Can You Have Individual Health Benefits and Group Benefits at the Same Time?

Yes. In some cases, you can have individual health benefits while also being covered by a group benefits plan through your employer.

For clients of Lethbridge Health Benefits, this can be especially useful because our Personalized Benefits Plan can be added as a top-up to existing group coverage. You do not necessarily have to choose between keeping your workplace benefits and having your own plan.

The right setup depends on the plans involved, their coverage limits, and their coordination rules.

Why Would Someone Have Both Group and Individual Benefits?

Employer group benefits can provide valuable coverage, but every plan is different. Your workplace plan may have limits on prescription drugs, dental care, vision, physiotherapy, chiropractic care, mental health services, or other eligible expenses.

An individual plan may help provide additional protection where your workplace coverage is limited.

At Lethbridge Health Benefits, eligible individuals who already have group benefits may apply for our Personalized Benefits Plan at any time as a top-up to their existing coverage.

This can be particularly appealing if you like your workplace benefits but want another layer of coverage rather than replacing them entirely.

What Does “Top-Up Coverage” Mean?

Top-up coverage is additional benefits coverage that sits alongside an existing plan.

For example, you might already receive health and dental benefits through your employer but want access to additional coverage available through an individual plan.

Depending on the specific policies and eligible expenses, having more than one source of coverage may help reduce the portion of certain healthcare costs that you have to pay yourself.

It is important to remember that having two plans does not normally mean you can collect more than the eligible expense itself. When more than one plan applies, insurers may use coordination-of-benefits rules to determine which plan pays first and how the remaining eligible amount is handled. The Canadian Life and Health Insurance Association maintains industry guidelines for coordinating health and dental benefits when someone has coverage under multiple plans.

How Are Lethbridge Health Benefits’ Personalized Plans Different?

This is where our approach differs from many conventional individual insurance products.

Our Personalized Benefits Plan is designed to give individuals greater flexibility over their benefits. Key features include:

No health questions and guaranteed acceptance. Our Personalized Benefits Plan is designed without medical questions and includes coverage for pre-existing conditions, subject to the terms and limits of the plan.

No minimum staff participation. Your employer does not need to enroll the entire workforce for you to have access to the Personalized Benefits Plan.

No minimum work hours. This can make the plan suitable for part-time, seasonal, casual, and shift workers who may not qualify for conventional workplace benefits.

Portable coverage. Your Personalized Benefits Plan can stay with you if your employment changes, rather than being tied exclusively to one employer.

Top-up availability. If you already have group benefits, you may apply for the Personalized Benefits Plan at any time as additional coverage.

These features make the plan useful for people who want more control over their benefits rather than relying entirely on what their current employer provides.

What Can Individual Benefits Add to Group Coverage?

The exact answer depends on the plan you choose and the coverage you already have.

Lethbridge Health Benefits offers Personalized Benefit Plan options that may include coverage for:

• prescription drugs
• extended health services
• dental care
• vision care
• life insurance
• AD&D
• mental health support
• travel insurance

If your workplace plan provides limited coverage in an area that matters to you, having an individual plan alongside it may provide additional protection.

What Happens If You Leave Your Job?

This is another important difference between employer-controlled benefits and your own Personalized Benefits Plan.

Traditional workplace group coverage is generally connected to your employment and may end when you are no longer eligible under that employer’s plan.

The Personalized Benefits Plan available through Lethbridge Health Benefits is designed to be portable, meaning you can retain the plan regardless of future employment.

That can provide more continuity if you change employers, move between full-time and part-time work, become self-employed, or otherwise experience a change in your employment situation.

Do You Need to Cancel Your Group Benefits?

Not necessarily.

If you already have useful benefits through work, there may be no reason to replace them. Instead, your individual coverage may be used as a top-up.

Group benefit plans themselves can provide a wide variety of protection, including health, dental, vision, life, disability, critical illness, and other benefits. The specific coverage is determined by the employer’s plan design.

The better question is often:

Does your existing group plan provide enough coverage for your needs?

If the answer is no, additional individual coverage may be worth exploring.

How Does Coordination of Benefits Work?

When two plans cover the same eligible expense, the order in which claims are submitted matters.

Coordination of benefits is the process used to determine how multiple plans contribute toward an eligible claim. Canadian industry guidelines exist specifically to establish consistent rules when a person can submit health or dental expenses to more than one plan.

However, the exact process depends on the policies involved. Before relying on two plans for a particular expense, confirm how your existing group plan and additional coverage interact.

Who Might Consider Having Both?

Having group and individual benefits may make sense for someone who:

• has good workplace benefits but wants additional coverage
• regularly reaches limits within their employer’s plan
• wants benefits that are not completely dependent on their employment
• expects to change jobs in the future
• works part-time, seasonally, casually, or on shifts
• wants a Personalized Benefits Plan they can retain if their employment situation changes

It is not automatically the best choice for everyone. The value depends on what you already have, what additional coverage you need, and the cost of maintaining both plans.

Frequently Asked Questions

Can I have two health benefit plans in Canada?

Yes, it is possible to have coverage under more than one health or dental benefits plan. The plans may need to coordinate eligible claims according to their respective terms and coordination rules.

Can I add Lethbridge Health Benefits coverage if I already have benefits through work?

Yes. If you already have group benefits, you may apply for the Personalized Benefits Plan offered through Lethbridge Health Benefits at any time as a top-up to your existing group coverage.

Will two plans pay twice for the same expense?

Generally, coordination of benefits is intended to coordinate reimbursement between applicable plans rather than allow reimbursement beyond the eligible expense. The exact amount payable depends on the plans and the claim.

Can I keep my individual benefits if I leave my employer?

The Personalized Benefits Plan offered through Lethbridge Health Benefits is designed to stay with you regardless of future employment, unlike traditional group benefits that are tied to eligibility under your employer’s plan.

Find Out Whether Top-Up Coverage Makes Sense for You

Your workplace benefits do not necessarily have to be your only source of coverage.

If your current group plan leaves gaps or you want benefits that can remain with you when your employment changes, Lethbridge Health Benefits can help you explore whether a Personalized Benefits Plan is a good fit alongside your existing coverage.

Schedule a free consultation to review your current benefits and learn what additional options may be available to you.