"Will I get back more in benefits than what I pay in premiums?"

The mindset of getting out ahead is common. However, focusing only on immediate financial returns can lead to misjudging the actual value of a personal health insurance plan.

Are You Buying for Just One Benefit?

If you’re purchasing personal health insurance for a single predictable expense, like prescription glasses or massage therapy, it’s easy to feel like you’re losing money.

For example:

🔹 If you pay $1,000 per year in premiums but only claim $300 for glasses, you might feel like you're wasting money.

🔹 If you only visit the dentist once a year for a check-up, you might think, "I could just pay for this out of pocket instead."

But focusing only on one benefit misses the bigger picture.

A Personal Health Insurance Plan (is meant to) Cover Both Predictable and Unpredictable Expenses

A well-rounded personal health insurance plan is designed to protect you from both expected and unexpected healthcare costs.

✅ Predictable expenses: Routine dental care, vision care, massage therapy, physiotherapy, chiropractic care, and other paramedical services. These are costs you plan for and foresee spending money on.

✅ Unpredictable expenses: Accidental dental injuries, ambulance visits, or catastrophic prescription drug costs (if covered by the plan). These are expenses you can’t foresee but could be financially devastating.

Net Savings vs. Peace of Mind

People don’t expect to get back the full value of their car insurance in claims yearly, but they keep it because one major accident would be financially devastating (yes - car insurance is legally required, but the analogy still works!).

Even if you don’t ‘make back’ every dollar you pay in premiums, your insurance reduces the financial risk when something unexpected happens.

Some personal health insurance plans may offer net savings—where the benefit reimbursement outweighs the premiums paid. When that doesn’t happen, the out-of-pocket amount is the cost of peace of mind, knowing you won't be left with massive out-of-pocket costs if an accident, sudden illness, or unexpected health expense occurs.

Personal health insurance isn’t just about breaking even on premiums vs. claims. Canadians should have a personal health insurance plan that balances reimbursements for predictable costs with protection for unforeseen medical events.

Disclaimer: The information provided in this article is for general informational purposes only and does not constitute legal, financial, or insurance advice. For complete details, please refer to CompareHealth's Terms of Use and Privacy Policy.

When considering personal health insurance, you may not qualify for all plans. There are two categories of personal health insurance in Canada:

1. ‘Traditional’ Personal Health Insurance

You won’t see the word ‘traditional’ used by any insurance provider. These are personal health insurance plans that anyone with a provincial/territorial health plan can apply for at any time, regardless of whether they previously had health coverage.

A common misconception is that all traditional plans require a medical questionnaire. This is not true—some providers offer traditional plans that are guaranteed issue.

🔹 Most traditional plans require a medical questionnaire to determine eligibility, meaning pre-existing conditions may not be covered.

🔹 Others offer guaranteed issue coverage, which means no medical questionnaire is required—even if the applicant didn’t have previous health and dental insurance.

2. ‘Conversion’ or ‘Replacement’ Health Insurance

These personal health insurance plans are for people leaving a group benefits plan - typically through an employer.

🔹 No medical questionnaire is required—coverage is guaranteed as long as the person applies within the required timeframe after leaving a group benefits plan. These personal health insurance plans tend to have higher premiums and lower benefit maximums to compensate for the higher insurable risk.

🔹 Some insurance providers, like Canada Life and Alberta Blue Cross, may also allow people to switch from another personal health insurance plan, but this is rare.

🔹 Time limits for applying for conversion/replacement plans can vary between 60 to 182 days after the previous coverage ends, depending on the insurance provider.

Waived Waiting Periods for New Plans

If someone is switching from an existing health insurance plan to a new personal health insurance plan with waiting periods, the new insurance provider may waive their waiting periods. However, this depends on the insurance provider, the specific personal health insurance plan, and the specific benefits with the waiting periods.

Understanding these two types of personal health insurance can help you choose a plan that best fits your situation.

CompareHealth shows both ‘traditional’ and ‘conversion/replacement’ plans (when applicable) with details on whether waiting periods can be waived.

Disclaimer: The information provided in this article is for general informational purposes only and does not constitute legal, financial, or insurance advice. For complete details, please refer to CompareHealth's Terms of Use and Privacy Policy.

