Did you know that some people assume that everything is covered by our universal healthcare? It’s not. And it’s a tough lesson to learn when the time comes that you have an accident or an illness and need to get treatment – and must pay out of pocket.
Unfortunately, the provincial plans don’t pay for everything when it comes to healthcare. That’s why buying a personal health insurance policy is one of the smartest things you can do.
Why aren’t certain services covered by the provinces?
If your health is in real danger, most of your treatment will be covered. Due to the exorbitant costs related to hospital services, these are automatically paid by the provinces, as the services that are the most serious and expensive usually are.
You may be required to pay for less urgent or cosmetic things. Depending on where you live, there are many services that are not reimbursed by your provincial health plan like:
Prescription Drugs
Some provinces may cover prescription medications for those age 24 and under and 65 and up. OHIP+ only covers certain drugs, so be aware that some may not be covered. To find out what’s covered in your province, you can find quick links to what’s covered in your province here.
Vision Care
Some provinces will pay for vision care services. In Ontario, eye exams are covered for children under the age of 18 and seniors over age 65. If you fall outside those age categories, you should find a plan that will cover you.
Glasses and contact lenses are also not covered by the provinces. If your require a prescription, you should be able to submit any claims to your own health insurance plan, provided it is a benefit of your plan – even if you shop online for your glasses. Laser eye surgery may be a benefit under some plans and is not covered by most provinces.
Registered Therapist Treatment
Some provinces will cover a portion of the cost for paramedical services like massage therapy, chiropractic care, or physiotherapy. If you or a family member requires treatment from a specialist, check your province’s health website. You may have to pay out of pocket unless you have a health insurance plan that covers them.
Acupuncture, speech therapy and psychology services fall into this category as well. If you need or are considering these kinds of help, you can rely on the extended benefits in your health insurance policy to help cover the costs.
Medical Items
Therapies aren’t the only method used to alleviate pain or immobility from injury or illness. Sometimes medical supplies are required and may be prescribed by your doctor, like:
- Hospital beds, grab bars, and more
- Casts, braces, and splints
- Crutches, canes, walkers
- Prosthetic body parts
- Medical equipment rentals (oxygen tanks)
These items are usually excluded from your provincial plan coverage, although some may pay a portion. Most health insurance plans will cover these costs under the extended health benefits, provided you have a doctor’s referral
Miscellaneous Services and Items
Some other things not covered by the provinces can include wigs after cancer treatment, custom made orthotics, naturopathic services, hearing aids, ambulance fees, and much more.
So, how can you avoid paying out of pocket? Check your health insurance coverage. If you are ever unsure if you are covered, talk to your insurer or call us at SBIS before committing to anything.
A private insurance plan is the best way to avoid shelling out money for unexpected medical expenses.
How to make the most of your extended health benefit coverage
As the cost of everything keeps going up, extended health benefits included in your health and dental insurance protect you against significant out‐of‐pocket expenses for medical services and treatments not covered by your provincial health care plan.
Look for a plan that provides high extended benefit (sometimes called paramedical) coverage like SBIS’ Prism Spectra S4 that covers up to $600 per year per practitioner (like a chiropractor, physio or podiatrist and naturopath), up to an annual combined maximum of $1,200*.
To get the most value from your extended health benefits plan:
- Get a doctor’s referral before buying any medical equipment or services
- Check with your insurer for a list of preferred providers or even those who have been are ineligible for reimbursement. Shop around. Ask your prescribing doctor questions so you know exactly what’s required to meet your needs. Use reputable service providers and get cost estimates from them to compare costs before you buy.
- Only purchase what was prescribed by your doctor. Avoid recommendations to buy other or additional equipment from suppliers or service providers without talking first to your referring doctor.
And take the time to understand your coverage – here are some great links for you:
Yes, your Extended Health Benefits have you covered
Extended health benefits are built into most Dental only or Health and Dental Plans. Many plans don’t require any medical questions when you apply. Most plans include access to medical professionals for video consultations, eliminating the obstacles of travel and waiting room delays which can help shorten the cycle between identifying your health problem and implementing a clinical solution like therapy, making taking care of your health more convenient. For more information on your health insurance options at SBIS, click here or give us a call Monday to Friday 8:45 a.m. – 4:45 p.m. Eastern Time at 1-800-667-0429 or 416-601-0429 – we’re happy to help.
*As of 2025
