Provincial health coverage

How can Sun Life personal health insurance bridge the gaps?

Healthcare coverage is different across provinces in Canada. While provincial health plans provide essential services, there may be gaps in coverage that could leave you financially vulnerable. That's where Sun Life's personal health insurance comes in.

This guide will help you:

  • Understand what your provincial plan covers
  • Identify potential gaps in your current coverage
  • See how Sun Life's plans can complement your provincial plan.

Understanding how provincial and private insurance work together

When it comes to healthcare coverage in Canada, it's important to understand how different types of insurance coordinate to protect you.

Provincial plans: Your first payer

Your provincial or territorial health plan is typically1 the first payer for any services it covers. This means:

  • Provincial insurance pays first for medically necessary doctor visits, hospital care, and diagnostic tests
  • You don't need to submit claims for these core services since you are not charged for them
  • Private insurance cannot replace or duplicate provincial coverage for these medically necessary services

Private insurance: Filling the gaps

Private health insurance plans typically act as a secondary payer that can:

  • Cover healthcare services and expenses not included in provincial or territorial plans
  • Provide enhanced coverage for services limited within provincial benefits or Employer/Group Benefit plans
  • May offer higher reimbursement levels and annual maximums than basic provincial or territorial coverage depending on age and financial factors

Understanding this coordination helps you:

  • Choose the right coverage level: Select private insurance that addresses your specific provincial or employer benefit plan's limitations and meets your needs.
  • Avoid over-insuring: You don't need private coverage for services your provincial plan already covers
  • Identify real gaps: Have peace of mind knowing what you'll actually pay out-of-pocket, like prescriptions, dental care, vision, paramedical services, and other unexpected costs.
  • Manage claims efficiently: Know which insurer to submit claims to based on the type of service

What’s covered in each provinceii? 

To start, here’s a snapshot of what’s covered, partially covered, and not covered in each provinceiii:

Province/Territory Dental Prescriptions Vision Medical Equipment Paramedical Mental Health
Alberta None, except medically necessary None Partial for seniors and children None Physiotherapy in hospital Covered, hospital psychiatric
British Columbia None, except medically necessary None If medically required None Physiotherapy in hospital Covered, hospital psychiatric
Manitoba None, except medically necessary Partial through pharmacare program Children, seniors, eligible conditions None Partial, limited chiropractic Covered, hospital psychiatric
New Brunswick None, except medically necessary None None None Physiotherapy in hospital Covered, hospital psychiatric
Newfoundland and Labrador None, except medically necessary Seniors & eligible conditions Children None Physiotherapy in hospital Covered, hospital psychiatric
Nova Scotia None, except medically necessary None Children, seniors, eligible conditions None Physiotherapy in hospital Covered, hospital psychiatric
Ontario None, except medically necessary Children & seniors Children, seniors, eligible conditions None Physiotherapy in hospital Covered, hospital psychiatric
Quebec

Children, partial.

None, except medically necessary

Partial Children, seniors, eligible conditions Partial Physiotherapy in hospital Covered, hospital psychiatric
Saskatchewan None, except medically necessary None Children & eligible conditions None Physiotherapy in hospital Covered, hospital psychiatric

Please note that this table excludes low-income eligibility plans or alternative age-based eligibility plans. Please consult your province’s health coverage web page for more information.

Interested in the Canadian Dental Care Plan?

Find available information about the new Canadian Dental Care Plan (CDCP) for uninsured Canadian residents on the Canadian Dental Care Plan website.

Go to the Canadian Dental Care Plan website

Alberta's provincial health plan, AHCIP, offers residents access to essential physician services and hospital-based care. While it provides strong foundational coverage, many everyday health expenses fall outside the public plan.

What's covered? AHCIP covers medically necessary doctor visits, diagnostic tests, surgeries, and hospital stays. Mental health care is covered only when delivered by a physician or psychiatrist, leaving gaps for therapy, counseling, and psychology services.