Group benefits and personal health insurance operate differently regarding cost, coverage, definitions, and eligibility requirements.

Understanding these key differences can help you manage expectations, especially those transitioning from a group benefits plan to a personal health insurance plan.

1. Cost Differences: Group Buying Power vs. Individual Pricing

Think of group benefits like bulk-buying at Costco—when many people pay into a plan, the cost per person is lower.

✅ Group benefits spread risk and costs across a large group, often making it more affordable per person. Employers may subsidize premiums, further reducing costs.

✅ Personal health insurance is typically priced based on the policyholder (and any family member) factors like age, so premiums can be higher. No one subsidizes these premiums, but tax incentives may be available.

2. Premium Structure: Fixed vs. Variable Pricing

✅ Group benefits have a fixed pricing structure, typically offering a:

• • Single rate (same premium whether you’re 22 or 52 years old); and
• • Family rate (same premium regardless of the number of dependents)
  
  Some group benefits plans offer a “couple” rate (which is uncommon).
  
  ✅ Personal health insurance does not follow a single pricing calculation method—different insurance providers calculate premiums differently:
  
  
• • Some offer single, couple, and family rates, similar to group benefits plans. These plans determine the rate by using the age band of the oldest participant/insured.
• • Some insurance providers look at the age of the primary applicant, even if the spouse is older.
• • Other insurance providers charge a premium for each covered participant/insured.
  
  3. Medical Questionnaires & Pre-existing Conditions
  
  ✅ Group benefits have no medical questionnaire if you enroll during the eligibility period. It automatically covers pre-existing conditions. Members who apply too late are likely deemed “late applicants” and could be subject to pre-existing condition exclusions, capped maximums and waiting periods.
  
  ✅ Personal health insurance may require a medical questionnaire, which can impact eligibility for coverage. Some personal health insurance plans are guaranteed issue, but these often come with limited or capped benefits.
  
  4. Coverage Limits & Caps
  
  ✅ Group benefits typically offer higher coverage limits - it’s common to see plans include unlimited prescription drug coverage, high annual maximums for paramedical services, and comprehensive dental coverage.
  
  ✅ Personal health insurance plans usually have capped benefits:
  
  
• • Dental coverage may be limited, and major dental may not be covered.
• • Paramedical services (e.g., massage, physiotherapy) can have per-visit maximums and lower annual maximums.
• • Co-insurance, which is the amount insurance providers reimburse, could be as low as 50%.
  
  5. Waiting Periods Are Common in Personal Health Insurance Plans
  
  ✅ Group benefits provide immediate coverage when you join the plan. Exceptions may apply if members are “late applicants”.
  
  ✅ Personal health insurance often includes waiting periods for benefits like dental or hearing aids. Depending on the insurance provider, these waiting periods vary from 3 months to 2 years. Sometimes, select waiting periods can be waived when transitioning from another plan.
  
  6. One-Size-Fits-Most vs. Customization
  
  ✅ Group benefits generally provide the same coverage for all employees under the plan unless the employer offers different classes of coverage or a Health Spending Account (HSA).
  
  ✅ Some personal health insurance plans can offer customization, allowing people to add or remove dental, vision, or travel insurance benefits. In addition, people can choose the personal health insurance plan that’s best for their circumstances.
  
  7. Dependent Eligibility Varies
  
  ✅ Group benefits typically cover dependents up to age 21 or 25 if they are full-time students in a recognized post-secondary institution.
  
  ✅ Personal health insurance may have different rules—some insurance providers do not cover dependents over 21, even if they are full-time students.
  
  8. How a "Year" Is Defined for Benefits
  
  “I need to use up my massage benefits before they reset on January 1st!”
  
  ✅ Group benefits base annual benefit maximums, like massage therapy, on a calendar year (resets January 1) for most benefits.
  
  ✅ Personal Health insurance may follow a different definition. Some plans primarily use a calendar year, while others use:
  
  
• • A policy year (resets on the policy’s anniversary date).
• • A benefit year (resets based on when the expense was first incurred).
  
  Sometimes, the definition of a ‘year’ for a personal health insurance plan can vary by province!
  
  Both group benefits and personal health insurance may have multiple ‘year’ definitions across various benefit categories.
  
