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).

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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.

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Example:

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If you have a $100 drug deductible and submit a $120 prescription, you pay $100, and coinsurance applies only to the remaining $20.

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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.