A Step-by-Step Guide to Individual Health & Dental Plans

A Step-by-Step Guide to Understanding Your Options and Implementing an Individual Health and Dental Plan for You and Your Family

Are you leaving your job, retiring, self-employed or just don’t have a benefits plan at your job? Have a plan, but there isn’t enough coverage in a certain area? A solution is to implement an individual plan.

It can be overwhelming to attempt to determine how to best go about placing insurance coverage for you and your family. This article outlines the important factors to consider when deciding if an individual health and dental plan is right for you and your family, including how to choose and implement a plan.

 

What do we mean by an “individual” health and dental plan?

What we call an “individual” plan is simply a health and dental program that is not a group employee benefits program; in short, it’s coverage for you and/or your family that you choose and pay for directly.

Even here in Canada, where we have a robust universal healthcare system, there are many out-of-pocket costs that fall outside of our provincial medical coverage. For many people, these expenses are covered either in full or partially through their employer’s group benefits program.

However, many Canadians are not, or are no longer eligible for a group benefits plan.

In the absence of a comprehensive group benefits program through your employer, expenses related to Dental, Prescription Drugs and Paramedical Practitioners (physiotherapy, massage, chiropractic, mental health therapists for example) can become a significant expense. 

Many Canadians are unaware that they can purchase a health and dental plan similar to the type of extended health and dental program they would have through an employer.

 

Who is eligible to purchase a private health and dental plan? Who is this type of plan for?

There are many reasons to seek individual coverage, however, we often think of people as falling into two buckets: those who are leaving a group benefits plan, and those who do not have access to a group benefits plan.

 

Those who were previously covered under a plan enjoy a special “conversion” privilege

For people who will or have recently lost their group employee benefits coverage, this can be for many reasons:

  • You have left your job
  • You have aged out of the group plan
  • You have retired
  • You have become a contractor/ freelancer
  • You are now self-employed as a small business owner
  • You are a dependent who is losing coverage under your spouse or parent’s plan

If you were previously insured under a group benefits program, you have a certain defined timeframe (usually 30-90 days, and this varies depending on the insurance provider) in which you have a conversion privilege.

 

What is a health and dental insurance “conversion plan”?

In fact, you may have heard the term “conversion plan” which is a bit misleading. This term is often used to describe the setting up of an individual plan, on the heels of leaving a group employee benefits program. Technically, you are not ‘converting’ the plan, you are simply eligible to set up an individual plan without any medical underwriting and approval, based on the fact that you’ve been previously insured. 

One important thing to note is that you may not want to exercise this conversion privilege, as it may be more beneficial to complete a medical questionnaire and obtain a medically approved plan instead.

Those who were not previously insured have different options for coverage

The second bucket refers simply to people who were not previously insured under a group benefits plan, within the defined timeframe used by the insurer (30-90 days typically). Setting up an individual plan could make sense if:

  • You’re self-employed/ a contractor/ a freelancer/ gig worker
  • You’re employed by a company without a benefits plan
  • You’re employed but do not qualify for the benefits offering
  • You’ve retired, but you’re now outside the conversion window

For new Canadians, visitors to Canada, travelers; there are special considerations and plan options for people in these circumstances, who may not be covered through provincial medical or be a resident of Canada

If you’re looking to set up coverage, there are many options through a variety of providers, at a variety of price ranges. Some plans are medically underwritten and require approval, while some plans are “guaranteed issue”, which simply means regardless of your medical status, you can obtain the plan.

 

Medically Underwritten or Guaranteed Issue: How do I know what type of plan I need?

The first thing to determine is whether you need to seek a non-underwritten plan. If you have any pre-existing medical conditions (i.e. prescription medications or conditions), you may need to go this route, as you would be denied coverage or have it significantly restricted if you were to disclose your medical situation.  

You could choose to apply then assess the results (i.e. certain medications will not be covered) and then decide which option makes the most sense for you.

 

What are the plan differences between medically UW and not?

Unfortunately, the coverage available on a guaranteed basis is typically ‘lesser’ while also being more costly than a medically Underwritten plan. The reason for this is simple: those that are seeking guaranteed issue plans generally have higher medical expenses, and the insurance company needs to take this into account, financially speaking.

