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Plan Tiers

Plan tiers refer to the different levels of coverage available within a group or individual insurance plan. Each tier offers a varying combination of benefits, coverage limits, and premium costs, allowing members to choose the option that best fits their needs and budget. Tiers are commonly labeled as Basic, Enhanced, or Premium, though terminology can differ by insurer. Higher tiers typically provide more comprehensive coverage and higher annual or lifetime maximums, while lower tiers focus on essential protection at a lower cost.

How It Works

Plan tiers are most often used in extended health, dental, and vision insurance. In Canada, individual health and dental plans are commonly available in basic, standard, or comprehensive tiers, each with different costs and coverage levels. Canadian insurers offer several tiers of coverage that members can use to supplement other plans and make coverage as comprehensive as needed. With some Canadian insurers, the coverage limit increases as you move up the plan tiers, and comprehensive orthodontic coverage is only available in higher-tier plans.

Example:

A Canadian insurer might offer three tiers of an extended health and dental plan: a Basic tier reimbursing 70 percent of prescription drug costs, an Enhanced tier reimbursing 80 percent, and a Premium tier reimbursing 90 percent with higher dental maximums and added vision care. A self-employed Canadian without group benefits can pick the tier that matches their family's healthcare needs, knowing that moving up to a richer tier later may require answering medical questions.

What to Watch For:

Before choosing a tier, members should compare the coverage details, coinsurance percentages, and annual maximums for each tier, since some tiers include benefits such as vision care or paramedical services that are not part of lower-level plans. Once enrolled, changes between plan tiers may be restricted, and upgrading to a higher tier may require medical underwriting.

Related Terms

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.

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.

Provincial Coordination

Provincial coordination refers to the process of aligning private insurance benefits with the coverage provided by your provincial or territorial government health plan. It ensures that the public plan pays for all eligible expenses first, and your private insurance covers only the remaining costs that are not paid by the government. This coordination helps prevent duplicate payments while maximizing your overall coverage.

Pharmacist

A pharmacist is a licensed healthcare professional who prepares, dispenses, and provides guidance on the safe and effective use of prescription and non-prescription medications. Pharmacists play a key role in ensuring that medications are used correctly, preventing harmful drug interactions, and advising patients on dosage, side effects, and storage. In many provinces, pharmacists also provide additional healthcare services such as administering vaccines, renewing prescriptions, and offering health consultations.

Prior Authorization

Prior authorization is the process through which an insurer reviews and approves certain medical treatments, procedures, or prescription drugs before they are performed or dispensed. It ensures that the recommended care is medically necessary, appropriate, and covered under the policy before expenses are incurred. Prior authorization helps manage costs and ensures the use of safe, evidence-based treatments that align with clinical guidelines.

Relevant Plans

Plans that relate to Plan Tiers

Alberta Blue Cross - Blue Assured - Basic

Alberta Blue Cross - Blue Assured - Basic

Can apply at anytime, at any age.

Alberta Blue Cross - Blue Assured - Enhanced

Alberta Blue Cross - Blue Assured - Enhanced

Can apply at anytime, at any age.

Alberta Blue Cross - Blue Assured - Enhanced+

Alberta Blue Cross - Blue Assured - Enhanced+

Can apply at anytime, at any age.

Alberta Blue Cross - Blue Assured - Premium

Alberta Blue Cross - Blue Assured - Premium

Can apply at anytime, at any age.

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