What Is Personal Health Insurance and Why Do Saskatchewan Residents Need It?
Your Saskatchewan Health Card covers doctor visits and hospital stays, but you’ll still need to pay out of pocket for prescription drugs, dental work, glasses and physiotherapy. These expenses can easily reach thousands of dollars annually. Personal health insurance fills these gaps by reimbursing you for healthcare costs your provincial plan doesn’t cover.
This guide explains what personal health insurance covers, who benefits most from private coverage and how to choose a plan that protects both your health and your budget.
Key Takeaways: What Is Personal Health Insurance and Why Do Saskatchewan Residents Need It?
- Your Saskatchewan Health Card covers doctor/hospital care and physician-ordered diagnostics, but not routine dental, eyewear, most outpatient prescriptions or ambulance costs.
- Personal health insurance helps cover those gaps: drug, dental, vision, paramedical, ambulance and medical equipment, so surprise bills don’t derail your budget.
- For residents 65+, the Seniors’ Drug Plan caps eligible prescriptions at $25; private coverage can still help with other eligible drug costs not covered.
- If you’re losing employer benefits, both the Saskatchewan Blue Cross Conversion and Retiree Plan offer guaranteed acceptance with no waiting period when your plan starts within 90 days of group benefits ending.
What is personal health insurance?
Personal health insurance, also called private health insurance, is coverage you buy as an individual or family to pay for healthcare services that Saskatchewan’s provincial health plan doesn’t cover. While your provincial card covers doctor visits and hospital stays, it excludes everyday expenses such as prescription drugs, dental work, eye exams and physiotherapy. Personal health insurance steps in to reimburse you for the costs you’d otherwise pay entirely out of pocket.
Why your Saskatchewan Health Card is only half the picture
Your Saskatchewan Health Card covers essential medical care, but it doesn’t cover as much as most people think. Understanding what’s included and what’s not helps explain why so many residents carry private insurance alongside their provincial coverage.
Hospital and physician services that are covered
The provincial plan covers medically necessary hospital stays, visits to your family doctor or specialists and surgical procedures performed in hospitals. Emergency room visits fall under this coverage, as do diagnostic tests like X-rays and blood work when a physician orders them.
Common expenses you still pay out-of-pocket
Here’s where the gaps appear. The cost of most prescription drugs prescribed outside of hospitals comes directly from your wallet, anywhere from $15 to $150 or more per prescription. If you’re managing a chronic condition like diabetes or high blood pressure, you might fill multiple prescriptions each month.
Routine dentistry also isn’t covered by the provincial plan, but hospital-based dental surgery that’s medically necessary is covered. A routine cleaning costs $150 to $300, fillings cost $150 to $400, and crowns can range from $1,500 to higher. Eye exams cost $75 to $150, and a new pair of glasses typically ranges from $200 to $800. Physiotherapy sessions average $80 to $120 each, and treatment plans often call for six to twelve visits.
Residents pay a fee per ambulance trip that typically ranges from $245–$325 (plus rural mileage); non-residents: ~$360.
For an individual, based on a 2023 Statistics Canada study, costs for healthcare rose by 11.2% from 2021 to $3,087.
Who should consider private coverage in Saskatchewan
Some people benefit more from personal health insurance than others, depending on their situation and existing coverage.
Self-employed and contract workers
When you work for yourself, you don’t have an employer offering group benefits. Personal health insurance becomes your only protection against healthcare costs that could otherwise drain your business cash flow or personal savings. Many self-employed people find that this coverage pays for itself within the first year.
Families with growing children
Kids can rack up healthcare costs quickly. Regular dental checkups, orthodontic work, prescription medications for ear infections or asthma, and new glasses as their vision changes. All of these expenses add up. What costs $500 for one child becomes $2,000 for four.
Retirees without group benefits
Most employer group coverage ends when you retire, right when your healthcare needs typically increase. Personal health insurance bridges this gap, covering the prescription drugs, dental work, and physiotherapy that become more frequent with age.
Key benefits included in personal health plans
Personal health insurance typically covers the expenses Saskatchewan residents face most often outside their provincial plan.
-
Prescription drug coverage
Drug coverage reimburses you for medications your doctor prescribes, typically covering 70% to 100% of costs depending on your plan. Most plans distinguish between generic and brand-name drugs, offering higher reimbursement for generics. This coverage works alongside Saskatchewan’s drug programs—if you’re enrolled in the Seniors’ Drug Plan, your private insurance can cover deductibles or co-payments the provincial program doesn’t.
-
Dental care
Coverage levels vary by plan and tier. For example, Saskatchewan Blue Cross Retiree Plan optional Dental reimburses 70–80% for basic and 50% for major services (maximums apply).
