What Ohip Covers And What It Doesnt
Before you can decide whether or not you need supplementary health and dental insurance, you should have an idea about the kinds of services OHIP does and doesnt pay for. The basic expenses covered by OHIP include:
- Visits to doctors
For a full list visit What OHIP Covers.
What OHIP doesnt typically cover:
- Prescription drugs/medicines provided outside of hospitals such as antibiotics, painkillers, and some cancer drugs
- Specified elective medical services such as chiropractors or massage therapists
- Semi-private or private hospital rooms
- Some medical exams, tests and vaccinations
- Dental care
Let Us Help You Choose The Right Nova Scotia Dental Insurance Plan
At SBIS, we have helped residents in Nova Scotia and throughout Canada select the dental insurance plan that meet their needs for more than 25 years. Let us put our experience to work for you. When you work with us, you will reap a variety of benefits, including:
- Financial protection and peace of mind because you have the insurance coverage you need to enjoy routine dental care.
- Access to high quality, affordable dental insurance plans with different levels of protection to meet your needs.
- Knowledgeable professionals who will work with you to assess your coverage needs and help you review the Nova Scotia Dental Insurance Plans available to choose from.
Choose SBIS to get the protection you need for you and your family at a price you can afford. A live person answers each and every phone call, Monday to Friday, from 8:45 a.m. to 4:45 p.m. Eastern time.
Should I Purchase A Fedvip Dental Or Vision Plan
The Federal government offers standalone “FEDVIP” dental and vision plans, separate and distinct from the FEHB program. The FEDVIP program shares the same Open Season dates as the FEHB program, but you join them separately. To enroll, use Benefeds or call 1-877-888-3337. In sharp contrast to regular health insurance benefits, there is no direct Federal government contribution to the cost of the premium. You pay it all, though with substantial tax savings to employees .
While these plans do have an element of insurance, in that they protect you against some unforeseen dental or vision expenses, they are best thought of as primarily pre-paid care. Most people enroll in these kinds of plans because they know roughly what kinds of expenses to expect, and plan to do a little better than breaking even. In effect, you pay for those new contact lenses or your recurring dental expenses on the biweekly or monthly installment plan, with protection against some unanticipated expense.
Like FEHB plans, FEDVIP plans offer three enrollment options: self only, self plus one, self and family. The premiums for self plus family are almost always about double or triple the self-only premium.
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What Is Supplementary Health And Dental Insurance
If you live in Ontario, you are probably covered under the government-funded Ontario Health Insurance Plan . When you are approved for OHIP, youll get an Ontario health card which enables you to go to a doctor, clinic, hospital or emergency room, and receive medical attention, tests and surgeries at no cost to you.
But OHIP only partially covers or doesnt cover some medical services like prescription drugs and vision care, and it does not cover dental care. To pay for medical needs and dental care that OHIP doesnt cover, you may want to consider purchasing supplementary health insurance also known as extended health insurance, or private health insurance, and supplementary dental insurance.
You might have supplementary health and dental insurance through your employer, known as group insurance, or you may decide to buy your own policies, known as individual insurance. Supplementary health and dental insurance is a way to get the medical services you need, at an affordable price. To find out more about the different types of supplementary health and dental insurance, visit Types of Supplementary Health and Dental Insurance.
Why Dental Care Is Important
Regular visits to the dentist are critical to your oral health. Routine visits help keep your teeth and gums healthy, and good oral health affects your overall health. Oral health issues, such as cavities and gum disease, can lead to more serious health issues, such as diabetes, respiratory problems and many others.
Oral health is important in all stages of life. Children, adults and seniors require proper dental care and should visit the dentist regularly. While it is recommended that we visit the dentist twice per year, many Canadians do not go as frequently as they should, often because they do not have adequate dental insurance.
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Find A Participating Dentist
For information about where to access services and what services are available near you, please contact your local public health unit.
If you are accepted into the program, you can access dental services through:
- partner Community Health Centres
- partner Aboriginal Health Access Centres
Access to the full range of dental services will vary across the province. The program will continue to expand in the coming year.
Federal Employees Dental And Vision Insurance Program
The Federal Employees Dental and Vision Insurance Program is available to eligible federal employees, retirees, and their eligible family members on an enrollee-pay-all basis. Employee must be eligible for FEHB in order to be eligible to enroll in FEDVIP. This Program allows dental and vision insurance to be purchased on a group basis which means competitive premiums and no pre-existing condition limitations. Premiums for enrolled federal employees are withheld from your salary on a pre-tax basis.
If eligible, you can enroll in a dental plan and/or a vision plan. You may enroll in a plan for self-only, self plus one, or self and family coverage. Eligible family members include an enrollee’s spouse and unmarried dependent children under the age of 22, or if age 22 or older, incapable of self-support. The rules for family members’ eligibility are the same as they are for the FEHB Program.
Enrollment will take place during the annual Federal Benefits Open Season in November and December. New and newly eligible employees can enroll within the 60 days after they become eligible.