  Key Takeaway: Understanding the Trade-Offs
  
  Understanding how benefit maximums reset helps prevent unexpected out-of-pocket costs. Check the personal health insurance plan’s brochure and policy for the “year” definition.
  
  Group benefits can provide higher coverage, no medical underwriting, premium subsidization, and lower premium costs, but accessing this coverage is typically through an employer. Personal health insurance plans offer flexibility and allow people to maintain coverage regardless of employment status, but they often have higher premiums, coverage maximums, and waiting periods before some coverage begins.
  
  Disclaimer: The information provided in this article is for general informational purposes only and does not constitute legal, financial, or insurance advice. For complete details, please refer to CompareHealth's Terms of Use and Privacy Policy.

Many assume premiums remain the same once they have a personal health insurance plan. However, like most insurance products, personal health insurance is subject to rate changes.

There are two main reasons why rates change:

1. Getting Older

Most personal health insurance plans adjust rates based on age bands.

Check to see if your age is listed below. If so, some insurance providers may adjust rates for a personal health insurance plan at your next birthday (if you have the plan, some may wait until the next policy anniversary).

Why is it a BINGO card? Maybe BINGO stands for something:

Boring Insurance Never Gets Old

This image just looks prettier than giving you bullet points of numbers.



For example, someone 24 years old (age 24 is in the picture above) may see a rate change for some personal health insurance plans when they turn 25.

EXCEPTIONS:

🔹 If the personal health insurance plan has multiple people and only one person enters a new age band, the premium may not change due to age-banding—especially if the plan is priced based on the oldest insured person.

🔹 Not all age-band changes result in higher premiums; for example, many personal health insurance plans reduce rates at age 65+ due to the availability of government-funded benefits for seniors.

2. Annual Rate Adjustments by the Insurance Provider

Insurance providers periodically review their overall risk and claim costs and may adjust rates for all policyholders.

🔹 These blanket rate changes typically occur once per year and commonly apply to everyone covered under those plans.

🔹 These annual adjustments are typically based on claims experience, inflation, and healthcare costs. However, some insurance providers hold their rates for extended periods outside this pattern.

The silver lining is most insurance providers earmark a specific month for annual rate adjustments. Knowing when rates increase means you can predictably plan ahead.

Here’s when insurance providers on CompareHealth typically adjust their rates:

✅ Canada Life – January
✅ GMS – June and December
✅ GreenShield Insurance – April (see rate changes in March)
✅ Manitoba Blue Cross – April (see rate changes in March)
✅ Manulife – January and May (changes typically take effect about a month ahead of time)
✅ Medavie / Ontario Blue Cross – November and January (verify); changes typically take effect a month ahead
✅ Pacific Blue Cross – June
✅ Saskatchewan Blue Cross – February (verify)
✅ Sun Life – April (verify)
✅ Special Benefits Insurance Services (SBIS) – April (see rate changes in March or earlier)
✅ The EDGE Benefits – October (see rate changes in September)
✅ Victor Insurance – December

📌 What Does ‘Verify’ Mean?
These insurance providers have adjusted rates in these months, but there isn’t enough historical data to confirm a set pattern.

Understanding these timelines can help policyholders anticipate potential rate increases and make informed decisions about purchasing or renewing personal health insurance.

Are There Personal Health Insurance Plans Without Age-Band Pricing?

Not all providers use age bands to determine premiums. Some may offer the same rate for all age groups. However, these insurance providers still review rates annually.

Understanding Rate Increases

While rate adjustments are expected for personal health insurance, knowing how and when they happen can help you manage expectations.

Disclaimer: The information provided in this article is for general informational purposes only and does not constitute legal, financial, or insurance advice. For complete details, please refer to CompareHealth's Terms of Use and Privacy Policy.

Does personal health insurance cover pre-existing conditions?

It depends!

Canadians may assume a personal health insurance plan offering high prescription drug maximums to cover their existing prescriptions. However, this is not always the case.

If you’re already taking prescription drugs, some personal health insurance plans won’t cover them.

General Rule for Personal Health Insurance:

Medical Questionnaire = No Pre-Existing Condition Coverage

Most personal health insurance plans that require a medical questionnaire will not cover pre-existing conditions unless explicitly stated otherwise (there are sometimes exceptions).