-
Vision care
Vision benefits cover eye exams every one to two years, plus a dollar amount toward glasses, contact lenses, or laser eye surgery. Basic plans might offer $100 to $200 every two years, while more enhanced plans provide $300 to $500 annually.
-
Paramedical services
Coverage extends to licensed practitioners, including physiotherapists, chiropractors, massage therapists, psychologists, clinical counsellors, naturopaths and dietitians. Plans typically set annual maximums per practitioner type—for example, $500 for physiotherapy and $300 for massage therapy—though enhanced plans may offer $750 or more per combined services.
-
Ambulance and medical equipment
Most plans cover ambulance transport to the nearest appropriate medical facility, reimbursing the portion you pay after any provincial coverage. Medical equipment and supplies like wheelchairs, walkers, diabetic testing supplies and compression stockings are also typically included, subject to annual maximums.
Coverage levels and typical cost ranges
Personal health plans come in tiers that balance coverage limits against monthly premiums. Here’s how they typically break down.
| Entry-level plans | Mid-tier plans | Enhanced plans | Optional add-ons |
|---|---|---|---|
| Basic coverage starts around $75 to $150 monthly for an individual, offering lower annual maximums—perhaps $500 for dental and $300 for paramedical services. Plans at this level are well-suited for healthy individuals who want protection against unexpected costs without incurring high premiums. | Balanced plans typically cost $100 to $250 monthly for individuals and $350 to $500 for families. Plans at this level offer moderate maximums, such as $750 to $1,000 for dental and around $300 to $500 per year for paramedical services, making them popular with families who have regular but not extensive healthcare needs. | Enhanced plans typically cost $150 to $300 monthly for individuals and $350 to $500 for families. Plans at this level offer higher maximums, such as $1,000 to $1,500 for dental and $750 to $1,000 for paramedical services, making them popular with families who have more extensive healthcare needs. | Many insurers let you customize coverage by adding travel insurance for trips outside Canada, extended paramedical benefits beyond standard limits, or enhanced dental coverage that includes orthodontics or higher reimbursement rates. |
Guaranteed acceptance versus medically underwritten plans
The application process differs significantly between plan types and affects both your eligibility and what you’ll pay.
Medically underwritten plans require you to answer detailed health questions and may request medical records. Insurers use this information to assess risk and determine your premium, coverage limits or whether to accept your application. Plans at this level typically offer more comprehensive benefits at lower costs for healthy applicants. However, they may exclude pre-existing conditions or charge higher premiums if you have health issues.
Guaranteed acceptance plans, on the other hand, approve all applicants regardless of health status without medical questions. However, plans at this level usually come with higher premiums and lower coverage maximums.
How to choose the right plan for your needs
Selecting personal health insurance means evaluating your specific situation against available options. Here’s how to approach the decision.
1. List your health priorities
Start by identifying which healthcare services you and your family use most frequently. If you take daily medications, prescription drug coverage becomes essential. Families with young children might prioritize dental and vision benefits, while active adults may value physiotherapy and chiropractic coverage.
2. Check existing coverage
Review what’s already covered through a partner’s group plan, a parent’s plan if you’re a dependent, or government programs like Saskatchewan Assured Income for Disability health benefits. Coordinating coverage prevents you from paying for duplicate benefits while ensuring comprehensive protection.
3. Compare benefit maximums
Annual maximums determine how much the benefits provider pays for each service category before you’re responsible for 100% of costs. If your family typically spends $1,800 annually on dental care, a plan with a $1,000 dental maximum leaves you paying $800 out of pocket, while a plan with a $2,000 maximum would cover most expenses.
4. Balance premiums and out-of-pocket costs
Lower premiums often mean higher deductibles, co-payments, or lower reimbursement percentages. Calculate your expected annual healthcare costs and compare what you’d pay in premiums versus out-of-pocket expenses under different plans. Sometimes paying slightly higher premiums saves money overall if you use healthcare services frequently.
5. Review benefits provider reputation and service
Research how quickly insurers process claims, whether they offer online submission and tracking, and their customer service ratings. Direct billing arrangements with pharmacies and dental offices can also simplify the claims process by eliminating upfront payments.
Losing group benefits or retiring? Your options
Transitioning from employer-sponsored coverage requires quick action to maintain continuous protection. You typically have three main paths forward.
Convert your group plan
With Saskatchewan Blue Cross, Conversion coverage must be in effect within 90 days of group benefits ending. Conversion typically doesn’t require medical underwriting, meaning you can maintain coverage regardless of health changes that occurred while you were covered under the group plan.
Buy a retiree-focused plan
Some insurers offer plans specifically designed for older adults, with benefits that emphasize prescription drugs, medical equipment and services like physiotherapy that retirees use more frequently. Plans at this level account for age-related health needs while keeping premiums manageable.
