OHIP does not pay for most prescriptions, dental care or vision care for working-age adults. Group health insurance through an employer is the most common way to cover them. If you are self-employed, between jobs or retired, a personal drug and dental plan can fill the gap.
The average cost of health insurance in Ontario depends on age, plan level and family size, so compare several plans. Help in English, Hindi and Punjabi at 1-855-500-5041.
Group health insurance in Ontario is an employer- or association-sponsored plan that sits on top of OHIP to help pay for drugs, dental, vision, paramedical care, and other out-of-pocket medical expenses for employees and their families. Because risk is pooled across a group, these plans are usually cheaper and easier to qualify for than buying comparable individual health insurance on your own.
OHIP covers medically necessary doctor visits, hospital care, many tests, and some limited dental surgery and eye care, but it does not cover prescription drugs for most adults aged 25 to 64 (OHIP+ covers eligible drugs for people 24 and under without a private plan, and the Ontario Drug Benefit covers people 65 and older), most dental work, routine vision care for ages 20–64, or many therapies like physio and mental health counselling. Group health insurance is designed specifically to fill these gaps, paying a large portion of costs that would otherwise come straight out of pocket.
Key points about the relationship between OHIP and group plans:
You generally must be OHIP-eligible to be covered under most employer group health plans.
OHIP is the "first payer" for hospital and physician services, while group plans are the first payer for things OHIP does not cover (like dental and most drugs for non-seniors).
For prescription drugs, OHIP drug programs (like ODB for seniors and Trillium for high drug costs) coordinate with private plans so that one plan pays first and the other covers some or all of the remainder.
For someone working in Kitchener, a typical setup is: OHIP for hospital/doctor, an employer group plan for routine drugs, dental, vision, and paramedical care, and possibly a health spending account (HSA) for extra flexibility.
Group plans are modular: employers choose which benefits to include and at what reimbursement levels. Coverage is usually organized into extended health care, dental, life and disability, and sometimes wellness and virtual care add-ons.
| Category | Typical Coverage Details |
|---|---|
| Prescription drugs | 70–100% of eligible drugs, often with a per-prescription copay or annual maximum. |
| Paramedical services | Annual maximums per practitioner for physio, chiropractor, massage, psychologist, social worker, naturopath, etc. |
| Vision | Eye exams, plus frames and lenses every 12–24 months up to a set maximum (for example, $150–$300). |
| Medical supplies | Items like orthotics, braces, diabetic supplies, hearing aids, often with caps per item or per year. |
| Out-of-province emergency | Emergency medical care when travelling outside Ontario/Canada, with high maximums (often $1–$5 million per trip). |
| Hospital | Semi-private or private room upgrade beyond what OHIP covers. |
Typical drug plans cover the majority of common prescription medications that require a prescription and are not purely over-the-counter, though each insurer has its own formulary and may require generic substitution. Many Ontario plans now include virtual physician visits, tele-mental-health, and online pharmacies to improve access and contain costs.
Dental is usually a separate component with its own maximums and coinsurance. Common structure:
Preventive and basic (cleanings, exams, fillings, extractions): 70–100% up to an annual maximum per person.
Major (crowns, bridges, dentures): 50–80% up to a separate or combined maximum.
Orthodontics (often optional): usually for children, with lifetime maximums (for example, $2,000) and 50% coinsurance.
Most "group health" packages in Ontario actually come as group benefits bundles that can include:
Basic life insurance (for example, 1–2× salary) and accidental death and dismemberment (AD&D).
Short-term and long-term disability insurance to replace income if an employee cannot work due to injury or illness.
Employee assistance programs (EAPs) offering confidential counselling, legal and financial advice, and crisis support.
Wellness tools such as fitness or mental health apps, health coaching, and preventive programs.
For very small businesses or professionals, HSAs are sometimes used instead of, or in addition to, traditional extended health and dental, reimbursing a broad list of CRA-eligible medical expenses up to a fixed annual dollar amount per person.
Group plans normally define who is eligible (for example, full-time employees working a minimum number of hours) and may have a probationary period before benefits start. Understanding these rules matters, because missing deadlines can lead to reduced coverage or medical underwriting.
Key practical rules in Ontario group plans:
Eligibility and waiting period: Many employers set a 3-month waiting period from hire date; benefits then start on the first of the following month.