CompareHealth Clearly Defines Prescription Drug Coverage for Pre-Existing Conditions

Many insurance providers do not explicitly state whether their prescription drug benefit (if offered) covers pre-existing conditions, leaving policyholders uncertain—the last thing you want is a surprise at the pharmacy counter that you’re on the hook for the entire cost.

To help with transparency, CompareHealth clearly distinguishes between:

✅ Drug coverage for newly-diagnosed conditions
These personal health insurance plans cover prescription drugs for medical conditions that develop after your policy takes effect.

✅ Drug coverage for pre-existing conditions
These personal health insurance plans cover prescription drugs for medical conditions that existed before your policy took effect, including those present during the application process.

How to Find a Personal Health Insurance Plan That Covers Pre-Existing Conditions

If you need coverage for existing prescriptions, look for personal health insurance plans that:
✅ Do not require a medical questionnaire
✅ Are conversion/replacement plans (applicable only to those leaving a group benefits plan)
✅ Explicitly state coverage for pre-existing conditions (this can include personal health insurance plans with a medical questionnaire!)

CompareHealth makes it easy to see which personal health insurance plans cover pre-existing conditions before you apply.

NOTE: Personal health insurance plans do not cover all prescription drugs. If you take any prescription drugs you want a personal health insurance plan to cover, contact the insurance provider to verify coverage.

Disclaimer: The information provided in this article is for general informational purposes only and does not constitute legal, financial, or insurance advice. For complete details, please refer to CompareHealth's Terms of Use and Privacy Policy.

Choosing a personal health insurance plan isn’t just about picking the one with the highest coverage amounts. Here are five questions to ask before committing to a plan:

1. Does this personal health insurance plan cover pre-existing conditions?

Many assume a personal health insurance plan offering prescription drug benefits will automatically cover their existing prescriptions, but this is often untrue.

🔹 Personal health insurance plans that require a medical questionnaire typically exclude coverage for pre-existing conditions.

🔹 If you need coverage for a pre-existing condition, look for:

• A conversion/replacement plan (if you qualify)
• A personal health insurance plan without a medical questionnaire
• A personal health insurance plan that explicitly states it covers pre-existing conditions.
  
  Check out CompareHealth’s article talking about pre-existing conditions!
  
  NOTE: Personal health insurance plans do not cover all prescription drugs. If you take any prescription drugs you want a personal health insurance plan to cover, contact the insurance provider to verify coverage.
  
  2. When do rates go up for me?
  
  Your monthly premium won’t stay the same forever. Most personal health insurance premiums increase for two reasons:
  
  🔹 Age-banding
  
  🔹 Annual adjustments by the insurance provider
  
  Make sure to check out CompareHealth’s article talking about rate changes! Understanding when and why rates change can help you plan for future costs.
  
  3. How easy is it to claim? (Is there an app?)
  
  Nobody wants to deal with paperwork after a visit to the dentist or chiropractor.
  
  🔹 Some providers have modern apps that allow you to submit claims instantly and receive direct deposit reimbursements.
  
  🔹 Others still rely on paper forms or may require you to pay out of pocket.
  
  4. Are there any waiting periods?
  
  Some benefits may not be available immediately when your personal health insurance plan goes into effect.
  
  🔹 Some personal health insurance plans may have a waiting period for basic dental (1-6 months).
  
  🔹 Major dental often has a waiting period (sometimes waived if you had previous coverage).
  
  If you previously had another health plan, ask if any of these waiting periods can be waived.
  
  Knowing what benefits have a waiting period is key to managing expectations (and your hard-earned cash flow).
  
  5. How long will it take to underwrite my application?
  
  The time it takes for your application to be approved depends on whether a medical questionnaire is required.
  
  🔹 Guaranteed issue personal health insurance plans are typically processed quickly, often within days.
  
  🔹 Personal health insurance plans that require a medical questionnaire can take one day to several months, depending on the complexity.
  
  🚨If you are leaving a group benefits plan, you typically have a limited window to apply for some personal health insurance plans (such as conversion/replacement plans). Underwriting timelines and delays can impact your eligibility for other personal health insurance plans if the one you want doesn’t work out.
  