What's not covered? AHCIP does not cover routine dental care, prescription drugs outside hospitals, vision exams or glasses for adults, most medical equipment, and services like massage, acupuncture, and chiropractic.

Is this coverage enough? Alberta residents often rely on private insurance to help pay for prescriptions, dental, vision, paramedical practitioners, and other out-of-pocket costs.

British Columbia's MSP provides publicly funded access to doctors, specialists, diagnostic tests, and hospital treatments. It forms the core of health coverage in the province but excludes many everyday health expenses.

What's covered? MSP covers physicians, specialists, diagnostic tests, and hospital treatments. Mental health services are covered when provided by physicians but not by psychologists or counsellors, leaving significant gaps. Paramedical services—such as physiotherapy, massage, chiropractic, and naturopathy—have very limited subsidized coverage, often with strict caps.

What's not covered? MSP does not cover routine dental care for adults, most prescription drugs outside the hospital, adult eye exams and glasses, or hearing aids.

Is this coverage enough? B.C. residents typically turn to private insurance for drug plans, dental and vision benefits, and additional health services.

Manitoba Health covers doctor visits, surgeries, hospital care, and some diagnostic services, forming the baseline of public health coverage for residents. However, many common health expenses remain uninsured.

What's covered? Manitoba Health covers doctor visits, surgeries, hospital care, and some diagnostic services. Mental health coverage is available through physicians and psychiatrists only; psychologists and counsellors must be paid out of pocket. Limited coverage exists for physiotherapy and chiropractic treatments, usually requiring referrals.

What's not covered? The plan does not cover adult dental care, routine vision care, glasses, contacts, and most prescription drugs unless individuals qualify for special pharmacare programs. Paramedical services like massage therapy, naturopathy, and acupuncture are not publicly funded.

Is this coverage enough? Many Manitoba residents require additional insurance for prescription drugs, dental, vision, and paramedical services.

New Brunswick Medicare provides foundational coverage for medically required care, including physician services, hospital stays, and diagnostic testing. However, many supplementary health needs fall outside the public system.

What's covered? Medicare covers physician services, hospital stays, and diagnostic testing. Mental health treatment from psychiatrists is covered, but services from psychologists and therapists are not.

What's not covered? The plan excludes adult dental work, prescription drugs (unless covered through separate provincial drug plans), routine eye exams and glasses, physiotherapy outside hospitals, most paramedical care, and medical equipment such as mobility aids or hearing aids.

Is this coverage enough? No, many New Brunswick residents often rely on private health insurance to cover these everyday health costs.

Newfoundland and Labrador's MCP covers core medical services such as doctor visits, hospital care, and diagnostic tests. While comprehensive for medically necessary treatment, it lacks coverage for many common health expenses.

What's covered? MCP covers doctor visits, hospital care, and diagnostic tests. Paramedical physiotherapy has limited coverage and often requires a referral. Mental health support with physicians is covered, but therapy with psychologists or counsellors is not.

What's not covered? MCP does not include routine dental care for adults, outpatient prescription drugs (except through separate drug programs), vision exams and eyewear, or most paramedical services such as massage, acupuncture, and naturopathy.

Is this coverage enough? Typically, residents find the basic coverage insufficient and often purchase additional insurance to cover prescription drugs, dental care, vision needs, medical supplies, and paramedical services.

Nova Scotia's MSI covers essential medical services, but the plan leaves significant gaps where private insurance is often needed.

What's covered? MSI covers medical services such as doctors, specialists, hospital care, and diagnostic tests. Mental health care is publicly covered only when provided by physicians or psychiatrists, leaving residents to self-fund therapy and psychological services.

What's not covered? MSI does not cover adult dental services, prescription drugs outside hospitals, eye exams and glasses for adults, hearing aids, physiotherapy outside the hospital system, or most paramedical practitioners. Massage, acupuncture, and naturopathy are not insured.

Is this coverage enough? No, many Nova Scotians purchase private insurance to manage prescription, dental, vision, and paramedical costs.