Combine with the provincial senior drug program
Eligible residents 65+ pay up to $25 per eligible prescription; the province pays the rest. Personal health insurance can cover this deductible and any co-payments, creating comprehensive drug coverage with minimal out-of-pocket costs.
5 steps to apply and start your coverage
Getting personal health insurance involves a straightforward process that can often be completed online.
1. Gather personal and health information
You’ll need your Saskatchewan Health Card number, birth dates for all family members you’re covering, current medications and dosages, recent medical history including diagnoses and treatments, and your family physician’s contact information.
2. Get an online quote
Most benefits providers offer online quoting tools that allow you to enter basic information to view plan options and estimated premiums. This lets you compare coverage levels and costs before committing to an application.
3. Complete the application
Online applications typically take 15 to 30 minutes and include detailed health questions for medically underwritten plans. Answer all questions accurately and completely—incomplete or inaccurate information can delay processing or affect your coverage.
4. Review underwriting or acceptance notice
For medically underwritten plans, the benefits provider reviews your application and may request additional information or medical records. You’ll receive an acceptance notice outlining your coverage, premiums, and any exclusions or waiting periods. Guaranteed acceptance plans typically provide immediate approval.
5. Activate your digital ID card
Once approved, you’ll receive a digital insurance card via email or through the benefits provider’s mobile app. This card includes your policy number, coverage effective date, and contact information for claims and everything you need to start using your benefits.
How claims work with Saskatchewan Blue Cross
Receiving reimbursement for healthcare expenses is a straightforward process.
Submitting claims online or by app
Saskatchewan Blue Cross members can submit claims through the secure online portal or mobile app by uploading photos of receipts and completing a simple digital form. You’ll need the service provider’s name, date of service, amount paid, and a description of the service or prescription information. Direct billing is also available at many pharmacies and dental offices, where the provider submits the claim directly and you only pay your portion.
Reimbursement timelines
Submit claims online or in-app; many providers offer direct billing, so you pay only your portion. Claims requiring additional documentation or review may take longer, though you can track claim status through your online account.
Added wellness perks that stretch your dollar
Saskatchewan Blue Cross membership includes benefits beyond basic coverage that support your overall health and financial well-being.
Blue Advantage discount program
Members access exclusive discounts on health and wellness products and services, including fitness equipment, gym memberships, weight management programs and health products at participating retailers. The savings can offset a portion of your premium costs while encouraging healthy lifestyle choices.
Individual Assistance Program & Virtual Care
Every personal health plan also includes access to our Individual Assistance Program (IAP) and Virtual Care, offered in collaboration with Homewood Health and Cleveland Clinic Canada. You and your family can connect with mental health professionals and Canadian-licensed providers by phone, video or online for everyday challenges and non-emergency health concerns. Since these services are included with your coverage, you can get support when you need it while helping to reduce out-of-pocket costs for in-person visits.
Protect your health and budget with Saskatchewan Blue Cross
Personal health insurance transforms unpredictable healthcare costs into manageable monthly premiums, protecting both your health and your financial stability. Saskatchewan Blue Cross has served Saskatchewan residents for nearly 80 years as a locally based, not-for-profit organization.
Explore personal health insurance plans and get a quote today to find coverage that fits your lifestyle and budget.
FAQs about personal health insurance in Saskatchewan
How do private plans coordinate with the seniors’ drug plans?
Personal health insurance coordinates with provincial drug programs to reduce your out-of-pocket costs. In Saskatchewan, eligible residents 65+ pay up to $25 per eligible prescription under the Seniors’ Drug Plan. Your private plan can still help with other eligible drug expenses that the provincial program doesn’t cover, such as medications outside the formulary, dispensing fees or ingredient costs above plan limits, or amounts after your private plan’s maximums, up to your policy’s coverage limits.
Are premiums for personal health insurance tax-deductible in Canada?
Individuals may claim eligible premiums as medical expenses for the federal non-refundable Medical Expense Tax Credit; however, rules vary and are subject to change. We do not provide tax advice, so please consult a professional tax accountant to help guide you through that process.
Is there a waiting period before coverage starts for Newcomers to Saskatchewan?
Most personal health insurance plans begin immediately upon approval, once you’re eligible for provincial coverage, but newcomers must first complete a three-month waiting period before their Saskatchewan Health Card becomes active. During this time, Saskatchewan Blue Cross offers a Visitors to Canada emergency medical (VTC) plan that can provide interim protection against unexpected emergency medical expenses while you transition to the province. For more details on coverage options during the waiting period, see our A Newcomer’s Guide to Saskatchewan Healthcare resource.