  Disclaimer: The information provided in this article is for general informational purposes only and does not constitute legal, financial, or insurance advice. For complete details, please refer to CompareHealth's Terms of Use and Privacy Policy.

If you Google "personal health insurance" you’ll struggle to find unbiased, accurate information. High-ranking results fall into one of these categories:

1️⃣ Lead Generation Websites

These websites likely appear first in your search results, as their content is search keyword-rich. Users can select a personal health insurance plan on their website and fill out their contact details for follow-ups. However, the information users see before submitting their contact details includes a detailed ‘review’ (score) of health insurance providers, with questionable and subjective scoring methods, outdated and incorrect plan details, and content riddled with grammatical errors.

2️⃣Insurance Providers Promoting Their Own Personal Health Insurance Plans

When you visit an insurance provider’s website, you’ll only see their products. While their coverage might be solid, you won’t get a side-by-side comparison with other insurers to see what best fits your needs.

3️⃣ Advisors Selling Limited Products (Often With Outdated Information)

Some advisors only sell personal health insurance plans from one or two insurance providers and advertise outdated brochures on their website, meaning the information you receive may not reflect current pricing, coverage, or eligibility requirements.

How CompareHealth is Different

CompareHealth helps empower you with the personal health insurance information you need and can connect you with advisors and insurance providers.

✅ You See Your Results First – Unlike other platforms, CompareHealth lets you review personal health insurance plan details upfront without requiring your contact information. You only provide your details to connect with an advisor or insurance provider.

✅ No Commissions or Hidden Agendas – CompareHealth is unlicensed, meaning we don’t favour one provider over another. Our goal is to provide accurate, side-by-side comparisons so you can make informed decisions.

✅ You Choose to Connect – If you’d like more guidance, you can request to connect with an advisor or insurance provider.

✅ Straightforward Plan Details – You get a full breakdown of plan designs, including optional benefits, pricing structures, and eligibility—without misleading sales tactics.

Why This Matters

Buying health insurance is a big decision.

CompareHealth puts you in control with easy-to-understand and unbiased personal health insurance plan information and can connect you with an insurance or insurance provider when you’re ready!

Disclaimer: The information provided in this article is for general informational purposes only and does not constitute legal, financial, or insurance advice. For complete details, please refer to CompareHealth's Terms of Use and Privacy Policy.

Numerous insurance providers offer personal health insurance in Canada. You’ve probably seen some commercials for health insurance on TV!

Here’s a breakdown of the insurance providers CompareHealth compares:

Canada Life

✅ Freedom to Choose

• Select
• Select with assured acceptance
• Select plus
• Select elite
• Guaranteed
• Guaranteed with drugs
• Guaranteed without drugs
• Guaranteed plus
• Guaranteed elite
  
  Group Medical Services (GMS)
  
  ✅ Personal Health Coverage – BasicPlan, ExtendaPlan, OmniPlan
  ✅ Replacement Health Coverage – ChoicePlan, PremierPlan, EssentialPlan
  
  GreenShield Insurance
  
  ✅ ZONE – 1, 2, 3, Fundamental, 4, 5, 6, 7
  ✅ LINK – 1, 2, 3, 4
  
  Manitoba Blue Cross
  
  ✅ Individual & Family Plans – Plan A, Plan B, Plan C, Accident Plan
  ✅ Blue Choice Conversion Plan
  ✅ Retiree Plans – Retiree Basic, Retiree Standard
  
  Manulife
  
  ✅ Flexcare
  
  
• ComboPlus Starter
• ComboPlus Basic
• ComboPlus Enhanced
• DrugPlus Basic
• DrugPlus Enhanced
• DentalPlus Basic
• DentalPlus Enhanced
  
  ✅ FollowMe – Basic, Enhanced, Enhanced Plus, Premiere
  ✅ Guaranteed Issue Enhanced
  
  Medavie Blue Cross*
  
  ✅ Complete Health - Entry, Essential, Enhanced
  ✅ Guaranteed Acceptance
  ✅ Retiree Plan - Silver, Gold, Platinum
  
  Ontario Blue Cross*
  
  ✅ Complete Health - Entry, Essential, Enhanced
  ✅ Guaranteed Acceptance
  
  *On CompareHealth, Ontario Blue Cross and Medavie Blue Cross are called ‘Blue Cross Health’.
  
