Canadians enjoy the benefits of a publicly funded health care system, but there are many areas the provincial plan doesn’t cover. That’s where group medical insurance comes in. Medical coverage includes: hospital coverage, drug coverage, medical supplies and equipment, paramedical services, out-of-province coverage, private duty nursing and ambulance fees.
Most of the basic hospital and surgical expenses are covered by provincial health plans. The hospital coverage allows insured individuals to obtain preferred accommodation with either the semi-private or private room option.
Prescription drugs is one of the most crucial coverages in a Group Benefit plan. Typically, this coverage accounts for 60% – 80% of the Extended Health Care (EHC) claims. Drug plans offer flexibility through coinsurance coverage (typically 80%) as well as a drug maximum ranging from $3,000 to unlimited.
Medical Supplies and Equipment
Any medical equipment necessary for treatment is covered by medical supplies and equipment. Here are some common items to name a few: sleep apnea machine, wheelchairs, canes, crutches, walkers, braces, prostheses, orthopaedic shoes and orthotics, support hose and compression stockings, kidney dialysis equipment, hearing aids and much more.
This benefit covers charges for the following paramedical practitioners: Chiropractor, Osteopath, Massage therapist, Acupuncturist, Athletic therapist/Physiotherapist, Social worker/Psychologist, Chiropodist/Podiatrist, Dietician/Naturopath, Audiologist/Speech therapist.
Maximums are per practitioner and range from $300 per practitioner per year to $1,000 per practitioner per year.
This benefit is provided as an emergency medical benefit for plan members traveling outside of the Province/Country for up to 60 days. This coverage is unlimited and will cover hospital expenses, services and supplies, physician fees and ambulance fees.
Private Duty Nursing
When a plan member or one of their dependents requires in-home care, this pooled benefit covers the cost up to a maximum per calendar year. The maximum typically ranges from $10,000 to $25,000.
All ambulance fees are covered including air ambulances.