Enrollment window: Employees typically have 30–31 days from becoming eligible to enroll themselves and dependants; missing that window often makes you a "late applicant."
Late applicants: Insurers may require medical evidence and can impose reduced coverage or waiting periods if you enroll late.
Pre-existing conditions: Group plans are often more generous than individual plans; many cover pre-existing conditions right away or with minimal waiting, whereas individual health policies can impose long waiting periods or exclusions.
When employment ends (resignation, layoff, retirement), group coverage usually terminates after a short grace period, but many Canadian group contracts include a conversion privilege. This gives you a fixed time (commonly 31 days) to convert certain benefits—like life, health, and dental—from group to individual coverage without providing medical evidence, though the premiums for the new individual policy will reflect your age and may be higher.
In Ontario, the cost per employee depends on the richness of the plan, average age and family size, industry, and claims history. For many employers, total benefit costs land around 5–15% of payroll, with small businesses often at the lower end if they choose modest coverage and cost-sharing.
Estimates for all-in health and dental packages per employee:
| Plan Type | Typical Monthly Cost Per Employee |
|---|---|
| Basic health + limited dental | About $80–$200 for single coverage, depending on age and industry. |
| Enhanced health + full dental | Roughly $100–$250 for single coverage. |
| Comprehensive (robust drug, dental, vision, paramedical, travel) | Often $150–$350+ for single, and significantly more for family. |
As an illustrative example only (actual costs vary by plan, insurer and group), monthly employer premiums might be about $181 for single coverage (health, dental, travel) and about $454 for family coverage, before any cost-sharing with employees. Small-business-focused arrangements like the national Chambers of Commerce Group Insurance Plan are explicitly marketed as affordable options for any size of Canadian business, including one-person and family businesses.
Most Ontario employers split costs with employees—for example, the employer might pay 50–100% of health and dental, while employees pay any remaining share via payroll deductions. Common patterns include:
Employer pays all health and 50% of dental, employees pay the rest.
Employer pays 50–75% of all premiums, employees pay the balance.
For HSAs, the employer funds a predetermined allowance (for example, $1,000 per employee), and claims are reimbursed from that pool.
From a tax perspective in Canada:
Employer-paid health and dental premiums are generally a tax-deductible business expense for the employer.
For employees, their share of group health and dental premiums can usually be claimed as eligible medical expenses on their personal tax return, subject to medical expense tax credit rules.
If the employer also faces Ontario's Employer Health Tax (EHT), that is a separate payroll tax obligation and not itself a taxable benefit to employees.
HSAs are also treated favourably: for incorporated employers, eligible medical reimbursements through an HSA are typically a deductible expense to the company and a non-taxable benefit to employees when structured correctly under CRA rules.
Designing a good group plan in Ontario is mostly about matching coverage, cost, and administration effort to your workforce and budget. For employers in Kitchener–Waterloo, you can work either with a local benefits broker or directly with insurers and association plans (such as your local Chamber of Commerce) to compare options.
Clarify goals: retention vs. cost control vs. high coverage; for example, tech firms may prioritize rich mental health and paramedical coverage, while trades may focus on strong disability coverage.
Decide who is eligible (full-time only vs. part-time, waiting period length, classes of employees) and whether you want a traditional insured plan, an HSA, or a hybrid.
Set a budget per employee, then adjust coinsurance levels, annual maximums, and deductibles to stay within that budget (for example, 80% instead of 100% reimbursement, or lower dental maximums).
Plan your rollout: most small businesses can launch a new group plan within 2–6 weeks once they provide employee census data and choose coverage, while larger organizations can take longer.
For employees evaluating a new job offer in Ontario, it helps to look beyond "you get benefits" and ask for the booklet or summary: focus on drug reimbursement percentage and maximums, dental coverage levels and annual caps, vision allowance and frequency, paramedical limits, out-of-country emergency coverage, and any waiting periods or pre-existing condition rules. If you expect a job change or retirement soon, it is also wise to check if the plan includes a conversion privilege so you can move to individual coverage without medical evidence if needed.
Compare health and dental insurance quotes from 20+ Canadian insurers on our health and dental insurance page. You may also like our critical illness insurance page. Or visit Life Advice Insurance Inc. at 912 Isaiah Pl, Kitchener, call 1-855-500-5041, Monday to Saturday, 9 a.m. to 9 p.m. Help in English, Hindi and Punjabi.