Health Insurance with Blue Cross

Health Insurance Frequently Asked Questions

Canada’s public health care system is highly regarded. You show your provincial health card for doctor visits and emergency care and the services are covered. You often don’t think about the cost. There are many services that aren’t covered, though. And many people don’t realize the gap until they get a bill.

That’s when health insurance can help. Here are the top questions MMHI advisors get about private health insurance plans.

1. What does provincial health care actually cover, and what am I missing?

Provincial health care plans cover the basics: doctor visits, hospital stays, emergency care, and some diagnostics. However, they don’t cover a number of services––like vision care, which should be annual expenses if we want to stay healthy. Here’s what's not covered:

• Prescription drugs: Most working-age Canadians pay out of pocket. But seniors and those with low-income may qualify for Pharmacare.
• Dental care: For most, cleanings, fillings, crowns, root canals. Low income Canadians may qualify for the federal dental care program.
• Vision care: glasses, contact lens, and routine eye exams in most provinces
• Paramedical services: these are for prevention and ongoing care, like physiotherapy, massage, chiropractic, and mental health counselling
• Private hospital rooms, medical equipment (hearing aids, orthotics, CPAP), and ambulance fees in several provinces
• Travel medical coverage: if you get sick outside of Canada, your provincial plan isn’t likely to reimburse you

Private health insurance is designed to fill exactly these gaps.

2, Will a pre-existing condition affect my coverage, or disqualify me?

A pre-existing condition is one you have at the time you apply for health insurance. Having a health condition doesn't automatically disqualify you. But, it means you need the right type of plan. Here are 3 options:

1. A standard medically underwritten plan: You’ll be asked detailed health questions when you apply. The insurer may exclude certain conditions or apply a waiting period. This is the best coverage at lowest cost, and ideal for those who are healthy.
2. Guaranteed issue plans: These accept all applicants with no health questions asked. Pre-existing conditions are often covered after a waiting period (typically 12 months). The premiums are higher and limits lower. But, if you have a history of illness, or you’re currently ill, they're a good option. Blue Cross Assured Access is a comprehensive option.
3. Conversion plans: If you have group coverage from an employer benefit plan and move to an individual plan, sometimes you can carry over pre-existing condition coverage. You often have a timeframe of 60–90 days after losing group coverage to make the switch. Read more about conversion plans.

3. How much does private health insurance cost ? What affects the price?

Cost is a common question and the short answer is: it depends. There are many factors that determine what you’ll spend on a monthly premium:

• Age is the biggest factor. As you get older, premiums increase because you’ll generally have more health issues.
• The province where you live can affect cost, because public coverage differs. This affects what gaps the private health insurance plan needs to fill.
• Plan tier: You have a choice in the level of coverage you want to pay for. Blue Cross plans, for example, offer 3 tiers so you can choose 60% coverage or 80% coverage for dental care.
• Deductible: A deductible is the amount you agree to pay before your insurance takes over. If you choose a higher deductible you’ll spend less on your monthly premium.
• If you’re a smoker, you’ll pay higher premiums across all insurers

4. I'm self-employed. What are my options and can I deduct the premiums?

When you leave a job with group benefits, and go out on your own as a freelancer, consultant, contractor, or small business owner, reality hits the first time you visit the dentist or pick up a prescription.

You could get coverage through your spouse's plan, or buy through a trade association, like a Chamber of Commerce. However, self-employed Canadians are the fastest-growing segment of individual health insurance buyers.

There are lots of health insurance options available to match your budget and needs. And the good news is the premiums are tax-deductible in Canada. Learn more about health insurance plans for self-employment.

5. How do I compare health insurance plans, and is going through a broker better than buying direct?

Health plans are harder to compare than most financial products. The benefit structures, drug lists, annual spending limits, and waiting periods can vary significantly between insurers. Here's what to check before you decide:

• Drug formulary: the list of medications a plan actually covers. Confirm your prescriptions are on it before buying.
• Dental waiting periods: most plans require 3–6 months of enrolment before dental benefits activate. Timing matters if you have upcoming work planned.
• Paramedical annual limits: a plan may cover physiotherapy, but a $300 annual limit covers two or three sessions. Check dollar amounts, not just whether a service is listed.
• Guaranteed renewability: this means the insurer can't cancel your coverage or spike your rates because your health has changed. Look for this, especially on long-term plans.

As a broker working with multiple insurers—Blue Cross, Manulife, GMS, and others—MMHI compares the market and matches a plan to your situation. Going directly to one insurer means seeing only their products. But using a broker costs you nothing extra; brokers are paid by the insurer, not the client.