgery. OHIP covers one major eye exam every 24 months for youth under 19 years old as well as seniors over 65.

As you can see, there are many things that you may need to access regularly that is not covered by OHIP. Prescription medicines, dental work, and eyeglasses are common items families need. Some employers provide additional coverage, but not all do.

To make up the difference, there are several health insurance providers in Ontario. That way you know you are financially prepared for any unexpected illnesses that come up. 

Blue Cross Ontario Plans

Blue Cross Ontario offers several packages to suit your unique needs. There is no deductible for any of the items you can buy. 

All plans include a pay-direct drug card. All plans also come with $5 million emergency travel medical coverage.

Basic Blue Choice

This plan is for those aged 16 through 74. For prescription drugs, this plan gives you 70% coverage up to $500 per calendar year per person.

You also get 70% coverage for dental care for a total of up to $245 per calendar year per person. Vision care is not included in this package. 

Basic Plus+

This plan gives you more dental benefits. You get up to $500 per person each year.

Prescription coverage also goes up to 80% per year. In your first year of coverage, you are covered for up to $500. In following years you are covered for up to $750. 

This plan gives you access to eye exams up to $50 every two years. This coverage doesn't cover prescription glasses. 

Blue Choice Balance

If you are going to need a high threshold for prescription medication, this plan is a good option. You get 70% coverage up to $5000 per calendar year. 

Dental benefits in this plan allow you up to $500 per person each year.

Vision care in this plan allows you up to $100 every two years. And you are eligible for an eye exam costing $50 every two years.  

Blue Choice

The Blue Choice package lets you choose only the benefits you need. The prescription coverage is 80% for a total of $10,000 per calendar year. 

Vision care in this plan allows you up to $150 every two years. And you are eligible for an eye exam costing $50 every two years.

Dental coverage goes up each year. During year one, you get 70% up to $750.

Year two allows you 75% coverage up to $1000. In year three, coverage is 80% for a total of $1,250 per year. 

Sunlife Health Insurance Ontario Plans

Sun Life Financial is an award-winning company that has won a place among the 2018 Global 100 Most Sustainable Corporations in the World.

They offer three options for health plans. 

Basic Plan

This plan is a low-cost option that provides basic dental and medical coverage.

You get 60% reimbursement for prescription drugs and dental care. The drug maximum is $750 a year. The dental annual maximum is $500.

There is no vision care in this plan. 

Standard Plan

This is Sunlife's most popular plan. It is a good option for those who want catastrophic drug and emergency travel medical coverage.

Prescription drug coverage is 70% up to $7000. After you hit that threshold, you will get 100% coverage for another $93,000 of eligible expenses.

The standard plan allows you to have 100% coverage for supplemental healthcare. This includes naturopathic services, registered massage therapists and so on. There is a $300 maximum per year.

You are eligible to get 100% coverage for vision care up to a maximum amount of $150 every two years. 

Enhanced plan

The enhanced plan offers extensive and comprehensive coverage. This plan has optional dental coverage that includes orthodontic and restorative services.

Coverage is 80% for prescription drugs for first $5,000. Then you are covered for 100% of the expenses up to $245,000 a year. If you think you may need extensive coverage, you should consider critical illness insurance.

You get 100% coverage for supplemental healthcare up to a max of $400 per year. The vision care threshold is $200 every two years and is 100% reimbursable.

Manulife Health Insurance

Manulife also offers three health insurance plans for individuals. 

Manulife Flexcare

This plan, as the name implies, allows you to choose the services that you need. There are also customizable add-ons. This way you can create a plan that is tailored to your needs. 

Coverage depends on what features you choose. 

Manulife FollowMe

If you are leaving a job and will no longer have access to a group benefits plan with Manulife, this plan is for you.

This plan allows you to keep the coverage that you are used to. 

Manulife Association

This third Manulife plan has four options to choose from. Each provides higher coverage than the other plans offered by Manulife.

Coverage includes prescription drugs, dental care, vision care, hospital coverage,  and travel.

Health Insurance Plans in Ontario

As you can see there are many options for health insurance plans in Ontario. This article just covers the plans of three of the major providers in Ontario.

The best way to get the best deal on health insurance plans is to compare prices and packages.

Get a quote to get the lowest insurance rates in Canada.

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