Overview
CPA Ontario now offers Health and Dental Insurance – exclusively for members and their families. If you’re a member who is self-employed, retired, if you don’t have a group health plan, or even if you just need some added coverage, this insurance can be especially valuable. CPA Ontario Health and Dental Insurance can help protect you from out-of-pocket health and dental costs, and offers you affordable coverage for a wide range of medical expenses. Members asked for it, and we’re proud to offer this new protection – to help meet your needs. CPA Ontario Health and Dental Insurance is not available to residents of Quebec.
CPA Ontario Health & Dental plans offer a wide range of coverage, which can include:
- Prescription drugs
- Dental care
- Vision care
- Hearing aids
- Registered specialists and therapists
- Medical equipment and supplies
- Ambulance services
- Hospital benefits
- Accidental death & dismemberment
- Homecare and private nursing
- Accidental dental
- And much more
Please see the Plan Choices section for complete details.
Your Health & Dental plan can include the following at no additional cost:
- Travel coverage
If you get sick or are injured while travelling outside your home country, you’ll have access to up to $5,000,000 in emergency medical coverage. Travel coverage is available up to age 65 and is included in every plan except Starter Health & Dental.
- Healthcare Online
You get 24/7 access to health care professionals (including physicians, nurse practitioners and nurses) online or through the app. Plus, you have easy access to lab results, prescriptions and refills, and referrals.
There’s also:
- No waiting period
You can begin making claims as soon as your application has been accepted (for costs incurred after the effective date of your coverage).
- 24/7 online claims
Making online claims can be fast and easy. You can use your benefits card at the pharmacy, and quickly submit most other claims online at your convenience.
- Tax-deductible premiums
If you are self-employed or a small business owner, a portion of your premiums may be tax-deductible.*
* Check with Canada Revenue Agency to verify your eligibility. This information is not to be relied upon as tax advice for specific situations.
Everyone’s health and dental care needs are different, so CPA Ontario Health & Dental Insurance offers a choice of five different plans.
| 1) Starter Health & Dental | 2) Essential Health | 3) Essential Health & Dental | 4) Enhanced Health | 5) Enhanced Health & Dental |
|---|
Get the details on each plan to determine which one works best for you.
Some points to consider:
- Get guaranteed acceptance with Starter Health & Dental.** That means no medical questionnaire or exams when you apply.
- All five plans come with core benefits that include:
- Prescription drugs
- Vision care
- Accidental dental
- Homecare and private nursing
- Registered specialists and therapists
- If you don’t want dental care, consider Essential Health or Enhanced Health.
- Get higher coverage amounts with Enhanced Health and Enhanced Health & Dental.
** Acceptance is guaranteed if eligibility criteria is met, and is subject to receipt of first premium payment.
As a CPA member, you can get affordable rates on all CPA Ontario Insurance Plans—and Health & Dental Insurance is no different.
See the rates that would apply to your province:
The Catastrophic rider*** covers the costs of medical care resulting from an unforeseen serious accident or illness.
For an additional fee, you can add the Essential Catastrophic rider to an Essential plan or the Enhanced Catastrophic rider to an Enhanced plan.
Once you have maximized the coverage under your Essential or Enhanced plan, the Catastrophic rider will provide additional benefits to the maximums indicated below.
| Benefit | Threshold | Co-pay | Maximums |
|---|---|---|---|
| Prescription Drug† Brand Name or Generic Drug Coverage†† | Enhanced
Catastrophic rider
$8,220 in claims
per year Essential Catastrophic rider $4,615 in claims per year |
100% | Unlimited |
| Homecare / Private Nursing, Durable Medical Equipment, Prosthetic Appliances | $7,500 in claims per anniversary year | 100% | $25,000 per anniversary year Lifetime maximum: $100,000 |
| Physiotherapist / Chiropractor | 100% | Coverage will continue for one full benefit year following the date of an accident requiring a 24–hour hospital stay |
See the rider fees that would apply to your province:
*** The Catastrophic Rider is not available to persons age 65 and over.
† Prescription drug coverage applies only to costs not covered by your provincial drug insurance plan, up to the maximums stated.
†† Excludes smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, erectile dysfunction drugs and drugs not requiring a prescription.
Eligibility
To be eligible for coverage under this policy, an insured person must:
- be covered under a government health insurance plan;
- be a resident of Canada;
- be at least 18 years of age on the date of application for this policy (unless a dependent child of a member);
- be a member of the Chartered Professional Accountants of Ontario, Bermuda, New Brunswick, Nova Scotia, Prince Edward Island or Newfoundland and Labrador at the time of application.
Where the insurer determines that an insured is or was not eligible for coverage under this policy, the insurer shall have the option to terminate this policy immediately, without any refund of premiums, upon providing notice to the insured of such termination, and reserves the right to recover any claims paid hereunder.
CPA Ontario Health & Dental Insurance is not available to residents of Quebec.
Dependant definition
A dependant is a child of the insured who is listed on the application and who is a natural child, adopted child, stepchild or foster child, or a child for whom the insured is by law responsible, who is unmarried, unemployed and dependent on the insured for financial support and is under 21 years of age.
Newborns
Children born while your policy is in force are added to your policy if an application with appropriate payment is made within 30 days of birth. If an application is received after the 30th day following the date of birth, medical information will be required.
Couple and family coverage
When applying for couple or family coverage, all individuals must be covered under the same plan.