Health and Dental
Why you need a health and dental plan
Having a private health insurance plan is a smart way to manage out-of-pocket medical expenses that are not covered by your provincial health plan. With The EDGE, Health & Dental insurance isn’t one-size-fits all; our benefits are completely customizable for everyone, giving you the option to choose health coverage only or health and dental coverage, as well as multiple upgrade options.
Our Health and Dental benefits are provided by Green Shield Canada and are issued to Canadians between the ages of 18-69, with coverage to age 75, and the option to choose single, couple or family coverage. Most coverage options are guaranteed to issue, regardless of pre-existing conditions.
You may be interested in private health and dental insurance if you are:
- Self-employed without an extended health care plan
- An employee receiving insufficient coverage from your employer-sponsored group benefits
- Not receiving adequate health and dental benefits from another plan
- A small-business owner with at least three non-related employees
Description
Why do I need a private health care plan if I am already covered by my provincial health insurance?
Government-sponsored health plans vary from province to province, and there are many medical services not covered by government plans. Even though you are insured by a provincial plan such as OHIP, MCS, or MSI, among others, extended health care services like physiotherapy, vision care and chiropractor services are usually not covered under public plans, but are essential for maintaining peak physical health. EDGE Health & Dental insurance supplements your provincial coverage, providing reimbursement for out-of-pocket costs not covered by provincial plans, and affording you comprehensive benefits to maintain your health and wellness.
With the exception of Quebec which covers some medications, provincial health insurance plans do not provide prescription drug coverage.1 The EDGE Health insurance helps bridge this gap by providing a basic amount of reimbursement for prescription costs. We also offer an optional drug upgrade to increase prescription coverage to 90% reimbursement per person, to a personal maximum of $1,000 for the first year, $1,500 for the second and $2,000 per year from the third year onward. Like all EDGE products, the underwriting process for this upgrade is simple.
Contact us, or speak with a licensed EDGE advisor for more information about the drug upgrade or our self-employed benefit plans.
Get a custom quote for EDGE Health & Dental plans today.
Interested in a health & dental plan for your small business?
Providing a comprehensive benefit package helps you attract and retain the best talent in a competitive, highly fluid job market. It also shows your employees that you care about their wellbeing, and that a competitive compensation package includes more than just a salary.
The Edge Benefits is the No. 1 provider of affordable, flexible benefit solutions for Canadian small businesses, with our Health & Dental coverage serving as the foundation from which to build a comprehensive employee benefits plan. For businesses enrolling at least three people to well over 100+ people in an EDGE health and dental plan, the drug upgrade underwriting requirement is waived.
Comprehensive medical care coverage with The Edge Benefits
EDGE health & dental plans provide flexible, affordable coverage for prescription drugs, paramedical services, emergency medical travel insurance, vision care, and routine dental care. Rates are reviewed annually and take into account the claims experiences from all EDGE policyholders as well as other market factors, which helps to keep your individual rates affordable and unaffected by pre-existing conditions or personal medical history. If a rate increase is deemed necessary, changes to monthly premiums will generally be effective October 1 of that year.
Our Health & Dental benefit packages afford you all the conveniences of modern technology. Not only can you apply for benefits online and receive quick approval, but as a plan member, you can also view your plan booklet at any time to see what expenses and medical aids are covered, submit claims online, view your claims history and coverage balances, search for providers, manage direct deposit banking information and print your personal explanation of benefits to seamlessly coordinate benefits with another carrier.
Covered services and eligible expenses under EDGE Health & Dental plans are reimbursed as follows:
Health Plans
Provided by Green Shield Canada. Issue ages 18-69, coverage to age 75.
