Health & Dental Insurance for Families

A family health and dental plan pays for the things OHIP doesn’t: prescriptions, dental visits, glasses, physiotherapy, counselling and the occasional surprise like a cast or crutches. If you have an employer plan, you probably already have this. If you don’t, whether because you’re self-employed, between jobs, on contract, or your employer simply doesn’t offer one, you buy it directly, and the price for a family lands somewhere between roughly $130 and $500 a month depending on the tier.

This guide covers what’s inside a family plan, how children change the price, the rules that specifically affect kids (OHIP+, orthodontics, the new federal dental plan), and how to pick limits you’ll use instead of paying for a tier you won’t.

It’s for Ontario parents without group benefits, and for parents who have them but are wondering whether to top them up.

What a family plan actually includes

Every insurer packages things a little differently, but a family health and dental plan is built from the same components. What separates a $150 plan from a $400 one is the limit on each.

• Prescription drugs. The insurer reimburses a percentage of each prescription (commonly 70–90%) up to an annual maximum. Basic tiers often cap at a few hundred to a thousand dollars a year per person; enhanced tiers go much higher.
• Dental. Split into preventive/basic (exams, cleanings, X-rays, fillings), major restorative (crowns, bridges, dentures) and orthodontics. Basic tiers cover the first category; enhanced tiers add the second; orthodontics is its own line and often optional or excluded.
• Vision. A fixed dollar amount every 24 months for glasses or contacts, plus an eye exam. Children’s eye exams are covered by OHIP annually until age 19, so the private benefit mainly pays for frames and lenses.
• Paramedical. Physiotherapy, massage, chiropractic, psychology, naturopathy and similar, each with a per-visit and annual limit. The per-practitioner structure matters: separate limits for each are far more valuable than one combined pool.
• Extras. Ambulance, medical equipment, hearing aids, private nursing, accidental dental, sometimes a small travel medical benefit.

If you want a fuller list of what the public system leaves out, what OHIP does not cover is the reference.

Indicative family health and dental insurance costs

These are illustrative monthly ranges for healthy, non-smoking adults under 60 with one or more children, drawn from the Canadian individual health insurance market. They are not quotes. Your premium depends on both adults’ ages, the number of children (and whether the insurer caps that number), the limits you select, the insurer, and whether you apply through medical underwriting or a guaranteed-acceptance plan.

Household	Basic tier	Mid tier	Enhanced tier
Couple, no children	roughly $90–$180	roughly $150–$280	roughly $200–$400
Couple + 1 child	roughly $120–$220	roughly $190–$340	roughly $240–$450
Couple + 2 or more children	roughly $130–$250	roughly $210–$380	roughly $250–$500+
Single parent + children	roughly $80–$170	roughly $130–$260	roughly $170–$350

How children are priced

Three things to know:

1. A child costs less than an adult. Children claim far less on drugs and major dental, so their rate is a fraction of an adult’s.
2. Many insurers cap the number of children charged. A family with four kids may pay for two or three. If you have a large family, this alone can decide the insurer.
3. Children age out. Typically at 21, or up to 25 if in full-time study, at which point they need their own coverage. See our guide on health and dental insurance for students for what happens then.

The ranges above assume both adults are under 60. Premiums step up in age bands, so a couple in their late 50s with a teenager will sit at the top of each range or above it.

The rules that affect kids specifically

OHIP+ and the “private plan pays first” rule

OHIP+ covers eligible prescription drugs for Ontarians under 25, but since 2019 only for those with no private drug plan. The moment your children are on your family plan, they’re off OHIP+. The family plan pays first, and if a drug isn’t on its formulary or you’ve hit the annual cap, OHIP+ does not fill the gap.

For most families with healthy kids this is irrelevant. It matters in two cases:

• A child takes an ongoing, expensive medication. Compare the plan’s annual drug maximum against the actual annual cost. If the plan caps at $1,000 and the medication costs $4,000, you may be better off leaving that child off private drug coverage (if the insurer allows it) so OHIP+ applies, and looking at the Trillium Drug Program for anything OHIP+ misses.
• You’re buying the plan mainly for dental and don’t need drug coverage for the kids. Some insurers let you buy dental-only or reduce drug coverage. Then OHIP+ stays in place for the children.

