As measles outbreaks reappear across the country, public health officials are warning about preventable illness on the rise. New research shows persistent gaps in vaccine coverage under private health benefits plans, which can also contribute to vaccine hesitancy among working Canadians.
According to the Private Drug Plan Leadership: Vaccine Coverage Report Card 2025 by Mapol Inc., only 71% of plan members have vaccine coverage through their employer-sponsored benefits plans – leaving nearly one in three Canadians without consistent access to NACI recommended but unfunded adult vaccines.
“When insurers treat vaccines as optional in their drug plans, they send the wrong message about prevention,” says Johnny Ma, President of Mapol Inc. “Vaccines are not a perk – they are a cornerstone of a healthy, productive workforce.”
The 2025 Report Card highlights important progress across Canada’s benefits landscape. Four more insurers – Alberta Blue Cross, Beneva, Co-operators, and iA Financial Group – have modernized their group plans to make vaccines a Standard Inclusion or increased annual vaccine maximums to at least $1,000.
These four insurers are joining established leaders such as Desjardins Insurance, Sun Life, and Empire Life, which already include vaccines as part of their standard drug coverage.
“By including vaccines as part of our standard drug coverage, we help ensure easier access to essential care, reduce the risk of illness and contribute to a healthier community,” says Neda Nasseri, Product Director, Pharmaceutical Benefits at Desjardins Insurance. “This reflects our belief that prevention is a key pillar of sustainable healthcare.”
This shift reflects the growing emphasis on preventive health in Canadian group benefits. Research by the Adult Vaccine Alliance shows adult vaccines save more than $2.5 billion annually in avoided health-care costs and productivity losses, generating a 341% return on investment for every dollar spent.
While the overall cost of vaccine coverage to plans is pennies on the dollar, Mapol’s analysis shows 1.5 million vaccine claims were declined in 2023 because vaccines were not included in the applicable plan design. These numbers illustrate the real-world implications of inconsistent coverage and the need for vaccine coverage modernization at the insurer level.
“When employees encounter uncertainty about coverage, it can reinforce vaccine hesitancy rather than confidence,” notes Ma. “Making vaccines a standard benefit helps clarify their importance and ensures equitable access no matter the size of the employer plan.”
It’s time to roll up our sleeves
The Vaccine Coverage Report Card 2025 outlines clear steps insurers can take to close the remaining coverage gaps and protect all Canadians:
- Make vaccines a Standard Inclusion in all drug plans.
- Increase or remove vaccine maximums (to $1,000 or higher).
- Eliminate prescription requirements for Schedule 2 vaccines.
- Enhance communication with plan sponsors and plan members to promote awareness of vaccine coverage.
“Science-driven plan design protects not only plan members but entire communities,” says Ma. “When science leads, everyone benefits.”
For more information, read the report card
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