Factors Influencing Health Insurance Premiums

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Health insurance premiums can vary so much from person to person, many people are left wondering how the final price was established. When an insurance company is determining the monthly or annual premium for your private health insurance plan, a number of factors are taken into consideration,

Factors Influencing Health Insurance Premiums

…such as:

  • Age
  • Marital Status
  • Dependents
  • Health History
  • Province of Residence
  • Maximums

The following provides some additional insight into the individual considerations that may affect your private health insurance premium.

Age, Marital Status, Dependents

While age may not affect your coverage eligibility, it will likely affect your health insurance premiums. Generally, the younger you are when you first apply, the lower your rates. Your marital status and number of dependents will also affect your insurance rate as there are more people covered under the policy. Packages are available for individuals, couples or families. It’s important to note that all eligible family members must be enrolled unless coverage for other members is provided by another carrier.

Health History

Your health history will be factored into the final price of your private health insurance policy. As can be expected, rates are generally lower for healthy individuals than they are for those with ongoing health conditions. However, even if you are under the care of a physician for an existing health condition it’s important to apply for coverage, especially if you have recently lost your group plan benefits. Pre-existing conditions are not necessarily automatic grounds for disqualification when applying for health insurance benefits.

Province of Residence

It’s important to understand that a private health insurance policy does not replace your provincial government health care; it supplements the existing benefits to cover treatments and equipment not covered by the provincial plan. Though all eligible Canadians are covered by government insurance, there are subtle differences between the provincial plans. Because of these differences, some drugs and services covered in one province may not be covered in another, hence the cost an individual pays for private insurance varies depending on the province of residence of the applicant.

Policy Maximum

The maximum limits set for your policy will affect the final rate. A higher policy limit will have a corresponding higher premium. However, the difference in premium is relatively small when considered against the potential shortfall if your health needs require significant out of pocket payments over and above your private health insurance coverage limit.

Other Considerations

While previously having group coverage doesn’t affect your insurance premium per se, there are programs available for those applying within 60 days of leaving their group plan. If you are coming off a group plan, it’s important to apply as soon as possible to be eligible for guaranteed coverage.

Your insurance broker is the best person to help you navigate the application process for health insurance. They can provide expert assistance in selecting the appropriate level of coverage for you and your family.


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