Deductible
A deductible is the fixed dollar amount you must pay each benefit year before your plan starts reimbursing eligible expenses. Think of it as your yearly participation in costs - once met, your plan covers claims according to its coinsurance. Some individual health plans in Canada have no annual deductible, while others apply one only to certain benefits (often $25–$100 per person).
Deductibles help insurers keep premiums lower by discouraging small or unnecessary claims. They reset each plan year and apply separately per person or family, depending on the policy wording.
Example:
If you have a $100 drug deductible and submit a $120 prescription, you pay $100, and coinsurance applies only to the remaining $20.
What to Watch For:
- Family deductibles may cap at 2–3 times the single amount.
- Some dental deductibles apply per calendar year; others per claim.
- Deductibles and co-pays are different - deductibles are annual thresholds; co-pays are per-transaction.