Where the gaps usually are
OHIP is built around physician and hospital care. Most working-age Ontarians without group benefits pay out of pocket for the categories below, which is where individual plans do their work.
- Prescription drugs
- Dental cleanings, fillings and major dental work
- Vision care, including exams, glasses and contacts
- Paramedical services such as physiotherapy, chiropractic, massage and mental health support
- Medical equipment, mobility aids and some supplies
- Travel medical coverage outside Ontario
Guaranteed acceptance compared with underwritten plans
Which route makes sense usually depends on your health history and on how soon you need coverage in place.
| Plan type | Health questions | Typical trade-off |
|---|---|---|
| Guaranteed acceptance | None | Lower annual maximums and pre-existing condition rules |
| Underwritten | Full health questionnaire | Higher limits, but the insurer may exclude or decline |
| Group conversion | Limited, within a set window after group coverage ends | Depends entirely on the prior plan and insurer rules |
How to compare plans without guessing
Premium alone is a poor comparison. The useful comparison is the total value a plan will actually deliver for the way your household uses care.
- Annual maximums by category, not just the headline number
- Reimbursement percentages, which often differ between basic and major services
- Waiting periods before certain categories become claimable
- Whether dental and drugs are core or optional modules
- Per-visit and per-practitioner limits on paramedical services
- Whether travel medical is included and for how many days per trip
Who typically buys individual coverage
- Self-employed people and contractors with no group plan
- Employees who recently left a job with benefits
- Retirees whose employer coverage has ended
- Families topping up a limited group plan
- New residents establishing coverage in Ontario
How Bluebird helps
As an independent brokerage, Bluebird Assurance compares plans across several Canadian insurers rather than presenting a single carrier's lineup. The goal is a plan whose limits line up with how you actually use care, at a premium you are comfortable maintaining.
Plan availability, limits, exclusions and pricing are set by each insurer and are subject to the terms of the policy.
Common questions
What does OHIP not cover?
OHIP covers many physician and hospital services, but generally does not cover prescription drugs for most working-age adults, dental care, vision care, paramedical services such as physiotherapy or massage, or most medical equipment. Personal health plans are designed for those gaps.
Do I need a medical exam for a health plan?
It depends on the plan. Guaranteed-acceptance plans ask no health questions but typically have lower limits and pre-existing condition rules. Underwritten plans ask health questions and can offer higher limits, with the insurer deciding what to include or exclude.
Can I get a plan after leaving a job?
Yes. Individual plans are available at any time, and some insurers offer conversion plans with relaxed health questions if you apply within a limited window after group coverage ends. Timelines and eligibility are set by the insurer.
Is dental usually included?
Dental is often an optional module rather than automatic. Plans commonly cover a percentage of basic services with an annual maximum, and major services, if included, are usually reimbursed at a lower percentage.
Keep reading
Options for Ontario owners covering themselves and a team.
Critical illness insuranceA lump sum on diagnosis of a listed condition.
Disability insuranceMonthly income replacement while you cannot work.
Life insurance in OntarioHow the rest of the protection plan fits together.
Health insurance for self-employedWhat to compare when you have no group plan.
Written and reviewed by Mathew Cordeiro, a licensed life and health insurance broker serving Ontario through Bluebird Assurance. This page is general information only, not financial or insurance advice. Coverage, features, eligibility and pricing vary by insurer and are subject to underwriting and policy terms.