Group Benefits Save You Money

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This particular article is an incredibly special one for me, not necessarily because of the topic but because of the timing of it. I am enormously happy to share with you that on July 15th, 2017 I had the enjoyment of contributing to the birth of my second daughter.  The experience of seeing her born and take her first breath of air was indescribable. You see my first daughter was born by C-section so all I heard was her first cry. This time I was front and center working with the nurses and doctors through the entire process. My baby arrived alert and awake and a healthy 6lbs 11oz. As the nurses placed her on my fiancé’s chest still living from the cord she wept and I smiled. Only when the cord had stopped pulsing completely I was asked would I like to cut it. I remember thinking about the stories you hear about babies being born at home, in a car or even an airplane and I thought how? Being at the hospital was a comforting feeling.

Then it was time to wait for the blood test, observation, and healing. We had chosen to recover in a private room. If not for group health insurance provided by her employer the cost would have had to be paid out of pocket. Canada’s provincial and federal health insurance only covers standard ward accommodation (four beds to a room) through Canada’s Medicare program. If you prefer to stay in a private or semi-private room during your hospital stay, a premium rate will be charged to you or your insurance company. During admission or pre-admission you are asked to make a request for accommodation. Your choices Include:

  • Private (one bed per room, private bathroom), $275 per day
  • Semi-Private (two beds per room, shared bathroom for two patients), $235 per day

Being a family advisor, I have consultations with clients about their group insurance coverage if they are lucky to have it or about purchasing private health insurance coverage. With so much information available about OHIP, group health insurance, and private health insurance, it’s no surprise that some misconceptions exist. Here are some misconceptions about private health insurance:

1. I have OHIP, so I don’t need private health insurance

Depending on your health care needs, you will likely need to pay out of pocket for prescription drugs, dental care, various forms of therapy and rehabilitation services, medical equipment and more. Most notably, prescription drugs, dental care, ambulance transportation, registered therapists, medical equipment and vision care for adults 18 to 64 years of age are not covered by government insurance plans in Canada. Private health insurance ensures you don’t pay out of pocket for medical care that OHIP does not cover.

2. I am healthy, so I don’t need private health insurance

Even young and healthy people could develop a serious illness, get injured or have an accident. Private health insurance coverage protects you from the financial burden of the medical care you need.

3. I can’t afford private health insurance

Cost is always a consideration when people explore their health care options. Depending on your relative health and age, you can choose the specific area of coverage that means the most to you for your health insurance plan.

If you’re married or in a common-law relationship, pay attention to how your health and dental plans can complement each other. Families with separate workplace plans may not realize they have overlapping coverage and can make claims on both for spouses and children. Often, individual plans will only cover a portion of certain medical expenses like dental surgery or prescription drugs—but by taking advantage of your partner’s benefits, chances are you’ll wind up with close to 100% coverage.

There are rules about which insurance company you submit to first, though. You must first file a claim with your own insurance provider, after which your spouse can then submit the outstanding balance to their provider. For kids, when there are two plans, the parent with the earlier birth date in the calendar year pays first.

Read through your benefits manual and you might be surprised by some of the more unusual perks you never knew were there. They can add a chunk of change to your household bottom line.


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