Full FAQ
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Yes.
Aeva will always feature the most competitive rates available in the Canadian marketplace. Guaranteed.
No.
Because MRI’s (magnetic resonance imaging) are covered by provincial health care plans (in all provinces and territories except Quebec) they are not covered by a health insurance plan.
All health care plans have a drug formulary (i.e. a 'list of drugs' that are covered under the plan).
The drug formulary will vary from one plan to the next.
Insurance companies do not publish their drug formularies publicly, as doing so could potentially result in poorer health outcomes for patients.
E.g. a doctor may be more inclined to prescribe a patient 'Drug A' versus 'Drug B' knowing 'Drug A' is covered and 'Drug B' is not - even though the patient should really be prescribed Drug B for their condition being treated.
If there is a particular medication you are uncertain about, a member of Aeva Support can potentially clarify with the insurance company(ies) if it is covered under their respective formulary.
Most health and dental plans generally do not cover orthodontics.
The few plans that do will typically offer limited coverage (e.g. 50% coverage to a maximum of $2,000 per lifetime), and have a waiting period (usually ~2 years) before the orthodontic benefit becomes available.
A pre-requisite for any health care plan in Canada is that you must already be a Canadian resident and covered by a provincial/territorial government health care plan.
If you have family visiting, we suggest you obtain Visitors to Canada insurance - which is a form of Travel Insurance designed for this purpose.
If you need assistance with Visitors to Canada insurance an Aeva representative can help you upon request by emailing support@aeva.ca.
Yes, but it will depend on your plan.
Most plans have optional add-ons that you can choose to add to your plan to better suit your unique personal needs.
For example; Travel add-ons may be available for your plan to include coverage for emergency medical expenses when you are travelling outside your home province.
Disclosing your pre-existing conditions is most relevant for Medically Underwritten health care plans.
With Medically Underwritten plans, by getting the opportunity to review your health history, the insurance company can potentially offer you a more comprehensive plan at a lower relative cost (i.e. better value).
The caveat to Medically Underwritten plans is that while they will offer better value to those who qualify medically, they will exclude (i.e. not cover) health conditions that you are already being treated for or taking medication for. These health conditions are referred to as 'pre-existing conditions'.
Pre-existing conditions are disclosed on a simple questionnaire. Medical tests such as blood or urine samples are not required when applying for health care plans.
For those who do not qualify medically for a Medically Underwritten plan, there are Guaranteed Acceptance plans available that will cover pre-existing conditions without need for a medical questionnaire.
Under some provincial/territorial government health care plans upon turning 65 you become eligible for prescription drug coverage.
In all cases, regardless of province/territory, the drug coverage will have a limited drug formulary (i.e. a 'list of drugs' that are covered under the plan. An individual health care plan through a traditional insurance company will often have much more expansive drug formulary.
In other words, some/all of the medications you take or may need to take may not be covered under the provincial/territorial government plan, but may be covered under an individual health care plan.
In addition to prescription drug coverage, individual health care plans will often include additional benefits that become relevant as one ages, such as home health care, mobility devices and hearing aids etc.
The cost of a plan (referred to as the 'premium') will vary depending on a number of factors such as:
- Your province of residence
- Which plan you choose
- Age of those insured under the plan
- How many people are insured under the plan (i.e. larger families will pay more than smaller families)
- Which optional add-ons you've included on your plan
No, there is no physical or other medical exam required to qualify for any health or dental care plan.
Medical exams are common for other forms of insurance, such as Life, Disability, Critical Illness etc.
Some plans include travel benefits (specifically Emergency Travel Medical - which covers emergency medical costs incurred when travelling outside of your home province).
Not all plans include travel benefits by default. In cases where travel is not included, there will be an optional add-on to include travel if you wish.
As long as you are covered by provincial healthcare, you will always be offered coverage when you apply for a plan through Aeva.
It is possible to be declined for a Medically Underwritten plan due to medical history.
You can always apply for a Guaranteed Acceptance plan, regardless of whether you have pre-existing conditions, or have been declined for coverage (e.g. declined for a Medically Underwritten plan).
Aeva shows you all the plans available to you in your local province/territory.
