As citizens of Ontario, you and your employees likely participate in the province’s health insurance, the Ontario Health Insurance Plan (OHIP). The province is able to provide OHIP coverage through a payroll tax deduction all working residents must pay. OHIP also receives funding through transfer payments from the Canadian Government.
OHIP members receive a health insurance card to use at the doctor’s office or cover emergency medical expenses. Though the OHIP insurance card allows cardholders to receive medical attention without incurring costs, the provincial plan doesn’t cover everything.
Supplemental health and dental insurance through group benefits is a way to ensure your employees have adequate health and dental coverage. Additional or extended health insurance will cover various medical costs that OHIP does not, at an affordable price.
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What Health Insurance in Ontario Covers
OHIP will cover the following medical expenses entirely or in part:
- Doctor visits
- Medically necessary ambulance services or transportation services between medical facilities
- Oral contraceptives to residents under 25
- Long-term or home care depending on the patient’s needs
- Medically necessary hospital services like lab tests, meals, and medication
- Eye exams for people under 20 and over 65 or anyone suffering from conditions requiring routine eye exams
- Dental surgeries in a hospital
Despite the coverage OHIP provides, it does have limitations on what the province deems as eligible expenses. For instance, OHIP will cover medications for patients during hospital stays, but patients cannot use the insurance to pay for prescription drugs after their discharge.
What OHIP Does Not Cover
Some necessary and elective medical services are not allowable under OHIP, such as:
- Cosmetic surgeries
- Paramedical services
- Dental services outside of a hospital
- Semi-private or private rooms for hospital stays
- Non-emergency ambulance services
This insurance option does make some allowances outside its parameters, like contraceptive coverage. While they are not typically permissible for people over 25 years old, those who qualify for specialty drug programs can use OHIP to pay for this treatment.
Is health insurance a taxable benefit in Canada? The short answer is yes and no. Learn here which of the 3 types of Health Insurance really a tax-free benefit.
What Is Supplemental Health and Dental Insurance?
Supplemental health and dental insurance covers specific expenses OHIP doesn’t. You and your insurance company will have a contract in which you will pay an annual fee or premium in exchange for group benefits.
It is worth noting that no insurance will pay 100% of all medical expenses. The portion of the costs paid by the cardholder is the deductible, and it varies by the policy. A coinsurance is sometimes required on top of the deductible.
Despite the out-of-pocket expenses, supplemental insurance often offers significant savings. The costs of supplementary insurance is often significantly less than the costs associated with employee sick leave and turnover.
Decrease Out-of-Pocket Medical Expenses through Extended Health Insurance Plans
Participating in the Ontario health insurance plan is an excellent way to reduce costs for many medical expenses. However, the coverage does come with conditions, limitations, and exclusions that can leave your employees with higher out-of-pocket expenses than you may expect.
At Group Enroll, we partner with major insurance companies throughout Canada and help businesses find insurance plans with benefits to fill in the gaps provincial health care plans create.
We specialize in providing quick quotes from leading insurance agencies that offer group benefits to employers for health care spending accounts, extended health care plans, and more. Our knowledgeable and dedicated team will help you find the proper medical, vision care, and dental coverage for your workers while helping your company save money.
Contact us to learn more about group benefits and how they can supplement provincial health care. You can also fill out our quick quote form to compare quotes from multiple Canadian insurance providers.