A family of four
Regular paediatric visits, two prescriptions, a planned procedure.
Often a good fitGoldLower costs at each visit outweigh a higher premium.
Health Insurance
Health cover, explained before you choose.
Major medical insurance is the foundation of most coverage plans. Here is what it is designed to support, what usually sits outside it, and how to read the numbers that matter.
- What major medical cover is built for
- How to read premiums, deductibles and limits
- Plain language, no sales pitch
Major medicalThe foundation.Doctors, hospitals, prescriptions
What it supports
Designed for the care you can’t predict.
Major medical insurance shares the cost of a wide range of care — from a routine check-up to an unexpected hospital stay.
Everyday care
Primary care visits, check-ups and the routine appointments that keep small things small.
Specialists
Referrals to cardiologists, dermatologists, therapists and other specialists in your network.
Hospital care
Emergency visits, inpatient stays, surgery and the care that follows.
Preventive care
Screenings, vaccinations and annual wellness visits, often at little or no cost.
Prescriptions
Medicines on the plan’s drug list, usually grouped into cost tiers.
Worth knowing
What often needs separate consideration.
Health insurance focuses on medical care. Several everyday needs usually sit outside it, and are worth weighing on their own.
- Dental care Cleanings, fillings and orthodontics for adults are usually a separate policy.
- Vision care Eye exams for adults, glasses and contact lenses often need their own plan.
- Income support Cash help around an accident or serious illness comes from supplemental cover.
Often separate
- Adult dental
- Glasses & contacts
- Income support
Usually inside major medical
- Doctor visits
- Specialists
- Hospital stays
- Emergency care
- Preventive care
- Prescriptions
Coverage varies by plan. Illustrative grouping.
Reading a plan
Every number, in one place.
Each plan’s deductible, out-of-pocket maximum and copays sit in one table beside your doctors and prescriptions, so no figure has to be decoded on its own.
- Network status for your doctors
- Prescription costs by plan
- Deductible, out-of-pocket maximum and copays side by side
Premium is only one number
Five numbers shape what a year really costs.
The premium is what you pay to have cover. The other four decide what you pay when you use it.
Premium
The monthly amount you pay to keep your coverage active, whether or not you use care.
Deductible
What you pay for many covered services each year before the plan starts sharing costs.
Copay
A fixed amount for a visit or prescription — for example, $25 for a primary care appointment.
Coinsurance
Your percentage share of a bill after the deductible, such as 20% of an approved cost.
Out-of-pocket maximum
The most you would pay for covered care in a year. After that, the plan pays in full.
A typical year, one illustrative plan$4,788$3,888 premiums + $900 care costs
- Premiums
- $3,888
- Deductible spending
- $640
- Copays
- $260
- Coinsurance
- $0
Needs, then numbers
The right plan depends on the life around it.
Three illustrative households, three different best fits. Your own answer starts with your own care.
A healthy couple
Annual check-ups, occasional urgent care.
Often a good fitBronzeA lower premium with protection against a rare bad year.
A self-employed parent
Steady primary care, one daily medication.
Often a good fitSilverPredictable copays with a moderate deductible.
Your next step
Explore health plans with your care in view.
Compare illustrative plans by doctors, prescriptions and total yearly cost.