Virtual healthcare today is an integral part of Canada’s healthcare ecosystem. It wasn’t always this way, with much of the sector’s development occurring since the onset of the COVID-19 pandemic in 2020. The World Health Organization (WHO) declared the end of the global health emergency in 2023.

Observers of the trend note that healthcare, although a changing entity (think the advent of nurse practitioner care and care provided by other medical specialists), is generally not known to evolve so quickly.

Prior to the pandemic, dominant virtual healthcare providers in Canada today had already built their systems – virtual care company Maple was founded in 2015; Dialogue, meanwhile, was established in 2016 as a telemedicine service. In cases, these services were developed by providing care in areas not covered by provincial healthcare.

Although virtual care companies associated with insurance and benefits offerings can range from mental health to social work – and these abound in the industry – this article concerns itself with the provision of virtual health care services which mirror those offered in typical general practitioner’s (GP) offices across the country. The services are often intertwined with others in an insurer’s employee benefits offering.

Virtual care development: the pandemic years

For companies like Dialogue, the pandemic was an opportunity to scale up, as the provision of healthcare became an emergency measure. Governments provided billing codes for virtual care during the pandemic.

“There was a lot of experimentation,” says Dr. Marc Robin, family physician and medical director with Dialogue. “Not all care was great care, but it was better than no care. And that was appropriate for the setting of an emergency situation,” he says of the broader healthcare system's emergency response during the COVID-19 pandemic.

Today, Robin is adamant that the time for experimentation is over and that virtual healthcare companies should be accredited. Dialogue itself was initially accredited by Accreditation Canada in November 2022. It received Accreditation Canada’s exemplary standing in 2025.

In the early days following the pandemic, some provinces began to make permanent some of the changes made during the pandemic. Maple, for instance, was embedded directly into maritime province’s healthcare systems. In Nova Scotia, New Brunswick and Prince Edward Island, Maple has contracted with the government to provide publicly insured services online, particularly to those without primary care physicians. In Newfoundland and Labrador, a similar contract was awarded to virtual technology and physician services company Teledoc.

Other provinces have been more restrictive. Some will allow doctors to practice privately, sometimes by opting out of the public system, other times by allowing both. Alberta is the latest province to make changes, when it proposed in November 2025 to allow doctors to toggle between both structures. (The legislative amendments are expected to come into force when the relevant bill is proclaimed in summer 2026.)

Saskatchewan reportedly has a virtual care license, both for doctors within its borders and those from outside of the province who provide virtual care to the province’s patients. British Columbia, meanwhile, allows out-of-province physicians to provide virtual care but assumes no responsibility for regulation – complaints are redirected back to the province where the practicing physician is licensed.

Manitoba, which has agreements with both Nunavut and Ontario to allow providers to practice virtually to provide service to northern residents, is reportedly the most restrictive province: “Out-of-province physicians cannot provide virtual care to Manitoba patients, and physicians in Manitoba must be able to provide in-person visits to any patients they see virtually,” Katherine Fierlbeck, professor of health policy at Dalhousie University notes in her recent C.D. Howe Institute paper on the subject entitled Disconnected: Inside Canada’s Patchwork of Virtual Care.

Ontario is also reportedly among the most restrictive provinces for doctors to operate in this fashion. “Ontario is essentially an outlier. They just happen to have the biggest population,” Fierlbeck says. “Ontario is really an outlier when it comes to what other provinces actually do allow.”

Where other provinces allow physicians to opt out of the public insurance system, Ontario is the only province that does not allow physicians to work outside of public insurance. 

“Physicians in Ontario can, of course, provide services directly for-profit if they are considered non-medically necessary services (example: cosmetic surgery), or if they are considered uninsured services. The two are not the same, as some uninsured services can also be medically necessary,” she adds. 

If, for example, a GP consultation is done via text in Ontario, the service is uninsured because this mode of delivery is not considered insured. Similarly, private clinics often use nurse practitioners, which fall outside the purview of the province’s legislation. 

“There are still many instances of private health care in Ontario despite its restrictiveness,” Fierlbeck notes.  

Four types of virtual healthcare are offered today

Broken down, virtual healthcare today falls into one of four categories:

1. GP-provided care.

Many services provided by a patient’s general practitioner, in most provinces can also be provided virtually. This is sometimes accomplished by provinces setting up dedicated platforms. This kind of virtual care is an extension of the medical care that most are accustomed to.

2. Private commercial providers.

Pay-to-play providers can also offer services directly to patients in exchange for a fee. Observers who discussed the matter with the Insurance Portal say the model is under pressure. “The pay-out-of-pocket model is becoming extinct,” Robin says. “Virtual care should not be an out-of-pocket experience. That’s aligned with what, as Canadians, we think of healthcare.”