It's important to understand that with health insurance, you generally get what you pay for.
i.e. A higher cost plan will tend to offer more money, for more benefits, treatments, and services. Conversely, a lower cost plan will tend to offer less money, for fewer benefits, treatments, and services.
Which plan is 'the best' for you and your family will often depend on your budget and what you can sustainably afford.
Aeva shows you all the plans available to you in your local province/territory.
Using Aeva you can filter the plans presented to you according to your budget.
It's important to understand that with health insurance, you generally get what you pay for.
i.e. A higher cost plan will tend to offer more money, for more benefits, treatments, and services. Conversely, a lower cost plan will tend to offer less money, for fewer benefits, treatments, and services.
Yes, you can cancel your health insurance plan at any time.
There may be a waiting period should you wish to rejoin a plan in the future after having cancelled.
Co-insurance is an amount paid by the insured person on health and dental claims expressed as a percentage.
E.g. Prescription Drugs may be covered at 80% on your plan. 80% is the co-insurance, which implies you must pay the remaining 20% out-of-pocket.
This is different than a copay (short for copayment), which is a flat fee paid by the insured person on some health care services.
Most health and dental plans will have some amount of co-insurance, though the percentage will vary. Some plans may also have a copay while others not.
There are three types of plans available, each treat pre-existing conditions and medications differently.
There are Guaranteed Acceptance plans available that will cover pre-existing conditions and medications with no medical questionnaire required.
Guaranteed Issue plans are for those leaving an employee group benefits plan, and will also cover pre-existing conditions and medications with no medical questionnaire provided you transition to the plan within 60-90 days of your employee group benefits terminating.
Lastly, Medically Underwritten plans will exclude pre-existing conditions and medications, and will only cover new conditions and medications after the coverage is in place.
You can compare all the plan details using Aeva's plan comparison tool.
Health insurance plans cover numerous health care expenses that are not covered under your provincial/territorial plan, such as:
- Prescription drugs
- Dental care
- Licensed health care practitioners (e.g. physiotherapists, massage therapists, chiropractors etc.)
- Vision care (e.g. eye exams, glasses, & contact lenses)
- Travel medical insurance
- Ambulance (ground/air), as well as other health care services & medical equipment
Plans will vary in terms of which benefits they include, so it is important that you understand what is included in the plan of your choosing.
No.
There are Guaranteed Acceptance plans available, which do not require a a medical questionnaire and can be applied for at any time. These can be a good option for those who may not qualify for a Medically Underwritten plan due to health history.
Contractors typically do not receive health insurance from their employer(s), and are often responsible for their own health insurance.
Any of the plans available on Aeva.ca would be suitable for a self-employed contractor.
Health and dental care plans are sometimes referred to as 'individual' or 'private' or 'extended' or 'supplemental' health and dental insurance.
These are all synonymous terms and really just different labels attempting to describe the exact same thing. That is: a health and dental insurance plan that you own, you pay for, and you control, and you have a direct relationship with the insurance company.
When they are referred to as 'extended' or 'supplemental' it is because they are designed to extend (aka supplement) your provincial government health care plan.
When they are alternatively referred to as 'private' or 'individual' it is because they are paid for and owned by you - as opposed to paid for by someone else on your behalf (e.g. an employer or the government).
Pre-requisite is that you must be covered by a provincial government health care plan.
The choice of having an individual health insurance plan for you and your family is a personal one.
As with any form of insurance you don't always need it, but when you do you're usually glad you have it.
If you insure your home or your car, why would you not also insure your own health - which is arguably the most valuable of all these items?
An individual health insurance plan helps cover unforeseen expenses which are not covered by a government health insurance plan.
e.g. prescription drugs, supplemental (added) costs of surgeries, consultations with licensed health care practitioners, dental and vision appointments etc.
Though it can vary from one insurance company to the next, you can expect you will generally receive payment within approximately 5-6 business days.
Submitting your claims online helps to ensure that all required information is obtained and that your claims are received and processed faster.
Alternatively, you can submit claims manually using a paper form. Naturally, paper forms are more error prone and can result in longer processing times. For this reason, using online claims is advisable.
Life events are major events such as getting married, having a child, or losing your employee group benefits.
