What’s in the “fine print”?
Every health insurance policy comes with a “Definitions” section. While this can be a dry read, you’ll get to see what the insurance company means by terms such as; medical professional, reasonable and customary charges, hospital etc. They will also give you their definition of drugs, medical necessity, or emergency etc.
They will also have sections dealing with what are the Limitations and Exclusions on the policy. Most will exclude cosmetic or elective surgery, procedures deemed experimental or supplies that do not qualify as a medical expense under the Income Tax Act, etc.
Unfortunately,many people don’t realize what is covered until they don’t get it. So, when you receive your policy take the time to read it. You don’t want a surprise at time of claim.
All Insurance Companies have some form of rescind policy which will allows you 10 or more days from receipt of your policy, to read it and determine whether you really want it or not. If within that time period you decide you don’t want the policy, you can cancel it and they will refund your deposit.
Pre- existing Conditions
If before becoming insured, you have a chronic medical condition that requires you to take ongoing treatment or certain drugs for that medical condition, an insurer may impose a pre-existing condition clause. What that means is that you will covered for all expenses unrelated to the pre-existing medical condition
Depending on the insurer they may chose to apply the pre-existing clause to all expenses including drugs, professional treatment or major medical supplies or only to some of them. If you have a pre- existing condition and have Emergency Travel coverage please read this section of the policy very carefully before travelling.
What’s Covered?
Individual Health and Dental plans cover most health and dental expenses not covered by your provincial health care plan.
We like to think of it this way. Life insurance ensures that your family will still the get the money you make, even if you’re not around to make it.
Coverage depends on which plan you choose, but the most comprehensive plans will provide coverage for:
Sally can the take that money, and pay off her mortgage, save for their children’s education, and have financial security to cope and move forward in life.
Prescription Drugs
Dental
Orthodontics & Major Dental, including emergency & restorative dental
Vision
Professional Services such as:
Masseuse
Chiropractor
Optometrist
Acupuncturist
Naturopath
Osteopath
Psychologist
Speech Therapist
Podiatrist
Chiropodist
Travel Health Insurance
Semi Private Hospital & Hospital Cash allowance
Medical Supplies- braces, crutches, wheelchairs etc.
Orthopaedic Shoes
Hearing Aids
In home Nursing & more…
For more detailed information, get a QUOTE
What’s not covered?
Generally, prescriptions and treatments that are not medically necessary, are not covered.
The following are not covered:
Elective Cosmetic Surgery
Laser eye surgery
Botox
Etc..
I am already taking medication, and I want those covered?
No problem, there are plans that cover existing drugs, and they are known as “guaranteed acceptance plans”. You can get a quote here, but the catch is that they have drugs maximums anywhere between $1,000 and $2,000.
There is plenty of other coverage included in guaranteed acceptance plans… but due to the low drug maximum, you should carefully weigh the pros and cons of covering your existing drugs.
For someone who is not on any drugs, or even for someone who is taking some inexpensive prescriptions… we highly recommend taking a standard plan which provides up to $100,000 of drug coverage per year.
What is the trillium plan?
Trillium is a government funded health plan, designed for individuals who spend more than 4% of their household income on drug costs.
To find out if your prescriptions will be covered you can search the drug formulary here.
To qualify, you must:
1. Have a valid ohip card,
2. Spend more than 4% of your household income on prescription drugs,
3. Be under the age of 65
4. Not be enrolled in Ontario works
What if I’m over 65?
In Ontario, you qualify for Ontario Drug Benefit when you turn 65. Most drugs are covered but not all, you can search here.
You would think that many policyholders would cancel their plans, but that’s not necessarily the case. There is plenty of other coverage included on the plan that makes it worthwhile to hold on to.
Should I keep my plan after 65?
Yes! You will still have coverage for..
Drugs not covered by ODB
Dental Coverage
Chiropractor
Naturopath
Speech Therapist
Travel Health Insurance
Vision Care
Optometrist
Osteopath
Podiatrist
Semi Private Hospital
Masseuse
Acupuncturist
Psychologist
Chiropodist