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Health and Dental

»Health Insurance

What Can You Possibly Expect?

The choices are many in the market place (Wise Financial Group Inc. can do the shopping for you) and it is very important to look at the fine print. A starting place we suggest is identifying a program that has a good lifetime limit of coverage per person, usually $1,000,000 or unlimited. Stay away from plans with nominal limits as we have seen huge claims. For the self-employed there should be no reason to downsize coverage as the premium is normally treated as a 100% business expense, and check out options like Cost Plus as this is an excellent tax break for some. If you have your own small business, don’t rule out a group plan, as the minimum needed is two.

Many people think that upon finding out that they have a medical condition such as Type I diabetes it is a good time to look to obtain health coverage. For individual extended health plans it does not work this way as pre-existing conditions will be excluded most times, and where they are not the coverage is normally inappropriate in terms of having good protection. If a company makes you an offer excluding pre-existing conditions it is often still worthy of consideration as the contract will still protect you from future illnesses and accidents. The best advice is to enroll into these programs while you and your family are healthy to protect you from the possibility of a big future hit.

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Your spouse and children are also eligible for benefits. Children must be dependant and under age 21 at the time of application. Coverage for children can usually be extended to age 25 for full-time dependant students. To be eligible, you must be a Canadian resident. For Health Care benefits, you and your family must be covered by a provincial/territorial government health plan.

What Might Be Covered?

Plans cover eligible expenses over and above those paid by your provincial or territorial government health plan. Benefits are usually subject to a calendar year deductible or co-insurance (normally 80%) but these are issues that can be tailored to suit the situation and need. Benefits most times are subject to an overall limit per lifetime for each insured person of $1,000,000 of expenses incurred in and out of Canada combined for those up to age 65

This a sample of what a plan may cover:

  • Semi-private/private hospital room (in Canada)
  • Out-of-Canada emergency care including hospital accommodation and reasonable and customary fees of a physician or surgeon
  • Prescription drugs/medicines.
  • A "pay-direct" drug card, which allows the insurer to pay the pharmacy directly.
  • Ambulance/air ambulance for emergency transport
  • Emergency dental care due to an accident
  • Home nursing care

Services of an acupuncturist, chiropractor, osteopath, chiropodist, podiatrist, naturopath, psychologist, physiotherapist, speech therapist and registered massage therapist.

  • Hearing aids (not batteries)
  • Orthotics (shoes and inserts)
  • Provincial/territorial user fees (where permitted by law)
  • Repatriation to home province/territory in Canada
  • Medical supplies and equipment such as artificial limbs or eyes, casts, crutches/braces, oxygen/equipment, blood/plasma, wheelchair, hospital bed

»Dental Coverage

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What Can You Possibly Expect?

For the business market the only real concern and issue concerning dental insurance is frankly the tax treatment of your own and your family’s expenses. Dental is pretty much money in and money out and can be a potentially great benefit for employees where the business participates in the cost. It’s the tax break we need to focus on, especially when it comes to orthodontics and major dental work.

Like the health insurance lots think to obtain coverage after they find out they need major dental work done, but beware of the fine print. Most insurers will not cover these situations and some companies include a waiting period for the dental coverage before it starts. Plan well ahead and make sure other priorities are addressed before buying dental insurance, for instance health and disability insurance, as these are the big risks.

What Might Be Covered?

Plans cover eligible expenses charged by a dentist usually based on the current General Practitioners Fee Schedule for your home province.

Benefits are usually subject to a calendar year deductible of $50 per insured person to a maximum of $100 per family, and/or co-insurance of normally 80% for Basic Dental Care and 50% for Major Dental Care, if included.

Benefits can be limited to a maximum of $1,500 or usually less for each insured person per calendar year.

This a sample of what a plan may cover:

80% of the cost of Basic Dental Care:

  • Diagnostic services (e.g., examinations, x-rays)
  • Preventive services (e.g., fluoride treatment, cleaning and polishing)
  • Minor restorative expenses (e.g., fillings, stainless steel crowns)
  • Endodontic services (e.g., root canals)
  • Periodontal services (e.g., treatment for gum diseases)
  • Oral surgery (e.g., extraction of impacted wisdom teeth)

50% of the cost of Major Dental Care:

  • Crowns
  • Dentures
  • Bridgework

If you terminate your insurance within the first year you may be subject to contractual conditions that may surprise you. For example if one buys coverage and uses the same and then cancels after many bills have been paid shortly after obtaining the plan some companies will make you pay back the money or at least pay premiums for one year. It sounds odd but companies have to protect themselves from misuse of the plan. Read the fine print or better yet work closely with your advisor as they can consult you best. Some limitations, maximums, and exclusions apply.

Contact your insurance representative Wise Financial Group Inc. toll free 1-877-779-4731 or email info@companybenefits.ca.

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