You can get all the latest information at the OPM web site, just go to , for dental plans, or go to for vision plans
The official enrollment website for Federal Vision and Dental Insurance is BENEFEDS at
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Dental Health Services In Canada
While the Canadian health care system and medical services plans provide coverage for virtually all physician and hospital health care costs, the majority of the responsibility for health care planning and delivery lies with the provinces and territories.
While 70% of the total cost of health care is covered by public insurance, a strong role has always been played by private out-of-pocket and employer-based insurance for services not covered publicly, such as dentistry, drugs and vision care.
For the most part, Canadians are responsible for financing their own dental care and typically do so in the following four ways:
The sources of funding for dental care services in Canada can be seen in Figure 2. In this chart, for illustrative purposes private insurance refers to all sources of private insurance including employment and non-employment related dental coverage.
Figure 2: Dental Service Expenditures in Canada 2015
This figure illustrates how small a proportion public dental services represent compared with other sources of funding for dental services in Canada. Public-sector dental expenditures are targeted primarily to children, seniors, eligible Indigenous individuals and the disabled.
How Much Supplementary Health Or Dental Insurance Do You Need
There are a wide variety of supplementary health and dental insurance plans, each with their own level of coverage, but the amount of health insurance you need is a highly personal decision. Only you can decide how much is right for you, but an insurance agent or company may be able to help you make those decisions. Visit the finding an insurance agent or company section of Working With an Insurance Agent or Company to find someone who can help you.
Factors to consider when deciding how much coverage you need include:
- How much can you afford to pay each month? Each year?
- Do you have any other supplementary health insurance through your employer, a parents group plan or a spouse/partner?
- Do you require prescription drugs on an ongoing basis?
- Are you willing to share a hospital room, or do you prefer a private room?
- Do you wear glasses or contact lenses?
- Do you receive medical services from professionals such as chiropractors or massage therapists?
- Can you afford to pay out of pocket for ambulance fees?
- Do you have a chronic illness that requires more extensive medical services than OHIP provides?
- Do you have a pre-existing medical condition? Some supplementary health insurance plans do not cover this. Be sure to shop around to find an insurer who might.
Supplementary Health and Dental Insurance | 101: Getting Started 4
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Why Buy Through Sbis
SBIS gives anyone who is losing or does not qualify for group benefits access to a supplementary Ontario Dental Insurance Plan from numerous top insurers in Canada. We also provide comprehensive coverage to business owners, entrepreneurs and anyone else wanting to minimize the financial risk of being underinsured.
As an independent broker, our mandate is to help you choose the right insurance carrier for your individual dental insurance coverage requirements. This means we will work with you to identify your specific needs, and then match you with the right carrier.
Dental And Vision Benefits
Loudoun County employees enjoy generous dental coverage, both in and out-of-network, through Delta Dental of Virginia. Delta Dental pays benefits based upon the type of services received. Out-of-network coinsurance is payable based on reasonable and customary charges. The costs of preventive and diagnostic services are not applied toward the deductible or annual maximum benefit.
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Adult & Child Dental Insurance In The Marketplace
Under the health care law, dental insurance is treated differently for adults and children 18 and under.
- Dental coverage is an essential health benefit for children. This means if youre getting health coverage for someone 18 or younger, dental coverage must be available for your child either as part of a health plan or as a stand-alone plan. Note: While dental coverage for children must be available to you, you dont have to buy it.
- Dental coverage isn’t an essential health benefit for adults. Insurers dont have to offer adult dental coverage.
Types Of Fedvip Enrollment
A self only enrollment covers only the enrolled employee or annuitant. An eligible individual may enroll in self only even though he/she has a family, but the family members are not covered.
A self plus one enrollment covers the enrolled employee or annuitant plus one eligible family member. Eligible individuals may enroll in self plus one even though they have more than one eligible family member, but the additional family members are not covered. The enrollee must specify during the enrollment process which one eligible family member he/she wishes to cover under a self plus one enrollment. The enrollee may change the covered family member to another eligible family member during an open season or because of a qualifying life event.
A self and family enrollment covers the enrolled employee or annuitant and all eligible family members. Enrollees should list all eligible family members when they enroll. All of the enrollees eligible family members are automatically covered, even if the enrollee fails to list all of them when enrolling on Benefeds, but claim payments may be delayed for family members who were omitted.
Generally, dual enrollmentwhen an individual is covered under more than one FEDVIP dental enrollment or more than one FEDVIP vision enrollmentis prohibited except when elimination of the dual enrollment would cause a covered person to lose coverage.
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Trends In The Insurance Marketplace
You cant quite reach into the mouth over the phone, but what we can do and what we had to rely on while the offices were closed during quarantine is the advancement of what we call tele-dentistry. Were looking for that to be at least a way to help connect somebody to their provider or their dentist when theyre in need when theyre in pain, when theyre having an issue or to avoid having to go back to the dentist if all they need to do is a quick follow-up visit with their provider.