This is why you will notice with many plans that the per-person coverage levels increase over time. For example:

  • Year 1- Dental at 70% to $500
  • Year 2- Dental at 80% to $750
  • Year 3 – Dental at 80% to $1,000 with Major also included, etc

Why would coverage get better over the duration of time you have the plan in place? Because the coverage is paid for on a month-to-month basis, and the plan can be cancelled at any time without repercussions, the insurance carrier needs to build in this sort of stepped coverage in order to ensure the plans remain financially viable.

 

When would I choose to complete a medical questionnaire instead of choosing a guaranteed issue product? 

If you do not have pre-existing medical conditions, it’s likely the best course of action is to complete a medical questionnaire and be “approved.” This should result in the best plan options at the lowest cost.

 

Why would you do a medically underwritten plan, if you’re coming off a group plan and you’re eligible for conversion/ no medical underwriting?

In short, to gain access to better coverage at a lower cost.  Consider the following simple comparison of the “best available” plan, for a Single person in the ages 18-44 bracket:

Conversion From Group

(Leaving another Plan)

Monthly Cost: $244


Drugs: 80% to $2300 (Year 1)

Basic Dental: $1000 (Year 1)

Vision: $300 / 2 years

Guaranteed Issue

(No Medical Issues)

Monthly Cost: $100


Drugs: 70% to $550 (Year 1)

Basic Dental: $450 (Year 1)

Vision: $150 / 2 years

Underwritten Standard
(Medical Questionnaire /Approved Standard)

Monthly Cost: $184

Drugs: 90% to $20K (Year 1)

Basic Dental: $1000 (Year 1)

Vision:

$250 / Year 1 – 2

Of course, the full scope of coverage is far more comprehensive, but the purpose of the comparison is to illustrate a few key areas people use the most.

 

Individual Health and Dental Plan Options Abound:

Whether you are leaving a group plan or setting up an individual plan for the first time, there are many providers available in the Canadian marketplace. It’s worth noting that if you are leaving a group plan, you do NOT need to use the same insurance provider that covered you under your former employer. You have the freedom to choose any plan, and the ‘conversion’ privilege of no medical underwriting still applies to you.

Here at the Immix Group, we frequently recommend Manulife, Green Shield, Sun Life and Canada Life plans (links per each). There are differences between them, and the plan that is right for an individual or family depends on their medical needs and preferences. Most carriers have options ranging from very basic coverage, up to very comprehensive coverage. And of course, the cost varies.

Luckily, there is a plethora of information available online.

 

How do I compare Individual Health & Dental insurance options? Luckily, it’s easy to compare options online.

For example, Green Shield’s site allows you to easily navigate and compare options, and see the pricing in real-time, without any obligation or requirement to enter your personal information. Manulife also offers excellent information online.

Alternatively, at the Immix Group, our advisors can help walk you through the best option for you, based on your individual circumstances and budget. Or, if you’re more into assessing things yourself, the links above allow you to self-purchase without talking to an advisor.

 

How much does an individual health and dental plan cost?

We cannot accurately state that one provider costs more or less than another; this varies quite notably based on the plan option selected and the age bracket, or whether the plan is for a single individual, a couple, or a family. The factors that affect the cost are:

  • Medically Underwritten vs. Guaranteed Issue
  • Age of applicants
  • Enrolment (Single, Couple, Family)
  • Plan selected, including add-ons (some providers charge for travel as an additional cost, for example, while others include this)

Prices range from under $100 per month to over $500 per month depending on the factors above.

Rates are subject to change, but historically we have not seen large increases. In fact, we have even seen rates decrease in the past! As mentioned previously, you are always paying month-to-month and can usually cancel the plan at any month, without financial penalty. Most providers allow for payment via credit card.

 

How do you make a claim with an individual health and dental plan?

It’s very similar to what you would have experienced through a group employee benefits plan. If this is new to you, the short answer is that most claims can be made at the point of service (the pharmacy or dental office for example, by providing your plan details), online, or via the mobile app.

There are some instances where claims need to be submitted via paper submission, but this is less and less common these days.

Most people report that the claims adjudication is straightforward, easy to understand, and claims turnaround times are reasonable. Again, while not identical, it is similar to the administration of claims under a group employee benefits program. Additionally, you will find many of the fringe services and programs available through a group benefits plan are also extended to those insured through individual plan offerings.

 

Are you looking to implement a plan, but still have questions?

As always, here at the Immix Group, we’re happy to help you in assessing your options and choosing the best plan to meet your needs.

Prefer to look and buy yourself? Feel free to browse through our site, where you can implement a plan online yourself.

