Comparing two health insurance plans is easier when you put the same questions beside each one: can you apply, is the care you need covered, how much could the plan reimburse, and what would you still pay?
Use the worksheet below with two current quotes and their benefit summaries. Keep the policy wording nearby. A short comparison can help you spot an unanswered question before you submit an application.
This guide is for people comparing individual health and dental plans outside Quebec. It provides general information, not a recommendation for a particular person or policy.
Start with the same information
For both quotes, use the same province, people to be insured, ages, coverage options and requested start date. Record the exact plan name and tier, quote date and any optional benefits. Ask whether the quoted payment includes applicable taxes or fees.
Check the coverage you already have. The Financial Consumer Agency of Canada recommends reviewing workplace benefits before buying additional insurance and checking both reimbursement percentages and annual limits. Read FCAC's health insurance guidance.
If group benefits are ending, confirm their actual end date with the plan administrator. Check time-sensitive replacement options and eligibility before choosing which application to submit. For example, Sun Life's eligibility page has specific requirements for Health Coverage Choice, including a 60-day application window and a restriction following a declined Personal Health Insurance application. Other products have their own rules.
Fill in your two-plan worksheet
Copy these rows into a note or print them. Write “confirm” where the documents do not give a clear answer. Keep eligibility, the start of coverage and the resetting of benefits separate.
| What to record | Plan A | Plan B |
|---|---|---|
| Insurer, exact plan and optional benefits | __ | __ |
| Quote date and total monthly payment | __ | __ |
| Eligibility and application deadline, if any | __ | __ |
| Coverage start date and waiting periods | __ | __ |
| Drugs or services you need confirmed as eligible | __ | __ |
| Deductible and reimbursement percentage | __ | __ |
| Eligible-charge basis and per-visit limits | __ | __ |
| Maximum for each benefit and who shares it | __ | __ |
| Reset date or multi-year period for each limit | __ | __ |
| Exclusions and requirements still to confirm | __ | __ |
| Estimated annual premiums plus unpaid care | __ | __ |
Check the care you expect to use
Start with two or three priorities rather than every benefit in the brochure. Your list might include a regular prescription, planned dental treatment or physiotherapy visits.
For each priority, record the expected number of visits or refills and the amount your provider charges. Then ask the insurer or a licensed advisor to check the exact plan:
- Prescription drugs: provide the drug name and Drug Identification Number, or DIN. Ask about the eligible amount, generic-drug rules, dispensing fees and any approval requirements. A drug appearing in a product description does not confirm your claim.
- Dental: use the treatment estimate and procedure codes from your dental office. Ask which benefit category applies, which fee guide is used, and whether a waiting period or treatment-frequency limit matters.
- Practitioner visits: check whether the provider's credentials qualify and whether limits apply per visit, per practitioner type or across several services.
These questions reflect real differences in policy wording. For example, Sun Life's Enhanced sample policy contains drug eligibility rules, generic substitution, dental waiting periods and fee-guide provisions. It is an illustrative sample; the policy issued to you governs your coverage.
Compare what a claim could actually pay
A reimbursement percentage applies to an eligible expense under the policy. It may leave you paying a deductible, a share of the expense, charges above an allowed amount, or costs beyond a benefit limit. Canada Life's explanation of out-of-pocket expenses describes these different costs.
Here is a fictional example for one practitioner visit. It is not a quote or a description of an available plan. Assume the service and provider qualify, all waiting periods have ended, there is no deductible and enough of each annual maximum remains.
- The provider charges $120
- Plan A treats $100 as eligible and reimburses 80%, paying $80. You pay $40
- Plan B treats the full $120 as eligible and reimburses 70%, paying $84. You pay $36
In this example, the lower percentage produces the larger payment. Changing the eligible amount, deductible or remaining maximum could change the result. Ask for the calculation when the wording is unclear.
Put dates beside the maximums
For each important benefit, record the amount, the period it covers and when it becomes available. Check whether the limit is per person or shared, and whether it changes after the first year.
The calendar matters. Manulife's Flexcare comparison chart for British Columbia and Saskatchewan, for example, uses calendar-year drug limits, anniversary-year dental limits and multi-year vision limits. That does not establish the rules for another plan or province.
Keep the effective date, the end of any waiting period and the benefit reset date on separate lines. A policy starting in October does not, by itself, tell you when every benefit resets.
Compare your likely costs and remaining gaps
For a simple first-year estimate, add 12 monthly payments, assuming the quoted rate stays unchanged, to the care costs you expect to pay after reimbursement. Do not count a deductible twice if it is already included in your unpaid-care calculation. Mark uncertain reimbursements clearly.
Then consider a second scenario: more eligible care than you currently expect. Where would each plan stop paying? Which exclusions or smaller limits could leave a gap you would find difficult to manage?
The routine-spending estimate is one comparison tool. It cannot predict future claims or measure every reason for buying coverage. Avoid treating unused maximums as money you will necessarily receive.
Resolve the remaining questions
Bring the two plan names, your completed worksheet and the unresolved rows to a licensed advisor. Ask for the relevant wording and written clarification where needed. You can start with our health insurance comparison tool and contact an advisor when you want help interpreting the differences.
The goal is a clear choice based on the coverage you understand, the costs you can manage and the conditions you have confirmed.
Frequently asked questions
Is the plan with the lowest monthly premium the cheapest overall?
Not necessarily. Add the premiums to what you expect to pay for care after reimbursement. Then compare exclusions and limits in a higher-use scenario. The result depends on the exact policy and your claims; a quote alone cannot predict your total cost.
Does 80% coverage mean the insurer pays 80% of my bill?
It means the applicable percentage is paid on expenses eligible under the policy, subject to its rules. A deductible, an eligible-charge limit, a waiting period or a benefit maximum can affect the amount paid. Ask the insurer to explain the calculation for the service you need.
Do all annual benefit limits reset on January 1?
No. A limit can use a calendar year, a policy anniversary or another defined period. Different benefits within one plan can use different periods. Record the reset rule for each benefit rather than assuming one date applies to everything.