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Tips for choosing the right family health insurance coverage

At a time when maintaining our physical and financial wellness occupies a big part of our minds, determining our family’s health insurance needs is essential to being well prepared for the unexpected.

Why do families need health insurance?

Many people believe that OHIP covers all their healthcare needs. However, there are lots of expenses that are not reimbursed by this program*, such as:

  • The services of numerous health professionals (physiotherapists and psychologists)
  • Dental care
  • Vision care
  • Medical equipment
  • Drugs and tests available in pharmacies

*The services covered depend on several factors related to a person’s age or situation. Refer to OHIP to learn more about the services covered.

Whether it is for a family member or for yourself, you may need to access these additional services. Unfortunately, the amounts for receiving health care can add up very quickly. Whatever your financial situation, unexpected expenses aren’t good for anyone.

If you have group insurance, it can help you pay for certain treatments not covered by your provincial health insurance plan. However, not everyone has access to a group insurance plan, and for many families, individual health insurance is the best solution to supplement OHIP coverage.

Why should a family purchase health insurance if they have minimal medical expenses?

In addition to the tax deductions you may be entitled to, the cost of your individual health insurance will likely be lower than the medical bills you would have had to pay out of pocket without this coverage. Many families are not aware of the amounts they are paying out of their own pockets for access to certain care. Over the years, these amounts could represent several hundred or even thousands of dollars. A sum much higher than the cost of an insurance premium. In other words, individual health insurance can save you money.

How can I choose my health insurance?

As with any other purchase, it’s important to take your time to explore the options available to you. This will give you the best possible chance of finding health insurance that truly meets your family’s needs. Products can vary widely, and choosing the right coverage is important.

Before making a choice, check what is covered by OHIP. Being well informed about coverage you have will help you better determine your family’s needs. Here are some relevant questions to ask yourself:

  • What types of medical treatment or services would be beneficial for you or your family members?
  • Are there any medical services you would like to have access to that are not covered by OHIP?
  • Have you thought about your future needs and those of your family?

Answering these questions will help you better understand the type of coverage you should purchase.

In addition, when choosing the level of coverage, each family should not only consider their immediate medical needs, but also plan for the future. “A private health plan can manage the family’s expenses but most importantly, it protects the family from unexpected future bills that could impact the family’s day to day budget and retirement savings.” says Max Mahardi, Business Development Manager. Your needs may change, and certain limitations may apply depending on your health or that of your family members. To have the maximum number of options when you make your choice, consider purchasing insurance while you are in good health!

Other things to consider when choosing your health insurance

  1. Pre-existing conditions: Does anyone in your family have a pre-existing condition? If so, what condition is it and what does it imply? While this does not necessarily mean that this condition will not be covered by insurance, certain restrictions may apply. Talk to your advisor or your insurance company when choosing your coverage.
  2. Policy use: Assess how you plan to use your insurance policy. If you don’t need all of the extended coverage, you may find it beneficial to purchase basic coverage, that will have a reduced premium. 
  3. Cost vs. coverage: The balance between the cost of health insurance and what it covers is an important factor for families. Determine how much you’re willing to pay and check what type of coverage that amount gives you access to. However, it is important not to stop at cost alone. In general, a cheaper plan will give you less coverage, which means you may have to pay for some services. Higher premiums will mean additional services or more comprehensive reimbursements.
  4. Coverage limits: Any insurance contract has limitations and reductions in coverage (that is, situations or services that would not be covered). Before purchasing insurance, read the policy carefully to know the conditions that apply and to determine if the coverage meets your family’s needs. 
  5. Customization: Another point to consider is your ability to customize certain components of your health insurance policy to meet the needs of your family. Find out about the possibilities to customize your insurance and seek the help of an advisor to help you choose a plan that meets your expectations.

Remember that when it comes to health insurance, the needs of a single person are very different from those of a family. All of the above can help you find the right level of coverage for your family.

 Article updated on December 17, 2020.