Accidental Death and Dismemberment:
Commonly referred to as AD&D, this benefit provides a lump-sum payment in the event of death due to accident, and a lesser lump-sum in the event of the loss or loss of use of the Insured’s limbs.
Extended Health Care:
Commonly referred to as EHC, extended health care covers eligible medical expenses not covered by the Provincial health plan that are the result of illness or injury in the Insured’s province of residence.
Benefits are payable for these services after the yearly maximum allowed (if any) under the Provincial health plan has been reached.
Paramedical services typically include:
- Speech Therapist
- Ophthalmologist or Optometrist
- Registered Massage Therapist
The annual maximum may be a flat amount per visit such as $20.00, up to a specified number of visits, such as 20. Another option may be a fixed maximum such as $600.00 total combined for all specialists, annually, until the maximum is depleted for the current year.
EHC will typically cover the purchase or rental of medical supplies such as:
- Cervical collars
- Ostomy supplies
- Non-motorized hospital beds
- Diabetic supplies
The insurer will usually set an annual maximum for all medical supplies such as $2,500.00 per year.
Coverage may also include:
- Prostheses and accessories
- Accidental dental coverage
- Hearing aids
Prescription drug coverage in a personal plan covers prescribed drugs that are not available over the counter. The drug coverage will typically cover the lowest cost generic drug available. The private insurance sector is responsible for the majority of all drug expenditures making this one of the most valuable forms of any insurance plan. Drug limits vary from $500.00 for a guaranteed issue (no medical) plan up to $10,000.00 or even $250,000 per year. Adding catastrophic health insurance coverage as an add-on to a personal health insurance plan can provide a higher amount of drug coverage or even an unlimited amount and greater extended health care security.
Vision care is often included with the base EHC plan and provides reimbursement toward the cost of prescription lenses, frames and contact lenses. The amount ranges from $100.00 every two years to $300.00 every two years. This benefit may also include coverage for eye exams.
Emergency Travel Medical Insurance:
Emergency travel medical insurance covers the Insured for the cost of emergency hospital and medical care when travelling outside of their province of residence or out of the country. The benefit typically covers an unlimited number of trips per year up to a specified number of days per trip, for example 30, 60, or 90 days. Some plans will only cover short trips such as nine days and offer the option of adding on extra days to the core plan at the time of applying for coverage. Some plans do not include any travel insurance coverage.
The contract will outline what pre-exiting condition limitations are applicable and what constitutes a pre-existing condition. Generally, a pre-existing condition includes any condition for which the insured had any symptoms, visited a doctor or was advised to do so, sought medical treatment, or took medication, whether the condition is diagnosed or not, if the activity in questions occurred within a specified period of time prior to departure. The time frame for varies from 90 days to 180 days typically.
The pre-existing condition period is measured from each departure date from the home province, and is not measured only from the plan’s inception.
Catastrophic Health Coverage:
Some insurers offer enhanced coverage to protect against catastrophic loss from serious accident or major illness at a reasonable rate. A deductible must first be satisfied, typically from $4,500.00 to $10,000.00 or more, after which the insured is protected against drug expenses. There may be limits per incident. Some plans have maximums of $10,000.00 to $25,000.00 and some provide unlimited coverage, with or without a lifetime maximum.
When designing the core plan one should factor in the core plan’s drug limit and the deductible for the catastrophic coverage to allow for seamless coverage.
Hospital coverage is typically purchased as an optional add on to a personal insurance policy. This feature provides for the additional cost of preferred over basic accommodation to be covered up to a stated maximum charge per day and a limited number of days per year.