Individual Insurance –Where Do I Start?

Woman thinking at computer.“Where do I start?” is one of the first questions people ask when it comes to purchasing personal health coverage.  Most of those who are investigating this route previously belonged to a group insurance plan – through an employer, a university or college program, or their parents’ plan. When the time comes to look at what’s out there for individuals, the seemingly endless options can be overwhelming.

While there’s a lot of information to take into consideration, a good explanation of the ins and outs of the process can go a long way in helping you make the right decision. Here are a few things to think about before taking the plunge.


Who needs personal insurance?

The short answer – we all do. While our provincial health care coverage ensures we have access to primary areas of medical care, insurance fills in the gaps. This includes coverage for prescription drugs, medical equipment, some services from registered professionals like physiotherapists or psychologists, vision care, dental care, and more. Individual coverage is designed for those who don’t have access to a group health care plan, most commonly those who are self-employed or between jobs.

What are your needs?

No two people are the same, so health care plans are designed to meet your unique needs. Start by writing down what coverage is important to you. For example, do you wear contact lenses? You’ll probably want to look at a plan that includes vision care. If you travel a lot, you should make sure your plan has coverage when you’re outside the country. It’s also a good idea to remember that your health could change, and if it does you’ll want to make sure you’re well taken care of. Most health care providers offer a number of pre-set plans that range in coverage from basic to everything you could possibly need. Look at things like maximum coverage, deductibles and exclusions to ensure you have a good understanding of what each entails.

I’m healthy. Why do I need a personal health plan?Hands around a heart.

While you can’t see into the future, what you can do is save yourself a lot of time, money and hassle by covering yourself now for the years ahead. When applying for your health care plan, you’ll be asked about any current or past health issues– if you have one, known as a pre-existing condition, there is a chance that it and all related expenses will be excluded from your plan. In addition, waiting to apply until your health has been affected can mean higher premiums or you could possibly be declined altogether. Health care coverage should be forethought, not something to look into once the unthinkable has already occurred.

Other considerations

Once you’ve narrowed down your options and evaluated different plans based on your needs, there are a few other things you might want to keep in mind.

  • Direct billing – will you have to pay out-of-pocket after every medical appointment or does your plan have an option for health professionals to bill your insurance company directly?
  • Claim process –are you required to fill out paperwork and mail your claim or can you submit your claim online?
  • Payment – how long does it typically take to receive payment and is it made by cheque or direct deposit?
  • Support – if you have an issue with your coverage or questions regarding a claim, do you know where to turn?

Life moves fast and everyone is busy – while these questions might seem superficial they can make all the difference when convenience is important.

Choosing the right coverage shouldn’t be a scary process. It’s all about figuring out what works best for you to ensure you feel as safe and secure in your decision as possible. If you still have a few more questions, this guide from the Canadian Life and Health Insurance Association should help: A Guide to Supplementary Health Insurance.

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