Our OHIP+ vs private drug coverage article works through both scenarios with numbers.

Public dental programs for children

Ontario’s Healthy Smiles Ontario program provides free dental care for children and youth 17 and under in lower-income households. Separately, the federal Canadian Dental Care Plan has been rolling out coverage for families under an income threshold who don’t have access to private dental insurance. Eligibility for both is income-tested and the rules change, so check the current criteria before assuming you qualify or deciding you don’t. If your family is eligible, it changes how much private dental coverage you need.

Orthodontics

Braces are the benefit parents ask about most and the one plans are most careful with. When an individual family plan includes orthodontics, expect:

• a lifetime maximum per child (often a few thousand dollars, not the full cost of treatment),
• a co-insurance of around 50%,
• a waiting period that can run 12 months or longer, and
• an exclusion for treatment already in progress or already recommended when you apply.

Many basic plans exclude orthodontics outright. If braces are likely in the next few years, buy the plan early, read the orthodontic clause specifically, and treat the benefit as a contribution rather than full coverage. Our guide to dental costs without insurance in Ontario gives a sense of the underlying prices.

How to size a family plan you’ll actually use

The most common mistake is buying the top tier “to be safe” and then paying $4,000 a year for benefits the family uses $1,500 of. The second most common mistake is buying the cheapest tier and discovering the drug cap when a child needs a $300-a-month prescription.

A practical method:

1. Add up last year’s real spending on prescriptions, dental (including any major work), glasses, and paramedical for each family member. Your pharmacy and dentist can print a summary.
2. Identify anything predictable in the next two years: braces, a wisdom-tooth extraction, ongoing physio, therapy.
3. Match the tier to that pattern. If the family’s dental spend is high but drugs are minimal, an enhanced-dental/basic-drug combination is often the sweet spot. Most insurers let you mix.
4. Check the per-person limits, not the family total. A “$1,000 drug maximum” is usually per person, which is what matters if one child is the heavy user.
5. Compare insurers at the same tier. The premium spread for equivalent coverage is wide, and the fine print differs more than the price.

Medically underwritten vs guaranteed acceptance for families

When you apply for an individual family plan, most insurers ask health questions about each family member. A pre-existing condition may be excluded for that person or, in some cases, the application declined. In exchange, healthy families get higher limits at lower prices.

Guaranteed-acceptance plans skip the questions and cover everyone, but with lower maximums and longer waiting periods. They’re the right choice when one family member has a condition that would otherwise be excluded, or when you’ve missed the window after leaving a group plan. We explain the trade-offs in guaranteed acceptance health insurance in Canada.

If you’re leaving an employer plan, check first whether the group insurer offers a no-questions conversion for the family. Applying within the conversion window (commonly 60 days) can waive both the health questions and the dental waiting periods, which is worth a lot when kids are involved.

Topping up a group plan

Plenty of families have an employer plan that’s fine for drugs and thin on everything else. Rather than buying a second full plan, look at:

• Coordination of benefits. If both parents have group plans, each parent claims through their own plan first and the spouse’s second, and the children go on the plan of the parent whose birthday falls earlier in the year. Between two plans, most families get close to 100% reimbursement.
• A dental-only or paramedical-only individual plan to cover the gap.
• A Health Spending Account if either parent is incorporated. An HSA can reimburse the family’s eligible medical and dental expenses, and the premium for a personal plan, with pre-tax corporate dollars. Our health spending account guide explains the setup.

Life events that change the answer

A family plan should be revisited at a few predictable moments: a new baby (add the child within the insurer’s window, often 30 days, to avoid a gap), a child starting post-secondary (they may gain a campus plan and can sometimes come off yours), a child turning 21 or 25, and either parent leaving a job with benefits. Our checklist on what insurance you need when having a baby covers the first of those, and the financial checklist for new parents in Ontario puts it in context alongside life insurance and a will.

How Hayes can help

We compare family health and dental plans from 30+ Canadian insurers side by side, so you can see the drug cap, dental waiting periods, orthodontic terms and per-child pricing next to the premium. If a lighter plan, a dental-only plan, a guaranteed-acceptance plan or an HSA would serve your family better than the one you were about to buy, we’ll say so. Our advice costs you nothing; insurers pay us.

For a broader picture of individual and couple pricing, see how much private health insurance costs in Ontario.

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