What Is Personal Health & Dental Insurance?
Personal health and dental insurance is private coverage that helps pay for health, dental, vision, and wellness-services that aren’t covered (or are only partially covered) by your provincial health insurance or employer plan.
It’s designed to reduce out-of-pocket expenses, give you access to more and better care, and protect your finances from unexpected medical/dental bills.
Some key features:
- Contributions are made with after-tax dollars (you don’t get a tax deduction when you contribute).
- Investment growth inside the account is not taxed, and withdrawals are tax-free.
- Withdrawals can be made at any time for any purpose.
Who Can Open a TFSA & Eligibility
To open a TFSA, you must:
- Be a resident of Canada.
- Be at least 18 years old (or the age of majority in your province/territory) and have a valid Social Insurance Number (SIN).
What Does It Cover — Common Features
Depending on the policy and provider, you can select or get coverage for:
Prescription Drugs
Partial or full reimbursement for drugs prescribed outside the hospital.
Percentage reimbursed, formularies, drug-tiers, deductibles matter.
Dental Care
Routine cleanings, exams, X-rays; fillings; root canals; crowns; orthodontics ( sometimes children / adult ) ; major dental work. Waiting periods often apply.
Vision Care
Eye exams, glasses, contact lenses, sometimes laser surgery.
Often limits per time period (e.g. every 2 years).
Paramedical / Wellness Services
Physiotherapy, massage, chiropractic, naturopathy, psychotherapy / counselling, dietitians etc.
Look for how many visits, annual max, percentage coverage.
Medical Equipment & Supplies
Hearing aids, orthotics, mobility aids, medical equipment for chronic conditions etc.
Private or semi-private hospital rooms sometimes included.
Emergency Travel / Out-of-Province Medical
Coverage when travelling outside your province or country, for urgent medical care.
This often comes as a rider or add-on.
Preventive & Diagnostic Care
Dental cleanups, checkups, vision tests; perhaps routine screenings, lab work depending on plan. Helps avoid bigger costs later.
What Drives Your Premium Cost ?
Understanding what drives price helps you pick wisely.
- Your age — older people tend to pay more.
- Your health/medical history — pre-existing conditions or chronic conditions may increase cost or require exclusions.
- Whether you use tobacco / nicotine products or have risky lifestyle factors.
- How much coverage you select (limits, number of paramedical visits, dental maximums, etc.).
- Waiting periods — shorter waiting periods = higher cost.
- Deductibles or co-insurance levels (how much you pay vs insurer).
- Whether you add riders (travel medical, orthodontics, higher vision limits).
- Location / province — costs and what is covered can vary by province.
Example:
A healthy 30-year-old non-smoker choosing a mid-tier personal health & dental plan with $1,000 dental max, vision every 2 years, moderate prescription drug reimbursement and paramedical coverage might pay somewhere between CAD $50 – $150/month (just illustrative — actual depends heavily on variables).
Comparing with Other Options
| Public / Provincial Health Insurance | Employer / Group Health & Dental | Personal Health & Dental | |
|---|---|---|---|
| Basic Medical Coverage | Covered (doctor visits, hospital, etc.) | Usually covered or partially | N/A or supplementary |
| Prescription Drugs, Dental, Vision | Often not covered or minimal | Often covered, but variable limits | You choose level of coverage |
| Flexibility | Low — based on province’s rules | Moderate — limited to what plan offers | High — customize to your needs |
| Portability | Yes (within province) | Usually lost if you leave job | Stays with you, though rates may adjust with age/health |
| Waiting Periods & Limitations | Minimal for basic medical | May have waiting for dental or specialized services | Yes, for many types of services |
Sample Plan Levels (Tiers / Options)
Here are some tiers you might offer / see, to help users understand trade-offs. You can design your own plans like this:
Basic
Minimal protection for low budget users.
- Prescription drugs (basic)
- Routine dental cleanings & exams
- Minimal paramedical visits
- Basic vision allowance
Ideal for : Relatively healthy individuals on a budget.
Trade-offs : lower maximums, longer waiting periods.
Standard
Expanded dental, more paramedical visits, travel medical included.
- Higher dental coverage (restorative work)
- More paramedical sessions (physio, counselling)
- Travel medical rider
- Better vision allowance
Ideal for : Families, travellers, those with ongoing needs.
Trade-offs : higher premium; may include features you don’t always use.
Premium
High limits, advanced dental & vision, large travel benefits.
- High prescription reimbursement
- Advanced dental & orthodontics options
- Generous paramedical allowance
- Large travel medical benefit
Ideal for : Chronic conditions, frequent travellers, serious dental/vision needs.
Trade-offs : highest cost, may require health questions.
