The Ontario Health Insurance Plan (OHIP) covers many medically necessary doctor and hospital services, but it does not cover everything Ontarians use day-to-day. Prescriptions outside the Ontario Drug Benefit program, most dental care, prescription eyewear, and paramedical services like physiotherapy or massage therapy are typically paid out of pocket — or through a private plan.
This article is a plain-language overview of what supplementary health and dental insurance generally covers in Ontario, what it does not, and how to compare options. It is general education only and is not personalized insurance advice. Eligibility, exclusions, and pricing depend on the carrier, the plan, and your individual situation.
What OHIP usually covers — and what it usually does not
OHIP is Ontario's public health insurance program. It generally covers visits to family doctors and most specialists, hospital stays, many diagnostic tests, and certain procedures considered medically necessary. The Ontario Drug Benefit (ODB) program may cover prescription drugs for residents who qualify, including most seniors 65 and over.
Common categories that OHIP typically does not cover include:
- Most prescription drugs for adults under 65 who do not qualify for ODB
- Routine dental care such as cleanings, fillings, root canals, and crowns
- Prescription eyeglasses, contact lenses, and most routine eye exams for adults
- Paramedical services such as physiotherapy, chiropractic, massage, and mental health counselling
- Medical equipment, mobility aids, and many at-home care expenses
- Out-of-province and out-of-country emergency medical care (typically only partial)
What supplementary health and dental plans may include
Private supplementary health and dental plans are designed to help cover some of the everyday costs that fall outside OHIP. Coverage varies widely by carrier and plan tier, and most plans have annual limits, co-insurance percentages, and waiting periods.
Categories you may see on a supplementary plan include:
- Prescription drug coverage with deductibles or co-pay structures
- Dental coverage that may include preventive, basic, major, and orthodontic categories
- Vision coverage for exams, frames, lenses, or contact lenses on a multi-year schedule
- Paramedical maximums for physiotherapy, chiropractic, massage, and similar services
- Mental health benefits such as psychologist or social-worker coverage
- Hospital benefits, semi-private room upgrades, ambulance, and out-of-province emergency travel medical
Individual plans vs. employer group plans
Many Ontarians receive supplementary coverage through an employer or association group benefits plan. Group plans often cost less per person because the risk is spread across many members, but coverage levels and eligibility rules are set by the plan sponsor.
Individual supplementary health and dental plans are designed for people without an employer plan — self-employed workers, contractors, retirees, students, or those between jobs. Some individual plans are guaranteed issue (no medical questions) but typically have lower limits or longer waiting periods. Underwritten plans may ask health questions and can decline applicants or apply exclusions.
Costs, limits, and common exclusions
Supplementary health and dental premiums depend on age, family composition, plan design, and the carrier's underwriting rules. Two plans with the same monthly premium can have very different annual maximums, co-insurance, or waiting periods, so it is important to compare the policy documents — not only the headline price.
Common exclusions and limitations to look for include:
- Pre-existing condition rules on certain plans or benefit categories
- Waiting periods before dental major or orthodontic services are eligible
- Annual maximums per category (for example, $500 per year for paramedical)
- Co-insurance percentages such as 80% or 50% of eligible expenses
- Excluded items like cosmetic dental, experimental treatments, or certain medications
How a licensed advisor can help
A licensed insurance advisor can walk through the structure of a plan in plain language, explain how benefit categories interact, and help you compare carriers based on your priorities — not based on a guaranteed outcome. SEENCO does not promise that any specific application will be approved, that premiums will not change, or that all expenses will be covered.
Once you have a shortlist, you can review actual policy documents — also called the benefit schedule or certificate of insurance — before submitting an application. This is usually the best way to understand what each plan does and does not include.
Questions to ask a licensed advisor
Bring these to your next conversation. A licensed SEENCO advisor can walk through each one in plain language — without promising any outcome.
- Does this plan have a waiting period before dental or major services are eligible?
- What is the annual maximum for prescription drugs, paramedical, and dental categories?
- Are pre-existing conditions excluded or limited under this plan?
- How does coverage work for emergency medical care outside Ontario or outside Canada?
- Can I add my spouse, common-law partner, or dependants, and how is family coverage priced?
- How are premiums calculated, and under what conditions can the carrier change them?
This page is for general educational information only and does not replace advice from a licensed professional.