Ontario's OHIP provides residents with medically necessary physician services, hospital treatments, and diagnostic testing. While comprehensive for core medical needs, OHIP does not cover many everyday health expenses.

What's covered? OHIP covers medically necessary physician services, hospital treatments, and diagnostic testing. Physiotherapy is only partially covered for specific age groups or qualifying medical conditions. Mental health coverage is available through physicians and psychiatrists but not psychologists or counsellors.

What's not covered? The plan excludes adult dental care, prescription drugs outside the Ontario Drug Benefit (primarily for seniors and eligible groups), routine eye exams for adults aged 20–64, glasses, and most paramedical services.

Is this coverage enough? No, many Ontarians use private insurance to fill gaps in prescriptions, dental, vision, and therapy services.

Health PEI provides core medical coverage, including doctor visits, hospital care, and diagnostic services. However, day-to-day health costs often fall outside the public plan.

What's covered? Health PEI covers doctor visits, hospital care, and diagnostic services. Some physiotherapy services are publicly funded, but massage, chiropractic, and similar treatments are not.

What's not covered? PEI does not cover standard dental care for adults, most prescription drugs (unless through separate drug programs), vision exams or eyewear, most paramedical treatments, or counselling and psychological services unless delivered by medical doctors.

Is this coverage enough? No, many PEI residents rely on supplementary insurance to cover drugs, dental, vision, and additional therapy needs.

Quebec's RAMQ program covers medically necessary physician care, hospital services, and diagnostic tests. The province offers more extensive drug coverage than most provinces, though premiums may apply.

What's covered? RAMQ covers medically necessary physician care, hospital services, and diagnostic tests. The province covers prescription drugs for residents enrolled in the public plan (or through employer benefits). Physiotherapy has limited public coverage, often requiring referrals. Mental health services are publicly available through physicians but not psychologists or psychotherapists.

What's not covered? RAMQ excludes adult dental care, routine vision exams and eyewear (with some age-based exceptions), and most paramedical services.

Is this coverage enough? No, Quebecers often rely on private insurance for dental, vision, paramedical, and expanded mental health support.

Saskatchewan Health covers physician services, hospital care, and diagnostic testing. While robust in medical necessity, it does not insure many everyday health services.

What's covered? Saskatchewan Health covers physician services, hospital care, and diagnostic testing. Drug coverage is available with some limitations. Limited coverage exists for chiropractic and physiotherapy but often with caps. Mental health coverage applies only to physician-provided treatments.

What's not covered? The plan excludes adult dental services, prescription drugs outside separate drug plans, vision exams and glasses for adults, and paramedical services like massage and acupuncture.

Is this coverage enough? No, private insurance is typically used to help pay for drugs, dental, vision, and therapy expenses.

The Northwest Territories offers comprehensive physician and hospital coverage, along with some additional benefits through extended health programs depending on eligibility.

What's covered? The Northwest Territories covers physician services, hospital care, and diagnostic testing. It offers strong core coverage for medical care, routine dental care, and vision exams and eyewear.

What's not covered? Many prescription drugs and most paramedical services are not covered unless individuals qualify for enhanced benefits (such as for seniors or Métis residents). Mental health therapy from non-physicians is also excluded.

Is this coverage enough? No, residents often use supplementary health insurance to manage drug, dental, vision, and therapy costs.

Nunavut's healthcare system offers comprehensive coverage for essential medical services while excluding certain specialized treatments and services from its standard benefits package.

What's covered? Nunavut provides full coverage for physician services, hospital care, and medically required diagnostic testing. The territory also offers additional benefits for residents who qualify under its extended health programs.

What's not covered? Adult dental services, most prescription drugs, vision exams and eyewear, physiotherapy outside hospitals, paramedical care, and mental health services from psychologists or counsellors are not included in standard coverage.

Is this coverage enough? No, Nunavut residents frequently rely on supplemental insurance to fill these gaps.

Yukon's healthcare system provides essential medical coverage while excluding certain services, leading many residents to supplement with private insurance for comprehensive health protection.

