Group Health Insurance Versus Individual Health Insurance: Understanding the Differences

Supplemental health insurance
covers things like massage.

According to the Organization for Economic Cooperation and Development, as of 2008, 75% of Canadians have some kind of health insurance to cover supplemental medical expenses and most of these people receive their health plan through a group plan with their employer.

Group health insurance policies consider all the members of the policy, meaning that all employees under the plan are blended into one pool when it comes to pricing.

When analyzing risk, insurance company looks at many variables, such as the type of business, how long the company has been in business, the number of employees and their age, gender and smoking status. As well, if the company has a benefit plan and past claim experience, that insurance company knows the health of each plan member will vary. Some employees may be sick or obese, while others may be very healthy. On most plans, employees are not underwritten for basic benefits, but optional life and disability insurance may be underwritten on the plan.

Individual health and dental plans take a very different approach from group plans because insurance companies underwrite each applicant. Under an individual plan, the insured may be approved for a standard plan, declined or rated. A rated policy means the insured is approved, but at a higher premium than what is offered to healthier individuals. Rated policies may also carry certain exclusions for pre-existing conditions, such as diabetes or high blood pressure..

For more details on health insurance in Canada, please contact us at 1-866-899-4849 or visit our Group Benefits or individual Health Insurance Quote Pages.

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