For more information and for assistance in choosing the best option, contact our office at 604-688-5559 or info@immixgroup.ca  – we love to hear from you!

Questions to ask yourself:

  • Evaluate whether you meet the criteria for a conversion plan and consider if this is the most suitable option based on your needs.
  • If yes, it may make sense to apply for a medically underwritten plan, which can provide better coverage at a lower cost.
  • Assess if you have any pre-existing conditions that could affect your coverage options and the type of plan you should choose.
  • Consider your and your family’s health and dental requirements to determine the type and level of coverage needed.
  • Determine how much you can afford to spend on insurance premiums each month and choose a plan that fits within your budget.
  • Think about whether you need extra coverage, such as travel insurance, and whether it’s included in the plan or available as an add-on.
  • Make sure you comprehend the distinctions between these types of plans to choose the one that best suits your health situation and financial needs.

Key Takeaways

  1. Individual health and dental plans provide direct coverage that is separate from employer-provided group benefits, giving you more control over your insurance needs.
  2. Individuals who are leaving group plans or do not have access to them, such as retirees, freelancers, and the self-employed, can benefit from individual plans.
  3. Those leaving group plans can set up an individual plan without medical underwriting within a specific timeframe, making the transition smoother and easier.
  4. You can choose between medically underwritten plans, which offer better coverage and lower costs for healthy individuals, and guaranteed issue plans, which are suitable for those with pre-existing conditions.
  5. The cost of individual health and dental plans varies based on factors like age, health status, and the level of coverage selected, typically ranging from under $100 to over $500 per month.
  6. Individual plans offer the flexibility to choose coverage options and providers, unlike employer-mandated group plans, allowing you to tailor your insurance to meet your specific needs.

FAQs

    • An individual plan is direct coverage you choose and pay for, separate from employer-provided group benefits. This can cover you and your family members.
    • Anyone, including those without access to a group benefits plan or those transitioning out of one, including retirees, freelancers, and the self-employed.
    • It allows those leaving a group plan to set up an individual plan without medical underwriting within a specified timeframe.
    • While it’s a nuanced decision, generally speaking, one would choose a medically underwritten plan if they are healthy for better coverage and lower costs, and opt for a guaranteed issue plan if they have pre-existing conditions.
    • To access more comprehensive coverage at potentially lower costs compared to guaranteed issue plans.
    • Costs vary based on factors like age, health status, and plan chosen, ranging from under $100 to over $500 per month.
    • Claims can usually be made at point of service, online, or via mobile app, similar to group benefits plans.
    • Individual plans typically operate on a month-to-month basis, allowing flexibility to cancel without penalties.
    • Plans are generally available to individuals of any age, though some may have limitations on out-of-country travel coverage at certain ages.
  • No, individual health and dental plans typically operate on a month-to-month basis, allowing you the flexibility to cancel the plan at any time without financial penalties.
  • While it differs from carrier to carrier, you can obtain a plan at any age, up to any age! One thing to carefully consider is any restrictions related to emergency out-of-country travel coverage, which for some plan offerings, can terminate at a certain age.
    1. Prescription Drugs
    2. Medical Equipment & Supplies
    3. Nursing and Homecare Support
    4. Vision Care
    5. Hospital benefits
    6. Registered Therapists and Specialists
    7. Dental Care Services
    • No, there is no age limit to apply for conversion coverage. Premiums for the coverage are age-banded.
    • There is no medical underwriting, and acceptance is guaranteed within 60 days of losing group coverage.
    • Most conversion plans offer coverage for the following: Dental, Prescription Drugs, and Paramedical Practitioners (physiotherapy, massage, chiropractic, therapists, etc.).
    • No, several insurance providers offer conversion plans. You are not tied to the carrier your previous plan was with.
Lindsay Byrka

Lindsay Byrka BA, BEd, CFP

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

Virtual Health Care is Everywhere

Virtual Health Care is Everywhere: Employer vs. Free Options, and the latest in Offerings.  


Back in 2020, we wrote about virtual care offerings, at the time prompted by the pandemic and the lockdown we were experiencing, which made routine doctor visits close to impossible.

While virtual care was available pre-pandemic (in fact, it dates back to around 2006), it was inconsistent and sometimes difficult to navigate. One silver lining of the pandemic is that the virtual healthcare space has exploded with new and expanded platforms, offering individuals and businesses a variety of options to meet a range of needs.