These life events may make you eligible to make changes to your plan outside of the normal periods.
As an example, if you have recently had a child you can potentially add them to your plan within a certain period of time without them needing the child to qualify medically - usually within 30 days of birth.
If you've experienced a life event, please contact support@aeva.ca at your earliest convenience so that we can assist with potential next steps where appropriate.
This is referred to as 'Coordination of Benefits'. While there are a number of different possible scenarios, the most common is where a couple are covered under two separate plans. In such a scenario, you will always submit claims in the following sequence:
- Your own benefits plan first.
- Your spouse’s plan (for any remaining unpaid amounts from step 1 above). Likewise, your spouse’s claims should be submitted to their own plan first.
A full blog post going deep on this subject can be found here: https://aeva.ca/blog/what-is-coordination-of-benefits
Separated partners can choose to keep each other on their health insurance policy, however usually when people legally separate, they find separate insurance plans for themselves.
This can vary from one plan to the next.
Manulife:
- Dependent children can stay on their plan up to the age of 21.
Sun Life:
- Dependent children can stay on their plan up to the age of 21, or up to age 25 if they are enrolled in post-secondary program.
Canada Life:
- Dependent children can stay on their plan up to the age of 21, or up to age 25 if they are enrolled in post-secondary program.
- Most group benefit plans (plans provided to a group of members most commonly by your employer, or an association) cover children to the age of 21 if they are not in school, or up to age 25 if they are enrolled in post-secondary program.
As with any form of insurance, health insurance is important for protecting against the risk of an unexpected event.
When it comes to health, an unexpected event could mean being diagnosed with a condition that requires a costly prescription medication as an example. These types of unexpected events have the potential to be financially devastating.
Health insurance plans can help cover expenses that are not covered by your provincial government plan.
Stepchildren can potentially be covered under your health health insurance plan. Generally, they would need to be unmarried and dependent on you for maintenance and support.
Biological and adoptive children can be covered as long you have legal guardianship.
No, only immediate family in your household would be eligible to be covered under your plan.
A grandchild can be added as a dependent if you have legal guardianship and they reside with you.
Yes, however depending on the plan underwriting may be required. i.e. Medical questions may be asked, and your spouse may need to qualify medically.
Adding or removing a spouse can occur at any time over the lifetime of the policy and the difference in premium will be billed or refunded accordingly depending on the case.
Some plans bundle the dental together with the health care, while others enable you to opt for the health care coverage only. Therefore, being covered for dental is a personal choice.
If you and your family are visiting the dentist frequently, you will likely get more value out of dental coverage than a person/family that goes less often.
Dental coverage isn't really insurance in the traditional sense, so much as it is more of a financing arrangement. Meaning, a dental expense isn't likely to bankrupt a person in the same way that a large health care expense has the potential to.
A full blog post going deeper on this subject can be read here: https://aeva.ca/blog/is-dental-insurance-important-to-have
Dependent children are eligible to be added to your health care plan at birth.
If you have a newborn child, you can usually add them to your plan without medical underwriting provided you apply to do so within 30-days of birth.
If you have a newborn child, please email support@aeva.ca for assistance in adding them to your plan.
There are a number of possible answers to this question, but generally one should consider applying for health insurance in the following circumstances:
- Ideally, when you are young and have relatively little health history.
- When you turn age 21, and are no longer a 'dependent' under your parents plan. This could be turning age 25 if you were a full-time student attending post-secondary (depending on which plan your parents have).
- When you become a Canadian citizen and are covered by a provincial government health care plan.
- When you leave your employer and lose your employee group benefits (applying within 60-days is best).
- When you separate from a spouse and need to find your own plan.
- When you are going self-employed.
- When your employee group benefits are underwhelming and you wish to supplement with your own plan.
Medical marijuana may be eligible depending on your plan. Please check your plan specifications.
It will always need to be obtained from a licensed producer, and issued by a licensed practitioner.
Seeds or plant material used to propagate cannabis will not be eligible.
You can find your Plan number and ID number on your wallet cards that come with your welcome kit and policy documents.
If you're unable to locate your Plan and ID numbers, please email support@aeva.ca and we'll be glad to assist in recovering these numbers for you.