What's covered? Yukon's health plan offers comprehensive medically necessary care, including hospital services, doctor visits, and diagnostic testing. Additional benefits exist for seniors under separate programs. Mental health support is covered only when provided by physicians or psychiatrists.

What's not covered? The plan does not cover routine dental care for most adults, prescription drugs (unless residents are part of specific programs), routine vision care, glasses, or most paramedical services.

Is this coverage enough? No, Yukon residents often purchase private health insurance to cover prescriptions, dental, vision, and paramedical needs.

How can Sun Life fill the gaps in provincial health coverage?

Most provincial and territorial health plans focus on medically necessary care from doctors and hospitals. However, many everyday health expenses fall outside provincial coverage. Here's how Sun Life's personal health insurance plans can help fill those gaps.

Common gaps in provincial coverage

Across Canada, most provinces have limited or no coverage for:

  • Routine dental care for adults
  • Prescription drugs (outside hospitals)
  • Vision exams and eyewear for working-age adults
  • Medical equipment like mobility aids and hearing devices
  • Paramedical services (physiotherapy, massage, chiropractic, etc.)
  • Mental health therapy from psychologists and social workers

Note: Some provinces offer limited coverage for seniors or specific eligible conditions. See the provincial breakdown above for details.

How Sun Life Personal Health Insurance can help

Sun Life offers three tiers of Personal Health Insurance (PHI)  to complement provincial coverage: Basic, Standard, and Enhanced. Each plan offers different coverage that’s catered to different lifestyles.  These plans are underwritten which means applications are reviewed to assess health and risk factors, which determines eligibility, premium rate, and coverage terms.

Basic offers affordable coverage for essential medical and dental needs. Our Standard plan provides more prescription drug coverage and includes emergency medical travel coverage. Finally, the Enhanced plan offers the most comprehensive coverage, with the highest prescription drug coverage and optional dental coverage that includes restorative and orthodontic services.

If you are leaving an employer or group benefit plan, Sun Life offers private health insurance options that do not require medical underwriting, provided you apply within the specified timeframe. This table breaks down the coverage details for each plan across various healthcare categories, allowing for easy comparison of benefits and reimbursement levels.

Coverage Area Basic Plan Standard Plan Enhanced Plan
Prescription Drugs

Basic coverage

60% reimbursement

$750 annual max

Standard coverage

70-100% reimbursement

$100,000 annual max

Enhanced coverage

80-100% reimbursement

$250,000 annual max

Dental (Optional)

Preventive only

60% reimbursement

$500 annual max

Preventive only

70% reimbursement

$750 annual max

Preventive, restorative & orthodontics

50-80% reimbursement

Varying maximums

Vision Not included

Included

$250 every 2 years

Included

$300 every 2 years

Medical Equipment

Included

60% reimbursement

$2,500 annual max

Included

100% reimbursement

$5,000 annual max

Included

100% reimbursement

$5,000 annual max

Paramedical

Included

$250 per year per practitioner

Included

$300 per year per practitioner

Included

$400 per year per practitioner

Mental Health

Included

$500 per year

Included

$1,000 per year

Included

$1 million lifetime max

Emergency Travel Medical Not included

Included 

$1 million lifetime max

Included

$1 million lifetime max

This summary does not provide full or complete product information. Please contact Sun Life for the full terms and conditions, exclusions and limitations of the above policies.

Sun Life's PHI plans are designed to complement existing provincial coverage, providing Canadians with options to ensure comprehensive healthcare protection.

By comparing provincial benefits with Sun Life's plans, you can make informed decisions about your healthcare needs and choose a plan that best fills any coverage gaps you may have.

Get personal health insurance

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Other types of health insurance

Disability insurance

Replaces part of your income if you can’t work because of illness or injury.

Critical illness insurance

Covers eligible expenses related to a covered critical illness.

Long-term care insurance

Offers a benefit if you become dependent on someone for your care.

This information is meant for educational and illustrative purposes only. Some conditions, exclusions and restrictions apply.