Quick Comparison
| Feature | Basic | Standard | Premium |
|---|---|---|---|
| Prescription drug reimbursement | Low % | Medium % | High % |
| Dental restorative work | Not included / limited | Included (higher limits) | Fully included |
| Paramedical visits (annual) | 2–5 | 10–15 | 20+ |
| Travel medical benefit | Optional / Addon | Included | Large limit included |
Example Scenarios
- Scenario A — Young Single
Maya is 28, non-smoker, works freelance with no group health plan.
She expects occasional dental cleanings, glasses every few years, maybe massage therapy occasionally.
She chooses a Basic or Standard plan: low premium, decent drug coverage, minimal paramedical.
- Scenario B — Family with Kids
The Nguyen family has two kids. They want orthodontics for the older child, regular dental checkups, prescription medications, vision needs.
They go with a Standard or Enhanced plan with good dental and vision maximums, more paramedical visits (physio, etc.).
- Scenario C — Someone with Chronic Condition
John, 50, has a chronic illness that requires regular medication and occasional physiotherapy.
He picks an Enhanced plan and ensures that pre-existing coverage options are clear; he prepares for slightly higher premiums but saves money and stress over time.
Sample Costs / Ballpark Figures
These are approximate, just for illustration:
| Profile | What They Want | Approx Monthly Premium* |
|---|---|---|
| Healthy 25-year-old, single | Basic dental cleanings, vision every 2 years, low paramedical visits | $40 - $70 CAD |
| Couple in their 40s with kids | Standard dental, orthodontics for child, good drug coverage, physiotherapy | $150 - $300 CAD |
| Person 60+ with chronic drugs | Enhanced drug coverage, frequent paramedical, possibly hearing aids & vision | $300 - $500+ CAD depending on province and health status |
* These are examples only. Your actual cost depends on provider, province, health status, coverage level, waiting period, etc.
Waiting Periods, Exclusions & Fine Print
These are common areas people overlook. Make sure you explain clearly:
| Category | Details |
|---|---|
| Waiting Periods | For certain services (e.g. major dental work, orthodontics) — sometimes 3–12 months. |
| Pre-existing Conditions | Whether illnesses/conditions before your policy starts are covered, partially covered, or excluded. |
| Annual / Lifetime Maximums | Example: dental maximum per year, vision every 2 years, paramedical visits per type per year. |
| Co-payments / Coinsurance | You may pay part of the cost beyond the coverage. |
| Eligible Provider | Some plans require practitioners be licensed/registered; some pay less for non-preferred providers. |
| Geographic Limitations | Emergency medical outside province/country may have limits or not all services covered. |
Why Work With a Broker for Health & Dental
-
Best Value Comparison
We search across multiple insurers to match you with the most cost-effective plan that fits your real needs. -
Clear Guidance
We break down complex terms, waiting periods, and fine print so you fully understand your coverage. -
Right Level of Protection
We make sure you’re not underinsured, helping you avoid unexpected costs or denied services. -
Claims Support
We assist with paperwork and claims, ensuring you receive every benefit you’re entitled to. -
Flexible Planning
We help you design a plan that grows with you as your health needs, family, and lifestyle change.
- Health & Dental Insurance FAQs
If I already have health & dental via work, do I still need this?
Maybe. If your work plan has limits (e.g. low dental maximum, limited vision, few paramedical visits), or if you lose job or move, your personal plan can fill the gaps.
Are the benefits tax-free?
Generally yes — health & dental insurance reimbursements are not taxable because they’re not income, just covering costs of health services.
Will my rates increase with age or health changes?
Often yes. Ageing, new medical conditions, or increased usage of services may lead to higher premiums.
Getting in early while healthy can lock in better rates.
Can I include my family / children?
Yes, most personal plans let you add dependents.
Be aware that adding them increases cost; check maximums per person vs per family.
What do I do if I need care outside of Canada or in another province?
Some plans include travel medical or out-of-province coverage as an add-on. Always check the maximums and whether pre-authorization or emergency only.
How does claims reimbursement work?
You submit receipts / proof of service. Depending on provider, either you pay upfront and get reimbursed, or the insurer may work with service providers for direct billing in some cases.
How to Choose the Best Plan for You
Here are steps / tips:
1 - List your health & dental needs
Think about both current and possible near-future (kids, braces, vision changes, physiotherapy, etc.).
2 - Compare plan features, not just price
What’s covered, waiting periods, maximums, paramedical options.
3 - Read the contract and policy definitions
(Especially “pre-existing”, “eligible provider”, “co-pay”, etc.).
4 - Consider your budget vs risk
cheaper plans have greater risk of out-of-pocket expenses.
5 - Time of application matters
applying while healthy often reduces cost; delays can increase risk.
6 - Think long-term
plan that stays with you, is portable, and adjusts with your needs.
Get Your Personalized Health & Dental Quote
Don’t let medical or dental expenses erode your savings or peace of mind.
Having the right health & dental insurance means more security, more choices, and less worry.