Dependent Eligibility

Dependent eligibility defines who qualifies for coverage under your family health or dental plan. Dependents usually include a legal spouse or common-law partner and children up to a certain age, commonly 21 or 25 if enrolled full-time in school. Some plans extend coverage to disabled dependents beyond these ages.

Knowing these criteria ensures continuous protection for family members and prevents claim denials due to ineligibility.

Example:

A plan may cover children until age 21, or until age 25 if they remain full-time students and are financially dependent.

What to Watch For:

Notify your insurer promptly of changes in marital status or dependents’ schooling to avoid gaps in coverage.

Related Terms

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).

Dental Accident

A dental accident is a sudden, unexpected event that causes injury to the mouth, teeth, or jaw, resulting from an external force rather than from decay, chewing, or normal use. Examples include being struck in the face, falling and hitting your mouth, or suffering an impact during sports. Dental accident coverage helps pay for the repair or replacement of natural teeth damaged in such incidents.

Dental Fee Guide

A dental fee guide is a provincially issued schedule that lists the standard or recommended prices for dental procedures. Each province and territory in Canada publishes its own guide annually, outlining suggested fees for everything from cleanings and fillings to crowns and dentures.

Dental Insurance

Dental insurance is a type of health coverage that helps pay for the cost of preventive, basic, and major dental services. It is designed to make oral care more affordable and to encourage regular checkups that prevent costly procedures later on. Dental insurance is offered through group employee benefits, individual plans, or conversion plans for people leaving workplace coverage.

Dentist

A dentist is a licensed healthcare professional who diagnoses, treats, and helps prevent conditions affecting the teeth, gums, and mouth. Dentists play a key role in maintaining oral health through preventive care, restorative treatments, and patient education. Common services include cleanings, fillings, crowns, root canals, extractions, and oral examinations.

Have questions about your insurance coverage?

Our licensed advisors can help you understand your options and find the right plan for your needs.