  Pacific Blue Cross
  
  ✅ Health and Dental – Bronze Health, Silver Health, Gold Health
  ✅ Guaranteed Acceptance – Essential Health, Bronze Health, Silver Health, Gold Health
  ✅ Retirement – Bronze Health, Silver Health, Gold Health
  ✅ Group Conversion
  ✅ Dental Only
  
  Saskatchewan Blue Cross
  
  ✅ Blue Choice
  ✅ Conversion
  ✅ Guaranteed Acceptance
  
  Sun Life Financial
  
  ✅ Personal Health Insurance – Basic, Standard, Enhanced
  ✅ Health Coverage Choice – Health and Dental Choice A, Health Choice B, Health Choice C
  
  Special Benefits Insurance Services (SBIS)
  
  ✅ Prism Spectra – S1, S2, S3, S4
  ✅ Prism Precision – P1, P2, P3, P4
  ✅ Prism Continuum – C1, C2, C3, C4
  
  The EDGE Benefits
  
  ✅ Base Health and Dental Plan
  
  Victor Insurance
  
  ✅ Retiree Benefits - Health and Dental Insurance
  
  —--
  IMPORTANT: There are other insurance providers not listed here. This list does not currently include association or employer-specific plans.
  
  Disclaimer: The information provided in this article is for general informational purposes only and does not constitute legal, financial, or insurance advice. For complete details, please refer to CompareHealth's Terms of Use and Privacy Policy.

Unlike applying for life insurance, personal health insurance underwriting typically does not require invasive medical exams, such as bloodwork, urine tests, and vitals. However, some personal health insurance plans require medical questions as part of the application process.

Personal health insurance plans with medical questionnaires tend to offer:
✅ Higher coverage maximums
✅ Lower premiums

If a plan requires a medical questionnaire, here are some common underwriting outcomes when the personal health insurance application is NOT approved as-is:

1. Exclusions for Pre-Existing Conditions

The insurance provider may exclude related reimbursements if there is a pre-existing condition.

🔹 Example: If someone has high blood pressure that’s treated with prescription drugs, personal health insurance plans with prescription drug coverage may not cover this condition.

🔹 Some providers may also exclude certain paramedical services (e.g., massage therapy, chiropractic care) if they are being used to treat a pre-existing condition rather than for general maintenance.

2. Premium Adjustments ("Rating a Policy")

Some insurance providers may increase the premium. This means the policy is “rated” based on a higher insurable risk (likely for reasons outlined in point 3), making it more expensive than the standard rate.

3. Declined Coverage

In some cases, an insurance provider may decline an application based on:

🔹 Medical history (e.g. chronic conditions)

🔹 Family history (e.g., hereditary conditions that increase risk)

🔹 Pending medical consultations or tests (if an applicant is awaiting a diagnosis or medical appointment, insurance providers may require a final decision before offering coverage)

If you're unsure how an insurance provider might assess your application, ask if they have an underwriting guide to better understand their risk evaluation process.

Should You Apply for a Personal Health Insurance Plan With a Medical Questionnaire?

If you have a pre-existing condition, you might assume a guaranteed issue plan is your only option—but that’s not always the case.

🔹 If your prescription drugs are inexpensive and you’re comfortable paying out of pocket, you may still benefit from a personal health insurance plan with a medical questionnaire that doesn’t cover these pre-existing conditions since it often includes higher overall coverage limits and lower premiums.

🔹 It’s a good idea to play the plan vs. benefit game with an advisor to determine which personal health insurance plan makes the most financial sense. CompareHealth can help you connect with an advisor or insurance provider to explore your options.

Group Benefits & Special Exceptions

🔹 If you are leaving a group benefits plan, you may qualify for a conversion/replacement plan, which typically does not require a medical questionnaire and covers pre-existing conditions.

🔹 Some plans may waive waiting periods if you had prior coverage.

Key Takeaway

If you’re applying for a personal health insurance plan with a medical questionnaire, expect higher coverage limits and lower premiums—but also potential exclusions for any pre-existing conditions.

Disclaimer: The information provided in this article is for general informational purposes only and does not constitute legal, financial, or insurance advice. For complete details, please refer to CompareHealth's Terms of Use and Privacy Policy.

