What Services Are Typically Covered by Private Insurance?
Learn what private health insurance can include, and how it fills the gaps in public health coverage
Private health insurance in Canada is designed to work alongside the public system, not replace it. While public insurance covers hospital visits, doctor care, and emergency services, many everyday and preventive health needs are not included. That is where private insurance steps in.
Whether through an employer group plan or a policy you purchase on your own, private insurance can help pay for services that are essential to your well-being but not funded by provincial health care.
Common Categories of Private Health Insurance Coverage
Most private health insurance plans cover a wide range of health-related services and expenses that fall outside of the public system. These benefits can be grouped into several key areas.
| Service Category | Examples of Covered Expenses |
|---|---|
| Prescription Drugs | Medications filled at a pharmacy, including chronic condition treatments |
| Dental Care | Exams, cleanings, fillings, root canals, crowns, orthodontics |
| Vision Care | Eye exams, prescription glasses, contact lenses, laser surgery (in some plans) |
| Paramedical Services | Massage therapy, physiotherapy, chiropractic, acupuncture, naturopathy |
| Mental Health Support | Counselling, psychotherapy, psychologists, social workers |
| Medical Equipment & Supplies | Wheelchairs, walkers, CPAP machines, orthotics, diabetic supplies |
| Hospital Enhancements | Semi-private or private rooms, TV or phone access during inpatient stays |
| Travel Medical Insurance | Emergency care outside your province or country |
| Health Spending Accounts (HSAs) | Reimbursement for a broad range of eligible out-of-pocket medical costs |
How Coverage Limits and Co-Payments Work
Most private plans include:
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Annual or lifetime maximums per category (e.g., $500/year for massage therapy)
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Co-payments or deductibles that require you to pay a portion of the cost
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Coverage tiers, where some services are only partially reimbursed (e.g., 80% of dental fees)
It is important to review your plan details so you understand:
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What services are included
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How much coverage you have per year
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Whether referrals, pre-approvals, or receipts are required
Note: If you have multiple plans (for example, through both your employer and a spouse’s), you may be able to coordinate benefits for higher total reimbursement.
Why Private Insurance Makes a Difference
Private insurance is especially valuable if:
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You or your family use paramedical or dental services regularly
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You manage a chronic condition that requires ongoing prescriptions or equipment
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You want faster or more flexible access to non-urgent care
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You travel frequently and want emergency medical coverage outside Canada
Caution: Private plans vary widely in what they cover and how much they pay. Always compare policy details before choosing a plan, and reassess your needs as your health or life stage changes.
Maximizing Your Coverage Through Planning
To get the most from private health insurance:
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Review your benefits booklet annually and after major life changes
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Keep receipts and submit claims promptly
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Understand your plan’s limits and how co-payments work
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Use wellness and preventive services to reduce long-term health costs
Private insurance can be a powerful tool for protecting your finances while maintaining access to a wide range of health services. Knowing what is included and how it fits with public coverage helps you build a more complete and responsive care plan.