Fierlbeck, however, says there is legal room for such entities to exist in Canada. Her C.D. Howe Institute publication explains the Canada Health Act in some detail, noting that it is the provinces which stipulate what is and is not considered an insured service. Those which are not, are generally fair game to be provided by private players.

3. Hybrid providers.

Companies like Maple, as noted above, have also been hired by provincial governments to provide services. These are administered using patient’s health cards.

4. Employer benefit plans.

Fully private, the provision of healthcare services through a virtual care provider, funded by an employer, is allowed in many cases because the modality itself and the care provided in this fashion do not fall under province’s definitions of what is an insured service. Robin says some provinces have made it very clear in the relevant legislations, that employer-funded virtual care is not an insured service. “The most important thing governments can do is identify or correct employer-funded virtual care as an uninsured service,” he says. “That ensures that employers can really play their role and take care of their human capital in the way they want to.”

An increasingly familiar (and in-demand) service

In 2024, the Canadian Chamber of Commerce noted that by 2023, a quarter of all Canadians had access to virtual care through employer benefits plans. “Maple says it actually has a patient list of seven million people,” notes Fierlbeck. “They like to say that they’re the biggest health care provider in Canada. I’m assuming this is in both their private and public arms.”

Dialogue, meanwhile, says 23 per cent of the population has access to its services. “80 per cent of Canadians expect employers to provide access to some virtual care, and Canadians use it,” Robin adds. He also notes that between 20 per cent and 25 per cent of Canadians also do not have access to a family physician, depending on the province. “About half a million Canadians left an emergency room last year not being seen,” he says. Approximately 50 per cent of Dialogue’s patients are not connected to a family physician or GP.

The value proposition virtual care companies present is compelling, as well: Employers like it, as it frees up their employees in moments where the pursuit of healthcare would otherwise take up considerable time. Employees enjoy the convenience. “Everyone sees that they can win,” Fierlbeck says. “It can be to the advantage of older people who are more housebound. It could be to the advantage of people in rural areas.”

Robin also notes that patients don’t pay and provinces don’t pay for the services – employers do. “And they think it’s a great deal because they see a return on their investment,” he says. “Every time a patient consults in primary care they tell us that they save about four hours of work.”

Productivity loss, absenteeism and presenteeism also reportedly improve when patients are given access to virtual care. “It provides a return on investment that is very, very significant for employers,” Robin says.

Concerns about virtual care

Among those concerned about the provision of virtual healthcare, data privacy and fragmentation, continuity of care and equity are often noted as problems.

Virtual care providers, however, point out that many of these concerns are rooted in problems with the larger system. “The pandemic didn’t create the access to challenges in Canada’s healthcare system; it exposed and intensified gaps that had already existed for years,” a Maple spokesperson writes in a statement to the Insurance Portal.

Equity concerns for instance – these are that only the wealthy, healthy and employed can access the services – may be valid, but it may also be worth noting that equity has never been a requirement of the system. (Ask someone in Northern Ontario if they think they have equitable access to healthcare, for example.) Proponents say employer-provided healthcare in turn frees up resources in the public system. Critics say the services risk draining talent and resources by drawing them away into private practice.

Neither side, however, would appear to have a lot of proof to support their positions. Says Fierlbeck: “It’s all modelling, right?”

Similarly, proponents say the question of data fragmentation is bigger than the virtual healthcare space alone. “It’s a big problem to solve. I don’t think any one province or any one healthcare institution can fix it,” Robin says. “The route we have taken is to empower patients to be able to communicate their data by providing them with detailed visit summaries, detailed action plans that they can share with their loved ones or primary care providers. We make their lab test results accessible to them, that sort of thing.”

He adds: “We work in 10 provinces and three territories…I wish we had better connectivity in Canada, but I think that’s a larger question.”

To address continuity of care concerns, provinces and healthcare providers have again adopted a piecemeal approach: Nova Scotia has prescriptions, even those prescribed by a virtual doctor, tracked by health card numbers.

Dialogue says it makes a point of providing follow up appointments so there is continuity of care. In the case of their mental health services, the company can follow patients for years. “We could show that people’s mental health score improved 40 per cent within thirty days, but we will follow them, sometimes many months, until they are fully functioning and back at work. Continuity of care is actually not that difficult in virtual care.”

He concludes by again calling for virtual care providers to be accredited. “Employer-funded care, people want it. People need it and it supports the healthcare system,” he says. “People need to be accountable for the care they provide. They need to be accredited.”