Group Health and Dental Insurance Explained

Group health and dental insurance helps eligible workers pay for certain medical and dental costs. The word group means coverage is arranged through an employer or another eligible organization.

In simple terms: This guide explains the main choices, the words insurers use and the questions worth asking before signing up. Coverage and prices depend on the actual contract. Always read the policy or benefits booklet.

What extended health means

Provincial health care does not pay for every expense. An extended health plan may help with eligible prescriptions, therapy, medical equipment and other listed services.

Prescription drug rules

Some plans use a drug list, called a formulary, to decide which medicines qualify. Others require approval for certain drugs. Employees should check the rules before filling an expensive prescription.

Dental checkups and fillings

Basic dental coverage often includes exams, cleanings and common repairs. The plan may limit how often services are covered or how much it pays.

Major dental work

Crowns, bridges and other costly treatments may have different reimbursement rates or waiting periods. Ask the dentist for an estimate before treatment.

Vision care

A plan may offer a set amount for glasses, contact lenses or eye exams over a certain period. Check the age and timing rules.

Counselling and therapy

Mental health counselling, physiotherapy and massage may be covered only when provided by an approved type of professional. Each service can have its own yearly limit.

Deductibles and percentages

A deductible is what the member pays first. A reimbursement rate is the share the plan pays after eligible costs and other rules are applied.

Who can join

Eligibility can depend on hours worked, time with the employer and family status. Enrolment deadlines matter, especially when adding a spouse or child.

Using two plans

If both partners have workplace coverage, coordination of benefits may let them submit eligible costs to both plans in a set order. Total payment cannot exceed the eligible expense.

Making a claim

Keep receipts and follow the insurer’s instructions. Some clinics bill the insurer directly, while others require the member to pay and submit a claim.

Questions to ask before choosing a plan

• Who can join, and when does coverage start?
• What is covered, and what is not?
• What will the employer and employee each pay?
• What are the yearly limits and waiting periods?
• How do employees make a claim?
• What can change when the plan renews?

Next step

Write down the benefits your team needs most and the amount your business can afford. Ask for written quotes based on the same employee details. Compare the actual rules, not just the price. Visit the group benefits page or contact Ali Aftab to ask questions. This article is general information, not personal insurance, legal or tax advice.