The shortage of family medicine providers, compounded by a severe cold and flu season has made virtual care offerings even more valuable in recent months. A huge number of Canadians do not have a family doctor, and for those that do, booking a same-day appointment is often extremely difficult, if not impossible. While an in-person visit is certainly warranted in many instances, sometimes a virtual visit will suffice, and it can definitely be more convenient: no commuting, parking, waiting rooms.

Studies show that over 50% of doctor’s visits could be handled without direct contact, meaning a virtual visit will suffice to resolve the concern. Through most virtual providers, you can access:

  • Diagnoses
  • Prescriptions
  • Sick Notes
  • Lab work orders, such as blood tests
  • Referrals to specialists
  • Imaging referrals (Xray, Ultrasound)
  • Mental health inquires and referrals

While all providers prescribe medications, they do not prescribe or refill narcotics and addictive controlled substances.

Table of Contents

Free vs Paid Options


You may have noticed the existence of free virtual health care offerings versus paid programs that can be purchased either by businesses for their employees, or even by individuals.

Why pay for a Virtual Health Program, with so many free options?


Employers can add Virtual Care programs to their benefits line-up. A typical paid employer-sponsored program means an enhanced experience, such as:

  • Wait times: free options are becoming heavily used, and wait times are becoming longer. Paid options guarantee quicker access.
  • Longer hours of availability; many paid options offer 24-7 care, in contrast to free versions.
  • Coverage for those in provinces/territories where virtual visits are not insured: currently only BC, Ontario, Alberta and Quebec cover virtual doctors visits under provincial care
  • Direct access to many specialists: often common specialists like dermatologists or pediatricians can be accessed through enhanced programs
  • Beyond regular medical doctor’s visits: practitioners are often available through enhanced paid programs such as counsellors and dieticians, naturopaths and most notably, mental health services.
  • Reporting: usage / ROI data is available through some providers

While the cost ranges, many of these programs are available as add-ons to your existing benefits program for a few dollars per employee, per month.

For example, Manulife’s program is provided through Telus Virtual Health Care and is available as an add-on to an insured plan for $3.95 per employee per month. Like other similar programs, it offers an app with 24-7 on-demand access to health providers via secure text, video, and live chat. Maple Virtual Health is another well-known and highly regarded offering that is also available through many insurance providers (RBC Insurance, for example). Maple Virtual Health can also be purchased stand-alone by employers, and it does provide some ability for free visits to non-members in qualifying provinces, but they are tapering this back to focus on employer-sponsored programs. Telus Health is the best known and largest of the virtual health platforms and offers employer-sponsored programs. It is worth noting that Telus Business mobility customers have access to the paid version of the Virtual Care program for free!
Virtual Health Care is Everywhere: Employer vs. Free Options, and the latest in Offerings

Free Virtual Healthcare Options


Depending on your province of residence, you may be able to access free doctor’s visits through some virtual providers. Some provinces cover virtual doctor visits, meaning you will pay no fee to access a doctor online (the doctor will bill the province, as they usually would with an in-person visit).

For residents of BC, Alberta, Ontario and Quebec, visits are free under some platforms. For those in other provinces, accessing a virtual provider typically costs around $30-40 per visit.

Most of these virtual providers connect via phone, live chat, video or secure text in order to connect with patients. The following are two notable virtual health care providers:

  • Telus Health – Telus has acquired numerous other providers and continues to dominate the virtual healthcare landscape. As mentioned previously, Telus Business mobility customers have access to the paid version of the Virtual Care program for free. The Telus Health MyCare app can be downloaded for free, and in covered provinces, doctor’s visits are billed to the province.
  • Tia Health One of the most well known and highly regarded platforms, with an easy to navigate system, Tia offers access to doctors, nurses and pharmacists by phone, video or secure messaging. Tia has also acquired a number of other virtual health providers, so has greatly expanded its network of clinicians.
  • Well Health Virtual Clinic Branded as a virtual walk-in clinic, this provider focuses on doctors visits, simple access to prescriptions and requisitions, and is free in covered provinces. A unique feature is you are able to choose your doctor from their listing.
  • Cover Health– Another virtual “walk in clinic” this platform is free in Ontario under OHIP and offers same day appointments, 7 days per week.

Virtual Mental Health Platforms


Accessing quality mental health services is difficult, and a significant barrier for many people is simply leaving the house. Accessing support through easy to navigate virtual platforms can be life changing. While the cost of the programs can be notable (the per-visit cost can be similar to an in-person session with a credentialed therapist), this can typically qualify under Extended Health paramedical coverage or through a Health Spending Account.

