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Medically Underwritten Health Care Plans
Health and dental insurance for self-employed individuals or anyone not covered by a employee group plan.
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What is a medically underwritten health care plan?
A medically underwritten health and dental insurance plan is often considered a 'standard' option in health insurance. The key feature of this plan is its 'medically underwritten' nature. This means that when you apply, you'll need to complete a medical questionnaire. Based on this information, the insurance company may also request your medical records from your physician to thoroughly assess your health status. This evaluation is a critical step in determining your eligibility and the terms of your coverage.
Like all health insurance plans, the primary purpose of a medically underwritten plan is to supplement your provincial government health care plan. It covers costs for health and dental services that are not included in your provincial coverage, thereby reducing your out-of-pocket expenses for these services.
Medically underwritten plans are often more cost-effective compared to other types of health insurance plans, offering more comprehensive benefits for each dollar spent. However, they typically exclude coverage for any pre-existing medical conditions. This exclusion is a significant consideration and underscores the advantage of obtaining such a plan earlier in life, when you are likely to have fewer health issues and a less extensive medical history. This proactive approach can ensure broader coverage and better value from your health insurance plan.
This type of plan is an ideal fit for:
Health insurance plans cover a combination of routine expenses (i.e. planned predictable expenses), and unplanned expenses. Every plan will vary with regard to coverage amounts for each of these benefits.
- A self-employed individual who needs to provide health benefits for themselves and their family.
- An individual who has little to no health history (i.e. few if any 'pre-existing conditions')
- An individual who is comfortable with their existing health conditions (if any) being excluded, but wishes to have a robust plan for everything else.
What does health insurance cover?
Health insurance plans cover a combination of routine expenses (i.e. planned predictable expenses), and unplanned expenses. Every plan will vary with regard to coverage amounts for each of these benefits.
- Prescription drugs
- Dental visits
- Paramedical services
- Vision care
- Ambulance (air / ground)
- Hospital accomodation
- Emergency travel medical
- Medical equipment
Get help with your health insurance planning.
Speak with a professional advisor who can help.
How much does health insurance cost?
There are a number of factors that can affect plan pricing, including:
Age
Generally, insurance cost less for younger age groups, and more for older age groups
Single, couple or family
Plan cost will vary depending on the number of people covered.
Province of residence
Plan cost can vary from one province/territory to the next.
Plan selection
Plans that include more benefits and higher coverage amounts come at a higher cost.
Other types of health care plans
There are two other types of health insurance plans; Guaranteed Issue, and Guaranteed Acceptance. The appropriate plan for you depends on your circumstances. An advisor can assist in determining the appropriate plan for you.
Guaranteed Issue
- No medical questionnaire
- Apply within 60-90 days of employee group benefits terminating
- Moderate relative cost
- Moderate benefits per dollar
- Covers pre-existing conditions
Guaranteed Acceptance
- No medical questionnaire
- Apply anytime
- Highest relative cost
- Lowest benefits per dollar
- Covers pre-existing conditions
Get in touch
Talk to an advisor who can understand your situation, answer your questions and help you build an insurance plan appropriate for you and your family.
Frequently asked questions
Answers to key questions about Medically Underwritten Health Care Plans
Medically Underwritten extended heath care plans will tend to offer better value (compared to other types of plans such as; Guaranteed Issue, and Guaranteed Acceptance plans).
I.e. more money, for more treatments and services at a lower relative cost.
Insurers are able to offer a better value plan when they are given the opportunity to assess your medical history.
The 'caveat' to a Medically Underwritten health care plan is that any 'pre-existing conditions' that you are being treated for or taking medication for will typically be excluded from coverage.
There are two other types of health care plans other than Medically Underwritten plans:
- Guaranteed Issue Plans: These plans can be applied for within 60-90 days of your employee group benefits terminating. You can transition seamlessly (no medical questions) to one of these plans so long as you apply within the 60-90 day window. Most insurers offer 60-days to make this transition, others up to 90-days. Guaranteed Issue plans tend to offer 'moderate' value relative to Medically Underwritten plans. The key benefit of a Guaranteed Issue plan is that pre-existing medical conditions (if any) will be covered - so long as you transition to one of these plans within the 60-90 day window.
- Guaranteed Acceptance Plans: These plans can be applied for at anytime, without needing to qualify medically (no medical questions). Guaranteed Acceptance plans tend to offer the 'lowest' value relative to the other plan types, but serve as a good option for those who cannot qualify for a Medically Underwritten plan, and are outside the 60-90 day window to qualify for a Guaranteed Issue plan.
It depends on the type of plan.
- For Guaranteed Issue and Guaranteed Acceptance plans, your coverage will be effective on the 1st of the next month after an application and payment is received.
- For Medically Underwritten plans, your coverage coverage will be effective on the 1st of the next month after an application has been approved (subject to qualifying medically) and payment is received.
- Medically Underwritten plans can sometimes take longer as the insurance company usually needs to obtain records from your attending physician(s). Average time to approval tends to be about 3-weeks. If the insurance company has difficulty obtaining the medical records from your attending physician(s) this may take additional time.
Still have questions?
Please contact our office and we'll be happy to address any questions you may have.
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