Buying private health insurance can feel like a daunting task. The number of choices and decisions can make it seem complicated. Provincial health care services provide coverage for things like doctor visits, medical tests, and hospital procedures. (These vary from province to province, so check where you live.)
But there are, of course, many medical services that aren’t covered. So investigating a private health plan to improve your coverage is a good idea, even if you already have a group plan with your employer. You never know when a medical emergency might happen and put a financial strain on you and your family.
Ask an insurance agent these 5 questions to ensure you get the right coverage.
1. Do I Meet Eligibility Requirements for Health Insurance?
Make this your first question so you don’t waste any time. Unfortunately not everybody is eligible for private health insurance. The first requirement for all Canadians is that they have a valid health card in the province they live in. If you tick that box, you’ll be asked about existing illnesses, injuries or other heath conditions. Some will bake you ineligible. As well, some health insurance plans require that you already have group plan coverage, and others prohibit coverage based on how old the applicant is. Some plans will guarantee acceptance, regardless of health status, age or other factors, but you’ll likely pay a bit more for this.
2. What if I Have a Pre-Existing Condition?
Having an injury or illness at the time of application doesn’t necessarily make you ineligible. Find out. If it isn’t covered you might still be able to get the insurance plan, but you’ll be responsible for costs relating to your pre-existing condition. It’s best not to hide an existing condition. If you tried to make a claim later for something related to it, the insurance company could refuse the claim altogether and policy could be voided.
With a pre-existing health condition:
- You may have to pay a higher monthly premiums
- Your coverage my be limited to exclude costs like prescriptions relating to your illness or injury.
- The health insurance provider may ask you to fill out a medical questionnaire, so they can evaluate your health and eligibility for coverage.
If you have pre-existing conditions, read the health insurance policy carefully so you know what you are and are not covered for. Contact your health insurance agent if you’re unsure about anything.
3. How Much Will Private Health Insurance Cost?
The answer is, it depends. With all the factors just described, it makes it hard to state a cost. As well, monthly premiums aren’t the only expenses you’ll have to pay. As you use health services and benefits, you might have to pay deductibles, copayments and coinsurance.
Additional health insurance costs:
- A premium is the base amount that you’ll pay every month for your health care coverage.
- A deductible is the amount you’ll pay for services that are covered, but before the health insurance starts paying. It’s similar to a deductible on car or house insurance.
- Coinsurance is incurred after you’ve reached the deductible for a particular covered service. It’s a percentage of the cost of the service.
- A copayment is a fixed expense for a covered service.
You only have to pay these costs when you use a service that’s covered. For example, if your dental coverage is 80%, you’ll pay the other 20% each time you visit. So you can imagine, it’s difficult to provide a total cost. Use your previous frequency of using health services to estimate what your expense will be.
4. Is There a Maximum Amount a Health Insurance Plan Will Pay?
Almost all health insurance plans have a plan maximum. This is the highest financial amount the plan will cover in a specific period of time. When the plan maximum is reached for a specific health care service, the insurance company will stop paying. The additional expense will be on you.
Some health insurance plans also have lifetime maximums, not just for individual services. A lifetime maximum is the most money the plan will pay out over your lifetime. If you reach the lifetime maximum, future health care costs will be your responsibility.
Plan maximum considerations:
- Maximums vary from plan to plan. It’s a good idea to compare a few options to find one that fits your needs.
- Do you have a pre-existing condition that is covered? If you think you’ll use the insurance coverage often, then a higher maximum is more beneficial.
- Are you genetically pre-disposed to some health issues? Are you concerned your medical expenses will rise in the future? Choosing a health insurance plan with a higher maximum can help make future costs more predictable.
5. What Does a Health Insurance Plan Not Cover?
Regardless of the plan you look at, there will always be services or supplies that wont’ be covered. Here are some of the usual exclusions.
- Treatments and services that your provincial health plan or pharmaceutical manufacturer’s assistance program already covers
- Any drugs, services or supplies that were prescribed for a family member, or by a family member or yourself
- Cosmetic or aesthetic procedures, unless it’s reconstructive surgery for tissue damage caused by an illness or injury
- If you’re in a long-term care facility, any supplies, services, and equipment that are used
- A duplicate or replacement prosthetic device or durable medical equipment, except if your condition has changed, or the device or equipment is beyond repair
- Any services or supplies that are required while serving in the armed forces, as a result of war, or from attendance at a civil commotion or riot
- Health care required due to injuries that are self-inflicted and deliberate
- Service costs that are more expensive that what is usually charged in your area, or unreasonably high
- Fees you may be charge because you missed an appointment, or to fill out claim forms
- Any experimental treatments, drugs, or tests that aren’t medically necessary
- Health care for injuries that are the result of carrying out or attempting a crime
Contact Your Medavie Blue Cross Agent
As you can see there are lots of considerations. Asking these 5 questions will help you choose the appropriate level of health insurance coverage for you and your family. Read more about our Blue Cross health insurance plans for Atlantic Canadians. And please don’t hesitate to call if you need more information. 1-866-848-8836.