Each insurance company will have its own secure client portal you can use for submitting your claims electronically.
Instructions for getting registered for online claims will be included with your policy documents. You will need your Plan and ID numbers in order to register for online claims successfully.
If you aren't yet registered for online claims, please use the following links:
Manulife Plans:
http://manulife.ca/secureserve
Sun Life Plans:
Canada Life Plans:
If you need assistance, please email support@aeva.ca.
Diabetic supplies may be eligible depending on your plan. Please check your plan specifications.
Some health care plans (i.e. usually the top-tier plans) may cover brand-name medications.
Other plans will often cover brand name up to the cost of a generic equivalent.
Use the Aeva plan comparison tools to compare which plans will cover brand name medications or speak with an Aeva representative.
Individual health and dental plans require that you be covered by a provincial/territorial government health insurance plan.
If you aren't covered by a government health insurance yet, we suggest you consider seeking out a travel insurance product referred to as 'visitors to Canada', which is designed to help cover you until you are eligible to apply for health and dental coverage.
Speak with an Aeva advisor and they can assist you with this.
Birth control may be eligible depending on your plan. Please check your plan specifications.
It depends on the type of plan.
For Guaranteed Issue and Guaranteed Acceptance plans, your coverage will be effective on the 1st of the next month after an application and payment is received.
For Medically Underwritten plans, your coverage coverage will be effective on the 1st of the next month after an application has been approved (subject to qualifying medically) and payment is received.
Medically Underwritten plans can sometimes take longer as the insurance company usually needs to obtain records from your attending physician(s). Average time to approval tends to be about 3-weeks. If the insurance company has difficulty obtaining the medical records from your attending physician(s) this may take additional time.
There are three different types of health care plans:
- Medically Underwritten
- Guaranteed Issue
- Guaranteed Acceptance
Each type of plan has a different approach to 'pre-existing conditions'.
Medically Underwritten Plans:
Will exclude pre-existing conditions. Conditions that are considered chronic in nature will generally be excluded on a permanent basis, while conditions that are acute in nature may be excluded initially with the potential to be reconsidered after a period of time (e.g. 12, 24, 36, 48 months).
Guaranteed Issue Plans:
Will cover pre-existing conditions, so long as you apply within 60-90 days of your employee group benefits terminating (some insurance companies offer 60 days to make this transition, while others 90 days).
Guaranteed Acceptance Plans:
Will always cover pre-existing conditions. An in-depth blog post article can be found here: https://aeva.ca/blog/what-are-exclusions-for-pre-existing-conditions-how-do-they-work
This varies from one insurance company to the next.
Manulife:
Premiums are due on the 1st business day of each month.
Canada Life:
Premiums are due on the 15th of each month.
Sun Life:
Premiums are due any day between the 1st to 28th of any given month. You can specify your preferred date at the time of application.
When your plan starts will depend on which type of plan you are applying for. i.e. Whether it is Guaranteed Issue, Guaranteed Acceptance, or Medically Underwritten.
For Guaranteed Issue and/or Guaranteed Acceptance plans:
Your coverage generally starts on the 1st of the following month after your application has been submitted and payment received.
For Medically Underwritten plans:
Your coverage generally starts on the 1st of the month after your plan is approved and you've accepted the offer.
Waiting Periods
Note that as soon as your coverage starts, you have access to most of the benefits in your plan. Some benefits may have a waiting period - which is a period of time that must first elapse before you can access and use certain benefits (these are most often found on certain dental and/or vision benefits). Please refer to your policy documents for more details.
A "pre-existing condition" means any condition that existed prior to the effective date of your health care plan.
Pre-Existing Condition means any disease or physical condition, whether diagnosed or not, for which symptoms occurred or medical treatment was sought, recommended, required, or obtained, from or by a Physician (medical treatment including any medical advice, consultation, care, diagnosis, treatment or service provided by a Physician), or for which drugs were prescribed by a Physician or taken by an Insured Person, during the 24-month period immediately preceding the Effective Date of Coverage.
An in-depth blog post article can be found here: https://aeva.ca/blog/what-are-exclusions-for-pre-existing-conditions-how-do-they-work
Premium receipts may be found in your chosen insurance company's secure online client portal.