| BASE HEALTH PLAN [Guaranteed Issue] |
Optional Health Upgrade [Guaranteed Issue] |
Optional Drug Upgrade [Underwritten] |
|
| PRESCRIPTION DRUGS Quebec residents: prescription drug coverage not available unless RAMQ Top Up product is selected. |
|||
| Maximum | Paid at 70% $400 per person, per year |
Paid at 90% per person $1,000 1st year $1,500 2nd year $2,000 3rd+ years |
|
| EXTENDED HEALTH CARE | |||
| Professional Services / Registered Therapists: | $1,000 per year combined for all practitioners | $1,500 per year combined for all practitioners | |
| Acupuncturist, Chiropractor, Chiropodist/Podiatrist, Registered Massage Therapist, Naturopath, Osteopath, Physiotherapist | $20 per visit, $400 per year |
$40 per visit, $500 per year |
|
| Psychologist/Registered Social Worker | $400 per year combined | $500 per year combined | |
| Speech Therapist | $400 per year | $500 per year | |
| Accidental Dental | $3,000 per person, per year | $10,000 per person, per year | |
| Ambulance Transportation | Includes land and air | Includes land and air | |
| Hearing Aids | Not covered | $500 every 36 months | |
| Medical Services: Diagnostic tests and x-rays, dialysis equipment, laboratory tests |
$2,000 per person, per year | $3,000 per person, per year | |
| Medical Items and Home Support Services (in-home nursing) | Year 1: $1,500 Year 2: $2,000 Year 3: $3,000 Year 4+: $4,000 per person, per benefit category, per year |
$10,000 per person, per year combined | |
| TRAVEL | |||
| Emergency Medical Travel Coverage out of Province / Country | 15 days per trip $5,000,000 per person, per year |
15 days per trip $5,000,000 per person, per year |
|
| VISION CARE | |||
| Prescription eyeglasses, contact lenses, laser eye surgery | Not covered | $250 every 24 months | |
| Eye examinations | Not covered | $65 per person, every 24 months |
Why do I need dental insurance?
Extended health care services such as general oral health care are not included in provincial health insurance, as outlined by the Canada Health Act. As a result, approximately six million Canadians avoid visiting the dentist every year because of the costs.2
Oral health is a major part of a person’s overall wellness. The Canadian Dental Association has shown a correlation between oral diseases and other health problems, like diabetes, heart disease and stroke.3 Receiving regular dental checkups and cleanings is a proactive way to care for your overall health, and to help prevent dental emergencies.
Investing in a private health insurance plan that includes dental insurance is an on’t cause financial hardship.
Receive the best dental insurance with The Edge Benefits
EDGE Health & Dental plan options are guaranteed issue, with the exception of our drug upgrade which is underwritten. Monthly premiums for all EDGE Health & Dental plans are not affected by the insured person’s medical background; rates are only determined by the insured plan member’s age and province of residence.
How long does it take to get dental insurance with The Edge Benefits?
Because most of our Health & Dental plan options are guaranteed to issue, coverage becomes effective on the 1st of the month following approval of your application. If you choose to apply for the prescription drug upgrade, coverage becomes effective after the upgrade is approved, which typically takes only a few weeks.
A basic health plan must be purchased in order to purchase a dental plan. The EDGE offers two dental plan options; choose a basic level of dental coverage, or upgrade your dental insurance to increase the amount reimbursed for each visit as well as your maximum annual coverage. View plan options and rates here.
Refer to the chart below for a list of covered services and eligible expenses.
Dental Plans
Provided by Green Shield Canada. Issue ages 18-69, coverage to age 75. Not available as a stand-alone product – must purchase a Health plan in order to purchase a Dental plan.
| BASE DENTAL PLAN [Guaranteed Issue] |
Optional Dental Upgrade [Guaranteed Issue] |
|
| Maximum | Paid at 70% $450 per person, per year |
Paid at 80% per person $1,000 1st year $1,000 2nd year $1,250 3rd+ years |
| BASIC PREVENTIVE & RESTORATIVE SERVICES | ||
| Recall exams, preventive cleaning, fluoride for children | Paid at 70% Available every 9 months |
Paid at 80% Available every 9 months |
| Bitewing x-rays | Paid at 70% Available every 12 months |
Paid at 80% Available every 9 months |
| Complete oral exams, full x-rays | Paid at 70% Available every 3 years |
Paid at 80% Available every 3 years |
| ENDODONTIC & PERIODONTAL TREATMENT AND DENTURE SERVICES | ||
| Periodontal scaling, occlusal equilibration | Paid at 70% 8 units every 12 months |
Paid at 70% 8 units every 12 months |
| Denture cleaning | Paid at 70% Available once every 12 months |
Paid at 70% Available once every 12 months |
| Denture relining or rebasing | Paid at 70% Available once every 3 years |
Paid at 70% Available once every 3 years |
With EDGE, you only pay for the types of health and dental coverage that you need. Design a custom plan that helps you maintain a healthy lifestyle for a predictable monthly rate. When purchasing health & dental benefits with The EDGE, in addition to other EDGE coverages, plan members also receive a multi-product discount on their Health & Dental premium.
Receive a quote from The EDGE today or connect with a member of our team to learn more about building a custom benefit plan to accommodate your needs and budget.
Contact The EDGE today to get a quote for Health & Dental benefits.