The Canadian Dental Care Plan (CDCP) is designed to help some Canadians access dental care, but an eligibility requirement raises questions for those with personal health insurance.

One of the CDCP eligibility requirements says:

"You don’t have access to dental insurance."

At first glance, this seems straightforward—if you have any form of dental coverage, you’re not eligible. But does this definition make sense when applied to personal health insurance?

Unfortunately, there are more questions than answers. Here are several questions the CDCP program needs to address with personal health insurance.

Does "Access to Dental Insurance" Include Personal Health Insurance?

Technically, anyone with a provincial/territorial health plan has "access" to buy traditional personal health insurance with a dental benefit. Personal health insurance is not an employer-subsidized benefit—it's a voluntary, private purchase. Does simply having the ability to buy personal health insurance disqualify someone from CDCP?

What about people who:

✅ Have a personal health insurance plan with only basic dental coverage?
Many personal health insurance plans only cover basic/routine dental services like cleanings, checkups, and cavity fillings, but no coverage for crowns, root canals, or dentures. If someone needs a crown, would the CDCP deny them coverage because their personal health insurance plan covers dental - even though it’s basic dental procedures only?

✅ Have a personal health insurance plan with minimal dental coverage?
Some personal health insurance plans offer as little as $250 per year in basic dental benefits. If a person uses up their coverage on cleanings, cavity fillings, and X-rays, does this mean they are on their own for additional dental work? If they cap out too early in the year, are they forced to pay out of pocket while others with no dental coverage qualify for full CDCP benefits?

✅ Have a personal health insurance plan with optional dental but chose not to add it?
Some personal health insurance plans allow people to choose whether to include dental coverage. If someone declines the dental option, does this mean they are still ineligible for CDCP because they technically had the right to add it? What about someone with a personal health insurance plan that allows them to add dental coverage later—would they be disqualified even if they never used the option?

What This Means for Canadians

Without clear definitions, the CDCP’s eligibility criteria could unfairly exclude people who:

🔹 Have a personal health insurance plan with dental that doesn’t cover major dental procedures.

🔹 Could technically add dental to their personal health insurance plan but chose not to.

🔹 Have a personal health insurance plan with small annual dental maximums and hit their cap too early.

This creates grey areas that could leave many people uncertain about their eligibility.

Final Thoughts

The CDCP must clearly define "access to dental insurance", especially for those with limited or optional dental coverage under a personal health insurance plan.

Until then, Canadians applying for the CDCP should seek coverage clarification before purchasing personal health insurance.

Disclaimer: The information provided in this article is for general informational purposes only and does not constitute legal, financial, or insurance advice. For complete details, please refer to CompareHealth's Terms of Use and Privacy Policy.

—---

When purchasing personal health insurance, many assume that once they buy a personal health insurance plan, they can keep it for life as long as they continue paying their premiums.

✅ Is A Plan Expiring Common? No. Most ‘base’ personal health insurance plans do not expire once issued—as long as you continue paying premiums, your coverage remains in place.

⚠️ Is A Plan Expiring Possible? Yes. While most personal health insurance plans do not have a built-in expiration date, there are exceptions, and it's important to understand where limitations might apply.

 

Situations To Be Aware Of

1. Issue Age Maximums (Eligibility to Apply)

Most personal health insurance plans have a maximum age limit for new applicants. You must apply before exceeding this age, but the personal health insurance plan typically won’t expire (see point 2) as long as you keep paying your premiums.

2. Plans That Have Expiry Dates

Some insurance providers have termination ages, meaning coverage will automatically end at a specific age. These plans may also have issue age maximums.

Benefits That May Expire Even If the Plan Doesn't

Even if a ‘base’ personal health insurance plan remains in force, some optional benefits or benefit categories have age limits or expiration dates for benefits like:
✅ Accidental Death & Dismemberment (AD&D)
✅ Travel Insurance

Some coverages may be reduced or terminated entirely at a certain age. Because these expiration rules vary by provider, always review these key facts before applying for coverage.

Disclaimer: The information provided in this article is for general informational purposes only and does not constitute legal, financial, or insurance advice. For complete details, please refer to CompareHealth's Terms of Use and Privacy Policy.