Premium may sound like something insurers are pitching as the “best” but actually, premium refers to what you pay your insurer. In other words, the monthly rate for your coverage.   Be careful taking the number at face value though.  Low premiums often mean the plan covers much less.   

You're probably somewhat familiar with this piece of insurance jargon.  Commonly tossed around as a plan feature, deductible is the dollar amount you must pay out of pocket before the insurer will begin to pay any portion of your bill.  Deductibles are good for the insurance company because in theory they help mitigate risk.  The idea is that if we’re paying the first bill ourselves we might think twice before incurring an unnecessary expense because “it doesn’t matter, my insurance will cover it”.  The insurer wants to avoid a deluge of minor claims which can really add up.  

Not all plans have deductibles, and amounts can vary, so you’ll want to look into plan details to make sure you’re getting the coverage level that’s important to you. 

Even the best benefit plans have limits on what’s covered.  Maximums refer to the maximum dollar amount a plan pays for claims during a specific time period.  Maximums may apply for a specific type of service (e.g. massage or physiotherapy) or for all services combined (e.g. an overall dental maximum). The time period in which a maximum is applied may differ as well. It is common to see per year or per visit maximums.    

Maximums are important to look at when comparing plans because they can affect how you'll actually be able to use your coverage and how much of your bills are paid. For example, even if your plan has a high overall maximum for the year, if there is a very low per visit maximum for a service, such as physiotherapy, you will end up having to pay out of pocket for treatment.  

Although this term sounds rather ominous (it’s a little too close to undertaker) it actually refers to the money guys,​ the people who pay your claims, usually a large insurance company. The underwriter reviews your application and assesses risk based on factors such as current health, age, previous health history, or sometimes lifestyle if you happen to be a stunt sky-diver to try to determine how likely it is you will have expensive claims. The underwriter then decides to take you on or denies coverage because they think you pose too big a risk to the plan. They may also approve your insurance coverage but adjust the monthly premium to account for higher risk.  
 
The bottom line, look for a plan that's underwritten by established, reputable insurers. And it's best to apply when you’re healthy.   

No doubt you’ve heard the ads  “acceptance guaranteed, no medical info required”.  Sounds easy, doesn’t it.  And in fact it is straightforward, on the surface. It refers to coverage that is guaranteed to be issued to you regardless of your age or the state of your health. That’s the upside.  The downside is that because these plans don’t involve health questionnaires, the underwriters can’t assess the risk involved in insuring you. So they set the rates high.  You should assume that guaranteed issue plans offer significantly less coverage and tend to be more expensive than plans that require information about your health.     
 
Guaranteed issue plans can be a good option if you don’t qualify for anything else due to a chronic or serious medical condition. But make sure you do your homework so you know exactly what you’re getting.  You don’t want to lose out on coverage you’re counting on.   
 
And if you’re currently healthy, don’t rely on guaranteed issue as a fallback for future.  If you become ill or injured, there’s a good chance these plans won’t offer the coverage you need.  We’ll say it again: the time to buy insurance is when you’re healthy.  

Think of this simply as brand-name and non-brand.   Generic drugs have the same active ingredients as their brand name counterparts so they carry the same health benefits.  But they’re sold under a generic label at a significantly lower price.  Substituting a lower cost generic alternative for a brand name drug is a way to keep claims costs lower for the insurance company.  And since your rates are based on the cost of claims made by everyone in your plan, generic substitution saves you money too. But if the generic drug doesn't work for you good plans, such as Health Plus, will substitute the brand name drug.   

So here’s to simplicity.  If you come across terms you don’t understand, don’t be shy.  The problem’s not you.  It’s up to your insurance company and advisor to translate insurance jargon and make things clear.   Don’t hesitate to ask.   

First up, health insurance, which covers some or all of your medical bills if you're injured or ill. Think of how important your health is to your work, your personal life, your family. Think of how pricey even routine health expenses can be, let alone nasty surprises.

In Canada, health insurance is split between the province and private insurers. Most of you know that in Ontario, residents are covered by OHIP (the Ontario Health Insurance Plan), but OHIP’s limitations often come as a surprise. While it’s great news for families that the government recently expanded OHIP to cover some prescription drugs for children, for most adults coverage is limited to visits to the doctor, some diagnostic tests, and in-hospital stays. You’re on the hook for everything else.

For this reason 24 million Canadians have opted to buy additional health insurance through private insurers. These plans cover basics like dental and vision care and routine prescription drugs. They also protect you in case of more serious accident or injury that can involve big, unmanageable bills.

The holy grail of health insurance is a good group benefits plan through an employer. Count yourself lucky if you have one of these. Good benefits are a huge draw to employees because the employer is required to pay at least part of the cost and all full-time employees are eligible, regardless of pre-existing health conditions.

However, if your company doesn't offer benefits, you still have options. Individual health plans such as Health Plus are available. Just make sure you look past the ads. While you obviously want a good price,  make sure you also consider the coverage maximums and limits for the services that are important to you. Some plans look good on the surface but coverage is actually quite inadequate and their rates keep going up. Look for a plan that balances good coverage and stable, reasonable rates.

Marketing of Health Spending Accounts is also on the rise. These are usually pitched as an alternative to group insurance for small business because they provide reimbursement for a wide variety of health expenses to a predetermined amount (e.g $1000-$2500). Employees/employers pay into an account to cover the claims. The flexibility of HSAs for routine expenses can be appealing but the biggest pitfall? They aren't insurance. If you're faced with a serious medical issue, they don't measure up. 

Life insurance pays a tax-free lump sum of money to family or other beneficiaries named in your policy. It can protect your loved ones in the event of your death by providing money to pay funeral costs, debts, or simply to continue paying everyday expenses. Policies are available as term life insurance, which covers you for a specific time period, or permanent life insurance, which as the name suggests, covers you as long as the premiums are paid. Permanent life insurance may also accumulate cash value you can use, should you live to a ripe old age or want the money sooner.

If you become sick or injured and unable to work, disability insurance provides a monthly tax-free payment to replace some of your lost income. Not only can health bills take a toll but so can everyday expenses. Disability insurance helps you maintain your standard of living, even if you’re ability to work has changed.

Different than disability insurance, critical illness insurance provides a tax-free lump sum payment if you’re diagnosed with a serious illness such as cancer, heart attack, or stroke. The money is yours to use as you see fit, whether that’s on additional medical treatment or supplies, living expenses, household help, or even a vacation.

Long term care insurance pays cash to help cover the costs of care in your home or a healthcare facility. Anyone who has helped care for an aging or disabled relative will know good care can be expensive and sometimes too hard to find. Canada's aging population, with seniors making up 15% and projected to rise to 25% within the next 20 years, makes having a plan in place all the more important. With this strain on the system, insurance gives you more control and choice in where and how you live.