See how a deductible, co-insurance factor and annual maximum split a health, dental, drug or vision claim between you and the plan, and why a group plan usually pays more.
Choosing a benefit loads typical individual and group settings you can then adjust.
Cost that qualifies under the plan (amounts above a dental fee schedule are excluded first).
You pay this first, 100%, before the plan pays anything. Resets each year.
Share of the remaining eligible expense the plan covers; you pay the rest.
Most the plan will reimburse in a year for this benefit. Slide to the top for no cap.
How this works. An extended health claim is settled in a fixed order, and each step
can shift cost back to you:
Fee schedule: anything above the schedule amount is not eligible (e.g. a $300 extraction vs a $225 schedule leaves $75 on you).
Deductible: you pay the first dollars 100% yourself (Jose's plan: a $100 dental deductible).
Co-insurance: the plan pays its percentage of what's left; you pay the rest (Consuela's plan pays 80%, she pays 20%; major dental is often 50%).
Annual maximum: once the plan has paid its yearly cap (routine dental is often about $1,000), the remainder is on you.
Individual policies let you pick and choose deductible, co-insurance and limits to fit your budget; group
plans are a pre-set package, usually with little or no deductible, so they typically reimburse more.
Educational illustration of standard Canadian insurance concepts. Figures are illustrative, not an insurer’s rates.
Illustration only, not a quote or advice. Figures are simplified for education and do not
reflect any specific insurer's rates. Consult a licensed advisor.