OMA Insurance or private coverage: how to decide

If you are a new attending, you probably enrolled in whatever the OMA offered and have not looked at it since. That is a reasonable starting position and a poor five-year plan.

What the association already covers

OMA Insurance is a subsidiary of the Ontario Medical Association operating on a not-for-profit basis. Two things sit under that name and they are different.

The OMA Priority Insurance Program is a ministry-subsidised health plan for Ontario physicians, funded from a combination of the ministry subsidy, OPIP reserves and member premiums. Eligibility requires OMA membership in good standing, a CPSO licence, active practice of at least 15 hours a week and Canadian residency outside Quebec. It covers prescription drugs, hospitalisation, paramedical services and assistive devices, and includes $2 million of emergency out-of-country travel coverage, a critical illness benefit of $50,000 paid after surviving 30 days with one of 25 covered conditions, and legal expense insurance (OMA Insurance).

New physicians can enrol without medical evidence within 90 days of receiving their initial offer. After that, medical evidence is required. That window is the single most time-sensitive item in this article.

Separately, OMA Insurance sells individually underwritten products: disability coverage of up to $25,000 in monthly benefits for members under 65 actively practising in Canada outside Quebec, critical illness coverage of up to $250,000 as a lump sum, and professional overhead expense coverage for the running costs of a practice (OMA Insurance).

Where the limits actually bind

Amount is the first limit. A $50,000 critical illness benefit inside OPIP is designed to absorb a shock, not to fund two years away from practice. If a cancer diagnosis would mean eighteen months of reduced billings, the number you need is a multiple of that.

Definition is the second. Read what the disability contract says about your own specialty before you compare premiums. An own-occupation definition is the clause that decides whether a proceduralist with a hand injury is paid for decades or for months.

Portability is the third. Association eligibility depends on membership and residency. If there is any chance of practising outside Ontario, a private individual contract that follows you is worth its higher premium.

The order to work through

Deal with the enrolment window first if you are inside it. Coverage without medical evidence is the one thing you cannot buy back later.

Then size the income gap. Household spending after tax, plus any practice cost that continues, less coverage already in place. The disability coverage gap calculator does this with your own figures.

Then decide whether the association plan fills that gap. If it does, stop. If it does not, layer a private contract on top rather than replacing what you have, and do not cancel anything until the new policy has been issued and delivered.

Finally, think about critical illness separately from disability. They pay for different problems. Disability coverage replaces income over time. A critical illness lump sum pays for the things that are not income: a spouse taking unpaid leave, travel for treatment, a locum for the practice.

What association coverage does well, and what it cannot do

Association plans are good at two things. They price a large group together, which usually helps younger and healthier members less than it helps older or rated ones. And they reduce underwriting friction, which is how a busy resident ends up with coverage at all rather than with a plan to arrange coverage.

They are less good at three things. They are sized for a member profile rather than for your mortgage. They depend on your continuing membership. And the terms are set by the plan, so the wording is something you read rather than something you negotiate.

None of that makes association coverage a poor choice. It makes it a base layer. The mistake is treating it as a complete answer because it arrived automatically, and the opposite mistake is replacing it wholesale because a private policy has a better brochure.

A reasonable review rhythm

Read the coverage once when you start practice, once when your income steps up, once when you incorporate, and once when a child is born or a mortgage is signed. Four reviews over fifteen years is enough for most physicians.

Between those points, the only change worth making is exercising a future increase option, because those rights expire on a schedule and cannot be recovered.

What about paying premiums through the corporation?

Where you pay premiums personally with after-tax dollars, disability benefits are generally received free of tax. Where the corporation pays and deducts the premium, benefits are generally taxable to you (Canada Revenue Agency). Professional overhead expense coverage is the case that belongs in the corporation, because the premium is a practice cost and the benefit reimburses deductible practice expenses.

OPIP

The OMA Priority Insurance Program, a ministry-subsidised health plan for eligible Ontario physicians.

Own-occupation

A definition of disability that pays when you cannot perform the duties of your own specialty, even if you work elsewhere.

Critical illness insurance

Coverage paying a lump sum on surviving a covered condition for a stated period, separate from income replacement.

Professional overhead expense

Coverage for the fixed running costs of a practice while you are disabled, not for your personal income.

Portability

Whether coverage continues if you leave the association or the province. Individual contracts are portable, association plans generally are not.

Insurance products and advice are provided by licensed advisors of AT Financial Group.

What to bring to a 20-minute review

Send your OPIP statement, any OMA Insurance certificates, and your hospital benefit summary. Add one number for what the household spends after tax. We will read the definitions, mark what the association already covers, and name only the gaps that are worth paying to fill.

Book a 20-minute review