Alternatively, you can contact your insurance company using their toll-free numbers and request an annual receipt be produced.
Each insurance company has a toll-free number you can call to update your payment information.
Additionally, you may be able to update your payment information online using your chosen insurance company's secure online client portal.
Individual health and dental insurance is designed to help pay for costs not covered by your provincial government health care plan.
This includes items such as:
- Prescription drugs
- Treatments by licensed health care practitioners
- Dental visits
- Vision care
- Ground/air ambulance rides
Each insurance company has a toll-free number you can call to update your contact information.
Additionally, you may be able to update your contact information online using your chosen insurance company's secure online client portal.
If you are not completely satisfied, let an Aeva representative know as soon as possible by emailing support@aeva.ca.
We will communicate with the insurance company to cancel your coverage and refund unused premiums paid (if any).
Canada has 13 different health insurance plans - one for every province and territory.
As benefits can and do vary from one province/territory to the next, we encourage you to check your local health authority website for exact details.
That said, government health care plans will generally not cover the following expenses:
- Prescription drugs
- Dental checkups and treatment
- Vision care
- Semi-private or private hospital rooms
- Registered/licensed specialists and therapists such as Acupuncturists, Chiropodists, Chiropractors, Naturopaths, Osteopaths, Physiotherapists, Podiatrists, Psychologists/Psychotherapists, Registered Massage Therapists, Speech Pathologists/Therapists
- Health-related products such as orthotics, hearing aids, prosthetics and medical equipment
- Health-related services such as ambulance, home care and nursing, medical coordination and second medical opinions
- Emergency medical care for travelers
Claims are paid in one of two ways:
- Direct deposit
- Cheque
The insurance companies offer online access to their plans, where you can view your claim history, claim status, and add your banking information for direct deposit of claims.
If your claim is approved, you will receive a direct deposit to your bank account. Alternatively, if direct deposit instructions have not been provided by you then a cheque will be issued and mailed to your physical address.
If your claim submission is complete and accurate, you will generally receive your claim reimbursement within 5-6 business days.
Though each insurance company will vary in terms of what they offer for online services, generally you can expect the following items to be accessible online:
- Status of any claims you have submitted
- Your claims history last 12+ months
- Benefit details for your plan including dollar maximums
The most common reasons for delayed payment of claims, or claims not being paid are as follows:
- Improper documentation/lack of receipts: Submitting claims without copies of the original receipts will likely result in rejection of a claim
- Costs submitted after 12 months: Claims must be submitted within 12 months of the date you paid for the expenses you're claiming
- Costs that aren't medically necessary: Generally, health claims must be deemed medically necessary under the terms of your plan. Preventative dental services aren’t usually medically necessary, however, they may be allowable if your plan covers them.
- Excluded conditions: Some plans (Medically Underwritten) require insured persons to qualify medically, which involves the completion of a medical questionnaire. As a result specific health conditions may be excluded on these plans. When a medical condition is excluded, it means that there is no coverage for any treatments – including but not limited to medications – related to the excluded condition. If a treatment that is normally used for an excluded condition is being used to treat an unrelated condition, your health provider must provide a written explanation. Include this explanation when you submit your claim.
A pre-determination of benefits is an 'estimate' of what your plan will cover for a particular dental procedure.
If there is any uncertainty around whether a particular dental procedure will be covered and/of if a proposed course of treatment is expected to cost more than $500, it is advisable to have your dentist office submit a pre-determination of benefits for you to the insurance company prior to the procedure being completed. To submit this information to the insurance company, your dentist will need your Plan Number and your ID number.
The insurance company will review the submission from your dentist and will reply in a written letter to you clarifying exactly what amounts (if any) will be covered by your plan.
This way you can make an informed decision as to how you wish to proceed.
You need a prescription for drugs and you may need a doctor’s note for some health care services.
Your health care provider may have already submitted your claim on your behalf using your Plan and ID numbers.
If your health care provider has not submitted your claim(s), you can submit your claim(s) yourself either online or on paper by mail.