Colleen Van Ham
Why Federal Employees Retirees And Survivor Annuitants May Want To Seek Alternatives To The Fedvip
Federal employees, annuitants and survivor annuitants may want to seek alternatives to enrolling in a dental plan offered through the FEDVIP. The reason is that one has to ask the question: What is the purpose of buying any insurance? The purpose is transfer of risk. The insured pays a small amount of money a premium to an insurance company in order to protect the insured from a financial catastrophe.
A classic example is homeowners insurance in which for example a homeowner who owns a homeowners insurance policy pays an annual premium of $1,500 to $2,000 on a house worth $500,000 to $750,000. If the house were to burn down, the insurance company in most cases would pay the cost of having the house rebuilt at its fair market value just before the house got destroyed. Obviously, the insurance company would be paying a far greater amount of money than the homeowner paid in insurance premiums through the years.
Dental insurance covers far less in dental expenses compared to what traditional medical insurance covers in medical expenses. Many dental plans may pay for only $1,000 or $2,000 of dental expenses incurred per individual per year. Dental insurance therefore is not the classic insurance in the sense that it protects the insured from the catastrophic expenses.
The following are some suggestions for employees, annuitants and survivor annuitants to consider during this open season before enrolling or re-enrolling in a FEDVIP dental plan:
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Blue Cross Blue Shield Dental & vision Plans
For additional coverage beyond our health plan benefits, we offer supplemental dental and vision plans, available to federal employees and eligible uniformed service members.
Were committed to supporting our members health and well-being during this time. If youre a BCBS FEP Dental member, learn more here. If youre a BCBS FEP Vision member, learn more here.
The Federal Employees Dental and Vision Insurance Program is a voluntary, enrollee-pay-all dental and vision program that offers you the chance to choose your carrier. Backed by the strength of Blue Cross Blue Shield, were proud to offer plans that help keep your mouth and eyes healthy.
Personal Health Insurance And Vision Care
Many personal health insurance plans partially cover vision care expenses. The amount and type of coverage varies, depending on the particular health insurance plan.
Vision care expenses that may be fully or partially covered are:
- Eye examinations
|Covers ophthalmologist as well as optometrist exam|
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What Ontario Blue Cross Covers
Our dental insurance can help offset the expenses of common dental treatments and oral surgery that OHIP does not cover. Have peace of mind in knowing that if an unforeseen dental issue arises, you can go to the dentist to get proper treatment without an expensive dental bill. We offer a variety of affordable and flexible health insurance plans for you and your family. Our plans have no deductible, making our coverage ideal for anyone who does not have group insurance.
Dental Coverage Options From Gms
GMS plans are flexible, and you may get same-day coverage when you buy online. There are no hidden benefit restrictions for health and dental. What you see is what you get, and there is no waiting period when you switch from another provider . Plus, you get quick claims payment when you submit your claims online.
SBIS gives you access to GMS Personal and Replacement Health Insurance Plans. Dental coverage for you and your family can be added to your choice of plan.
GMS Personal Health Plans: Choose from one of three GMS Personal Health Plans, add on the dental protection you need, and consider a spectrum of other coverages. Each year, you may adjust your benefits to remove or add coverage .
GMS Replacement Health Plans: Youre accepted. Guaranteed. No medical questions. Just make sure your plan begins within 60 days of the end date of your group benefits. Once youve got it, youve got it. Youll never have to reapply! Choose from three plans for the health coverage you need and add on your benefit for preventative, basic and major dental care.
As a leading agency for individual dental insurance plans, SBIS offers:
Contact us to learn more about how you can expand your Ontario dental insurance coverage with affordable insurance plans from SBIS. Request a no-obligation quote or free information package today!
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Federal Employees Have Three Options For Saving On Expenses
Dental costs can be one of the more predictable healthcare expenses for families. An annual exam and cleanings are scheduled events, and even restorative procedures like crowns are often planned in advance. Knowing your anticipated dental care needs gives you an opportunity to plan the best way to pay for them.
There are three ways federal employees can save on dental expenses: through a Federal Employees Health Benefit plan benefit, through a Federal Employee Dental and Vision Insurance Program benefit, or through a flexible spending account .
FEHB Plan Benefits
First start with your FEHB plan. Youll need to know what, if any, dental benefits your plan offers. Look in section 5 of the plan brochure. Virtually all FEHB plans provide coverage of accidental dental injuries, but many state that they have no other dental benefits. This is not always a complete story because it refers only to official plan benefits. Most official benefits are limited to preventative procedures, but some are more generous.
Some plans provide a dental savings program described in the Non-FEHB benefits available to plan members section of the plan brochure. These unofficial benefits always require the plan member to use a specific provider network, and youll need to contact the plan to find a list of participating providers and to learn more about available discounts.
FEDVIP Plan Benefits
Here are a few more things to know about how FEDVIP plans work: