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Why do I need provincial coverage to qualify for health insurance?

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If you want to purchase health insurance, did you know that you must be covered by your province’s health care insurance plan first? Here’s why.

In Canada we are lucky to have Medicare, our publicly funded healthcare system. Instead of having a single national plan, we have 13 provincial and territorial healthcare insurance plans. Under this system, all Canadian citizens or permanent residents have reasonable access to medically necessary hospital and physician services without paying out of pocket.

The provincial and territorial healthcare insurance plans must meet the standards described in the Canada Health Act in order to get their full payment under the Canada Health Transfer, including

  • Administration and operation on a non-profit basis by a public authority
  • Coverage for all residents
  • The full cost of medically necessary services provided by hospitals, physicians and dentists, when dental service must be performed in a hospital
  • The same funded services when a Canadian travels within Canada, and some limited coverage for travel outside of the country.

When a resident moves to another province, they can continue to use their original healthcare insurance card for three months. This gives them enough time to register for the new plan and receive their new health insurance card.

The provincial and territorial plans must provide all qualified residents reasonable access to medically necessary services. Access must be based on medical need and not the ability to pay.

Why insurers verify your provincial coverage

By verifying your provincial coverage, a health insurer knows

  • Your citizenship and residence status
  • That your costs for medically necessary services are covered.

Private health insurance in Canada is also known as supplemental health insurance. It is designed to complement publicly funded healthcare — not replace it. Knowing that you have provincial coverage confirms for an insurer that you will use your private health insurance as it is intended: to help pay for routine and emergency medical treatments that you and your family need, and protect you from out-of-pocket costs associated with those needs.

Healthcare services not covered by the healthcare system

Not everything in Canada related to healthcare is free. Services not covered by the system include

  • vision care
  • dental care
  • prescription drugs
  • ambulance services
  • nursing care in the home
  • and many more.

That’s where health insurance comes in. Having a plan can help you offset the costs of different treatments and items related to keeping you healthy.

When deciding whether or not you should get a plan, check your province’s health coverage and see where you could use a top up. Here are the websites you can check to learn more about your provincial plan:

Each site should give you an idea of what you are already covered for, and which services are excluded.

What if you are new to Canada or visiting for an extended time?

If you are visiting Canada for an extended period of time, no matter the reason, one thing is for sure: you will need health insurance.

Moving to Canada or visiting for a long period does not automatically result in public health coverage. That is because our healthcare is paid for by our taxes. If you haven’t been paying tax in Canada, you aren’t eligible.

Even once you become a permanent resident there is a waiting period of (typically) three months to get provincial health insurance. That’s three months with no healthcare coverage, which needs to be addressed.

So what should you do? As a temporary resident of Canada, you can purchase an emergency health insurance plan that will keep you covered for the duration of your stay.

Covered by provincial health care? Now choose your supplemental health insurance

There are many different supplement plans with different coverage to choose from. How do you choose one that’s perfect for your needs?

Compared to the provincial plans, supplemental health insurance offers more comprehensive benefits for a broader range of products and services, including

  • Prescription drugs
  • Dental care
  • Treatment by a specialist (psychologist, chiropractor, acupuncturist, etc.)
  • Transportation to the hospital
  • Home healthcare
  • Semi-private or private hospital accommodations

Plans and prices vary depending on your age, whether you have a pre-existing condition, and how much coverage you want.

Call one of our SBIS representatives to talk about the cost; we’re sure to have a policy that matches your needs and budget — especially considering how expensive the out-of-pocket alternative can be.

Nobody plans to have a medical emergency, but if you have insurance you won’t have to worry about getting care if something does happen. Whether you are covered by a provincial health plan or not, SBIS can help you get the insurance protection you need, so call today.

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