Submit your claims online:
- Within 12 months of the date you were charged
- After you've paid more than any deductible in your plan
- Specify the currency if your claim is for services outside Canada
- Hold onto original receipts and applicable supporting documentation for 12 months
Submit your claim on paper by mail:
- Within 12 months of the date you were charged
- After you've paid more than any deductible in your plan
- Specify the currency if your claim is for services outside Canada
- Include original receipts and applicable supporting documentation
- Make sure you've signed your claim form
Prescription drug receipts must be original receipts (not statements) and show:
- Name of drug
- Drug identification number (DIN)
- Date of service
- Prescription number
- Prescription strength and quantity
- Drug cost
- Dispensing fee (if applicable)
All other receipts must be original receipts on the printed letterhead of the person or company providing the service and show:
- Name of patient
- Date(s) of service
- Description of service
- Cost of each service
- Proof of payment
If your chosen health insurance plan includes travel coverage, you'll be able to claim costs due to medical emergencies when travelling outside your home province.
Your policy documents will include 24x7x365 toll-free support numbers to dial in the event of a medical emergency. You'll need to provide your respective Plan and ID numbers when you call support so they can confirm your coverage and assist with next steps.
Whenever possible, please call these numbers in advance of incurring any medical expenses in order to ensure that you are directed to the best possible facilities and the maximum amount of any expenses incurred are paid for by the insurance.
You have 12 months from the date you incurred an expense for a health and dental service to submit your claim for reimbursement.
Yes. You will always be able to claim on your provincial/territorial government health care plan. Any amounts not covered by your government plan you would pay out-of-pocket yourself.
If you are not covered by a government health care plan (e.g. non-Canadian residents, or visitors to Canada), you would pay 100% of any medical expenses out-of-pocket, which can be costly.
For those who are working towards Canadian residency, or are visiting Canada, it is advisable to look into Visitors to Canada insurance, which will help to cover medical costs for those not yet covered by a provincial/territorial government health care plan.
To be eligible for an individual health insurance plan, you must meet the following requirements (regardless of insurance company):
- Be a resident of Canada
- Have coverage under your government health insurance plan
- Be at least 18 years of age on the date of application for the policy, except for children of an insured person.
- Quebec residents must also be registered under the RAMQ Prescription Drug Insurance Plan or have equivalent coverage under a group plan.
Note: If the plan is Medically Underwritten it will require a medical questionnaire, and you will need to qualify medically. If you do not qualify due to your health history there are alternative options (e.g. Guaranteed Acceptance plan) available.
Premium is insurance industry terminology for 'the amount you pay for your insurance'.
Premium amounts will vary depending on age of the people insured on the plan, number of people insured on the plan, plan selection etc.
Premiums are most often paid on a monthly basis.
Yes, health insurance plans have plan maximums and benefit maximums.
Plan maximums can be annual maximums (maximum amount to be paid out by insurance provider in a year) and/or lifetime maximums (maximum amount to be paid out by insurance provider during the lifetime of your policy and/or benefit).
Once you have maxed out your health insurance plan the insurance company will not reimburse future claims.
Each benefit included in your plan may also have an annual maximum, which will refresh each year.
Individual health insurance helps to pay for health and dental expenses you may incur.
As a Canadian resident you are covered for basic medical services by your provincial/territorial government health plan.
Individual health insurance plans in Canada are generally referred to as 'extended' health care - because they extend or supplement your government health plan and help fill-in the gaps by covering expenses that your government plan does not.
It's not unusual to be covered by multiple health plans.
You can be covered under an employee group benefits plan and have your own individual health insurance plan.
If you are covered by multiple plans, you would submit your claims sequentially. i.e. Claim first on one plan, and then submit the outstanding balance to the second plan.
You cannot however claim the full amount of the same expense twice.
A copay (short for copayment) is a flat fee paid by the insured on some health care services.
E.g. the insured pays a flat $10 on prescriptions and insurance covers the remaining balance up to plan and annual maximums (maximum amount to be paid out by insurance provider in a year).
Health and dental plans vary from one insurance company to the next with respect to copay.
Some insurance companies may have a copay on their plans while others not. Some insurance companies may have co-insurance instead of copay, or some combination of the two.
Co-insurance is also an amount paid by the insured on health and dental claims expressed as a percentage not a flat fee.