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Health Insurance

Health insurance is a type of coverage that helps pay for medical and healthcare expenses not fully covered by Canada’s public health system. It protects individuals and families from the high cost of prescription drugs, medical services, and treatments that fall outside provincial or territorial government health plans. Health insurance can be obtained through an employer’s group benefits plan or purchased individually from a private insurer.

Typical health insurance plans include coverage for prescription drugs, vision care, medical equipment, hospital accommodations, emergency travel medical care, and paramedical services such as physiotherapy, massage therapy, and chiropractic care. Some plans also include optional riders for dental, life, or critical illness coverage. Health insurance plays a vital role in bridging the gap between government-provided healthcare and the full cost of maintaining health and wellness.

Example:

If your provincial plan covers only hospital and physician services, and you need a $300 pair of prescription glasses, your private health insurance plan with vision coverage can reimburse you up to your plan’s vision maximum, such as $250 every two years.

What to Watch For:

Review what your plan includes and excludes. Each policy has its own limits, waiting periods, and reimbursement levels. Confirm whether benefits renew annually or every two years, and check for per-visit or per-claim maximums. Coordination of benefits may apply if you have multiple plans through your employer and spouse.

Related Terms

Extended Health Care Insurance

Extended health care insurance (EHC) is supplemental coverage that helps pay for medical expenses not covered by your provincial or territorial health plan. It protects you from out-of-pocket costs associated with services such as prescription drugs, vision care, medical equipment, hospital upgrades, emergency travel medical care, and paramedical services like physiotherapy or chiropractic treatments.

Healthcare Spending Account (HCSA)

A Healthcare Spending Account (HCSA) is a flexible, employer-funded benefit that reimburses employees for a wide range of eligible healthcare expenses not fully covered by their group insurance plan or a government health plan. It allows employees to use allocated funds toward medical, dental, and vision expenses based on their personal needs. The Canada Revenue Agency (CRA) regulates which expenses qualify under the Income Tax Act, and reimbursements from an HCSA are received tax-free.

Coverage / Benefit

Coverage, sometimes referred to as a benefit, is the range of health or dental services, supplies, or treatments that your insurance plan agrees to pay for under its terms and conditions. Each benefit represents a category of care, such as prescription drugs, dental services, vision care, or paramedical treatments.

Provider

A provider is a licensed healthcare professional, facility, or service organization that delivers medical, dental, vision, or paramedical care to patients. In the context of insurance, a provider is any individual or entity authorized to perform covered services and submit claims for reimbursement to an insurer. Providers include physicians, dentists, pharmacists, physiotherapists, chiropractors, optometrists, hospitals, and clinics.

Treatment

Treatment refers to any medical, dental, or therapeutic care provided by a licensed healthcare professional to diagnose, manage, or improve a health condition, injury, or disease. In the context of insurance, treatment includes all services, procedures, medications, and interventions that are deemed medically necessary to restore or maintain health. It can range from routine doctor visits and prescription drug use to surgery, rehabilitation, and specialized therapies.

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