Qualifying for a Health Insurance Plan

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Although Canada provides health insurance for all of its residents, there are many products and services that are not covered under the provincial plans.  As a result, many people turn to individual health insurance to fill in the gaps not covered by the government plans.  But, unlike the provincial plans, not everyone is guaranteed coverage for all individual plans.

Before you begin your search for a Canada health insurance plan, there are a few things you need to know about qualifying.  Some plans accept all applicants no matter what.  Others only accept applicants that meet certain criteria.  If you apply for a plan that does not accept everyone, the factors listed below will play a role in determining whether or not you qualify.

Medical History

For non-guaranteed acceptance plans, your medical history is a key factor in determining your eligibility.  When you apply for this type of plan, you will be required to complete a questionnaire about your medical history and/or undergo a medical exam.  If you have certain pre-existing conditions, you may not qualify for coverage, or you may be subject to certain exclusions.


As you age, certain changes to your health are inevitable.  As a result, you are more likely to need health insurance than ever before.  However, your age may also disqualify you from certain plans or from being covered for certain services.  Some plans will only cover individuals under a certain age, while other plans exclude some services for individuals over a particular age.

Previous Health Insurance Coverage

Whether or not you recently had health insurance coverage could also play a role in your eligibility when you apply for a new one.  Some plans offer guaranteed acceptance if you apply within a certain amount of time after leaving your employer’s group health insurance plan.  If you do not purchase an individual plan within that time period, you may be required to complete a medical questionnaire to determine your eligibility.

In addition, if you recently cancelled your coverage under an individual health insurance plan without obtaining coverage under a group plan, there may be a waiting period before you can re-apply for coverage under an individual plan.

Choosing the Health Insurance Plan That’s Right For You

With so many factors influencing a person’s eligibility for an individual health insurance plan, it can be difficult to find the plan that’s right for you and your family.  A qualified insurance professional can review the available plans with you and help you determine which plans will best suit your situation.


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