Split Modules
Split modules refer to the structure of a health insurance plan that allows members to mix and match different coverage categories, such as drug, dental, and extended health care. Each module operates independently with its own premiums and limits.
How It Works
In a split-module design, each coverage category is its own module, and a modular flexible plan differs from a standard benefit plan by giving members the ability to choose aspects of their benefit plan, primarily for the Health and Dental categories. The Health and Dental components can have tiered options with varying coverage levels and maximums, so a member may choose a higher tier for Health but a lower tier for Dental. Premiums can vary by tier, with a higher tier generally carrying a higher premium, and members typically cannot change tiers outside the initial or eligibility month until renewal or after a qualifying life event. These modular coverage categories map to the gaps left by Canadian provincial plans, which generally cover hospital and doctor visits but leave out most prescriptions, dental, vision, and paramedical care such as massage, physiotherapy, and chiropractic. Splitting coverage into modules provides flexibility to tailor coverage to personal or family needs, so someone with strong dental coverage through a spouse may choose to purchase only the health and drug modules. For employers, splitting or limiting benefits is one of the common levers used to manage and reduce group benefit premium costs.
Example:
A self-employed person in Ontario whose partner already provides family dental coverage through a workplace plan chooses a Canadian individual plan structured in split modules. They select the prescription drug and extended health modules to cover physiotherapy and massage that OHIP does not, but decline the dental module since it would duplicate their partner's coverage, paying premiums only for the categories they actually need.
What to Watch For:
A key nuance is to confirm how deductibles and maximums apply, because some insurers treat each module separately while others share combined limits. Because premiums can vary by tier and members typically cannot change tiers outside the initial or eligibility month until renewal or after a qualifying life event, check the timing rules before you commit to a tier. Splitting coverage gives you flexibility to tailor a plan to personal or family needs, but confirm which modules and tiers you actually require so you only pay for the categories you need.