Two notable mental health platforms are:

  • MindBeacon With a focus on mental health support, specifically, Cognitive Behavioural Therapy, MindBeacon is highly regarded in the virtual mental health support space. As the online practitioners are credentialed psychologists or social workers, fees can typically be submitted through benefit plans.
  • Inkblot Launched in 2018, Inkblot Therapy strives to alleviate the extremely long wait times that many people face in accessing mental health support. As a platform focused exclusively on mental health, Inkblot offers confidential virtual therapy, CBT, continuity of care, webinars and training, trauma and treatment services, chronic disease management, psychiatric consultations and collaborative care, work and life support

Virtual Health is here to Stay!

The pandemic provided the opportunity for expansion and innovation in the virtual health landscape. While there will always be the necessity for in-person medical treatment and virtual offerings should not be exclusively relied upon, they do solve numerous problems people face in accessing healthcare, and provide a comfortable and convenient alternative, where appropriate.

Whether you choose to implement an employer-sponsored paid program or not, employers should take the time to ensure employees are aware of the virtual health landscape, and the options available to them. There are many educational materials available that can be distributed to employees to assist in spreading the word.

Please feel free to reach out if you’d like to learn more. We love to hear from you!

FAQ’s on Virtual Care

Can a virtual health care provider prescribe medication?

Yes, this is one of the core services, however they will not prescribe controlled or addictive substances.

Can I see a specialist through a virtual care provider?

Sometimes, yes but more commonly you must still be referred to a specialist by a regular GP. Under some paid programs, specialists can be accessed.

Can I access virtual care if I’m not in one of the provinces where it’s insured under provincial coverage?

Yes, the same service is available, but a per-visit cost is charged that starts around $30. Subscriptions to virtual care platforms are available as well.

Can I see my own doctor through virtual care?

It depends! If your doctor works for one of the providers, you may be able to see them through a virtual care platform. Or they may provide this through their clinic.

How do I connect with a virtual provider?

Typically, you will engage online through your computer, table or smartphone. Once booking an appointment, you can usually choose a phone call, text, live chat or video conferencing for the appointment.
telehealth plan insights by Immix Group

Key Takeaways

• Virtual health platforms today offer a convenient and effective solutions for many medical concerns.
• There are numerous free virtual health platforms available today.
• Paid options typically provide enhanced services, namely guaranteed quicker access.
• All Employers should promote virtual health care offerings to their employees, whether or not you provide an Employer-paid version.
Lindsay Byrka

Lindsay Byrka BA, BEd, CFP

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

Conversion Plans- Individual Health Care & Dental Plans

Help ensure individuals do not lose coverage between jobs and in retirement

When changing employers, leaving a company, or retiring from the workforce, considering healthcare and dental costs and options can be stressful for many people. 

A gap in health and dental coverage can mean significant out-of-pocket expenses for some families. Unfortunately, many individuals do not qualify for coverage due to health issues. The solution to this concern is a ‘conversion plan,’ which offers uninterrupted coverage without medical approval.

When a member applies for individual Extended Health and/or Dental coverage within 60 days of losing coverage under an employer-sponsored plan, they are guaranteed coverage with no medical underwriting.  Unlike typical individual health and dental plans, these plans cover pre-existing conditions and acceptance is guaranteed.

Coverage

Most Conversion plans offer coverage for the following:

  • Prescription Drugs
  • Medical Equipment & Supplies
  • Nursing and Homecare Support
  • Vision Care
  • Hospital benefits
  • Registered Therapists and Specialists
  • Dental Care Services

 

Qualifying

To qualify, members must apply within 60 days from the date their group coverage terminated. They must have been covered under a group plan for at least 6 consecutive months. Action coverage under their provincial government health plan must be in place.

Choice

Each insurance provider offers several options to choose from so that individuals can select the coverage that best suits their needs and budget. Several insurance carriers offer conversion plans; the carrier does not have to be the same one through which the individual had group benefits.

Coverage will likely not be identical to the coverage under the plan; however, plans are comprehensive and cover most medically necessary expenses that individuals and families incur.

As an employer, you can educate terminating employees about this option. Please feel free to have them contact our office at 604-688-5559 or info@immixgroup.ca  for assistance in choosing the best option for their situation.

Lindsay Byrka

Lindsay Byrka BA, BEd, CFP

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

Affordable and innovatively structured employee benefit programs