PAY
Eligible services
What is covered?
Review which prescription, dental, vision and paramedical services are included and excluded.
Health & Dental Plans Guide
Make everyday healthcare costs more predictable.
Individual health and dental plans can help with eligible prescription drugs, dental care, vision care and paramedical services when workplace coverage is unavailable, limited or ending.
Health & Dental Essentials
Six details to review before choosing a plan
The right plan should reflect the services you expect to use, the limits you can accept and the premium that fits your budget.
WAIT
Reimbursement level
Percentage paid
Plans may reimburse a percentage of an eligible expense rather than the full amount.
TERM
Annual maximums
Yearly limits
Each benefit category may have a dollar limit, visit limit, frequency limit or combined maximum.
JOB
Deductibles
Your share first
A deductible may need to be paid before eligible reimbursements begin or may apply each year.
WAIT
Waiting periods
When it starts
Some benefits may begin immediately while others become available only after a stated period.
READ
Pre-existing conditions
Eligibility varies
Medical history, current treatment and medication needs may affect eligibility or the plan offered.
Everyday Coverage
Coverage for the care people use most often.
Depending on the plan, eligible expenses may include a mix of routine and unexpected healthcare costs.
- Prescription drugs and dispensing fees
- Routine and major dental services
- Vision exams, glasses and contact lenses
- Physiotherapy, massage and chiropractic care
- Mental-health and other paramedical services
- Emergency travel benefits on some plans
Who May Benefit
Useful when workplace coverage is unavailable or limited
Individual plans may help people who pay healthcare expenses directly or want to review gaps in existing coverage.
Understand the Difference
Employer and individual health plans may work differently
Individual Health & Dental Plan
- You select from the plan options available to you.
- Coverage can continue independently of a specific employer.
- Premiums, reimbursement levels and maximums depend on the selected plan.
- Eligibility and treatment of pre-existing conditions vary.
Employer Group Health Plan
- Coverage and eligibility are determined by the employer’s plan.
- The employer may pay some or all of the premium.
- Coverage may include dependants, subject to the group rules.
- Benefits can change or end when employment changes.
Illustrative Family Scenario
How a plan could help a family manage eligible costs
This example is for education only. Actual reimbursement depends on the selected plan’s terms and limits.
Example
A family has no workplace health benefits.
They compare expected prescription, dental, vision and paramedical needs with the premiums, reimbursement percentages and annual limits available.
Prescription coverageSubject to formulary + limits
Routine dental carePercentage + annual maximum
Vision careFrequency and dollar limit
Paramedical servicesPer-visit or yearly maximum
Family premiumBased on selected plan
Biggest mistake: comparing only the monthly premium
A lower-priced plan may also reimburse a smaller percentage, cover fewer services or provide lower annual maximums. Compare what you are likely to claim, what the contract excludes and what you would still pay yourself.
Planning Your Coverage
Three details people often overlook
Understanding the contract is essential before deciding whether the expected value and protection suit your needs.
INC
Actual reimbursement
Premium vs value
Estimate what the plan may reimburse after percentages, deductibles, maximums and excluded expenses.
SAVE
Coverage definitions
Eligible ≠ unlimited
Review formularies, frequency limits, reasonable-and-customary rules and provider requirements.
TIME
Timing and maximums
When + how much
Confirm waiting periods, yearly resets, per-service limits and lifetime maximums where applicable.
Frequently Asked Questions
Health and dental plans, explained simply
What can a health and dental plan cover?
Depending on the plan, eligible expenses may include prescription drugs, dental care, vision care, paramedical services and other listed benefits.
Will the plan pay 100% of every expense?
Not necessarily. Reimbursement percentages, deductibles, annual maximums, frequency limits and exclusions can leave an out-of-pocket balance.
Are prescription drugs automatically covered?
No. Coverage may depend on the plan’s formulary, drug identification number, authorization rules, dispensing-fee limits and annual maximums.
Can I get coverage with a pre-existing condition?
It depends on the product and eligibility rules. Some plans require medical underwriting while others may limit or exclude certain existing needs.
Is there a waiting period?
Some benefits may start immediately and others may have a waiting period. Confirm the effective date for every service category.
Can I cover my spouse and children?
Many plans offer couple and family options, subject to eligibility, dependant definitions and the plan’s terms.
What happens if I change jobs?
An individual plan is not tied to one employer, while group benefits can change or end with employment. Conversion options may sometimes be available.
Is a plan always better than paying directly?
Not always. Compare annual premiums with expected eligible reimbursements, limits and the value of protection against unexpected costs.
Learn with Lava
Book Free Consultation
Do you know what your current coverage actually pays for?
Review your prescriptions, dental needs, family situation, existing benefits and budget in a focused complimentary consultation.