What Do Provincial Health Plans Not Cover?
OHIP, MSP, AHCIP and their counterparts cover medically necessary physician and hospital care — and surprisingly little else. For most working-age Canadians, provincial plans typically exclude:
- Dental care — cleanings, fillings, root canals, crowns, orthodontics (federal dental programs assist some income groups, but coverage for most working families remains private).
- Prescription drugs outside hospital for many adults, depending on province, age, and income.
- Vision care — routine eye exams for adults in most provinces, glasses, and contact lenses.
- Paramedical services — physiotherapy, massage therapy, chiropractic, psychology and counselling, beyond limited exceptions.
- Out-of-country emergencies — covered at only a token level, which is why travel insurance exists.
A single root canal and crown can cost as much as a year of family premiums; supplemental insurance turns those unpredictable bills into a predictable monthly cost.
Who Needs a Private Health and Dental Plan?
- Self-employed professionals and small-business owners with no group benefits — premiums may also be deductible as a business expense in some situations (confirm with your accountant).
- Employees without benefits — part-time, contract, and gig workers.
- Families whose group plan is thin — topping up low dental maximums or missing vision care.
- People leaving a group plan — retirement, job change, or layoff (see the conversion window below).
- New permanent residents who have provincial coverage but discover it stops at the dentist's door.
How Do Plan Tiers Work?
Most insurers structure individual plans in tiers, typically three:
- Basic: core prescription drug coverage and preventive dental (check-ups, cleanings, fillings) with modest annual maximums — the affordable entry point.
- Mid-tier: higher drug and dental maximums, more paramedical practitioners with larger per-visit and annual limits, plus vision allowances.
- Comprehensive: the highest maximums, major dental work (crowns, bridges, dentures) after any waiting period, richer paramedical, vision, and often some travel medical coverage built in.
Common fine print across tiers: reimbursement percentages (often 70–100% depending on service and tier), annual maximums per benefit category, and waiting periods of several months for major dental. Matching the tier to how your family actually uses care — orthodontics coming? glasses every two years? regular physiotherapy? — is where comparing plans pays off.
Guaranteed-Issue vs Medically Underwritten Plans
Individual plans come in two flavours. Medically underwritten plans ask health questions and can decline applicants or exclude conditions, but generally offer better prices and richer benefits for healthy applicants. Guaranteed-issue plans accept everyone regardless of health — valuable for people with significant medical history or ongoing prescriptions — but typically cost more, cap benefits lower, and may phase in coverage. Which is right depends entirely on your health profile; this is a five-minute conversation with an advisor that can save years of mismatch.
Leaving a Group Plan? Mind the Conversion Window
When you retire, change jobs, or are laid off, most insurers offer a conversion option: enrol in an individual plan within a set window — typically 60 to 90 days of losing group coverage, varying by insurer — with no medical questions asked. Miss the window and any new plan can underwrite you, meaning conditions you developed during your working years could be excluded or the application declined. If a departure is coming, talk to an advisor before the group coverage ends, not after. This is also a natural moment to review life insurance, since group life coverage usually ends at the same time.
How Do You Choose the Right Plan?
Start from usage, not from price. Pull last year's receipts — dental visits, prescriptions, glasses, physiotherapy — and total what your family actually spent; that number tells you which tier pays for itself. Then check the details that differ most between insurers: the dental fee guide year the plan reimburses against, per-visit and annual paramedical caps, whether orthodontics is covered at all (many individual plans exclude it), and drug coverage for any medication a family member already takes. Families expecting braces, ongoing prescriptions, or regular therapy should weight those benefits far above small premium differences. Finally, decide underwritten vs guaranteed-issue based on your health history — the wrong choice here is the expensive mistake, not a $15 premium gap.
What Do Health and Dental Plans Cost?
Premiums vary by age, province, family size, tier, and whether the plan is underwritten — as a general frame, individual plans often start under $100 per month for basic coverage, with comprehensive family plans running several hundred per month as of 2026. The right comparison is not premium vs zero; it is premium vs what your family already spends at the dentist, pharmacy, and optometrist, plus protection against the big surprise. Champp compares plans from 15+ insurers and lays out that math for your actual usage — free, in English, Hindi, or Punjabi. Request a comparison.