Insurance Matters

Personal Health Insurance – Coverage for government shortfalls

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BY: ANDREW STEWART

Adopting proper lifestyle habits is key to living a happy and healthy life. From proper nutrition and exercise to home safety, disease awareness and prevention, being informed and proactive is the best approach to living your best life. But what do we do when we get sick, injured or need to visit a hospital. We live in a great country and are lucky to have a health care system that gives Canadian residents reasonable access to necessary hospital and physician services without paying out-of-pocket. Canadians most often turn to primary health care services as their first point of contact within the health care system. In general, primary health care coordinates patients to receive quality care from diagnosis to recovery when more specialized services from specialists are needed. So, a good question you may ask yourself is do I need a personal health care plan?

What is personal health insurance?

Personal health insurance products are designed to lower your risk from expenses and to fill the gaps your provincial medical care policy does not cover. Many people don’t buy supplemental health insurance for reasons that usually sound something like this: “The government covers me,” I’m healthy – I don’t need insurance,” “I have other financial priorities,” “I’d only claim a few things a year.” While provincial health plans provide coverage for many health expenses, there are gaps that can have a significant impact on your finances. You should consider personal health insurance if you don’t have health benefits through your employer. Maybe you’re losing your group coverage or you’d like additional benefits not offered by your employer’s plan. If you wanted to apply for such coverage your provincial medical insurance must be currently active (health card). As an advisor, I try to remind people that the benefits provided by the government will only cover basic medical needs, like a trip to the doctor or hospital.

The constant reassessment of health care funding is putting more emphasis on health care spending on the individual. Reduced coverage for prescription drugs and specialized care, coupled with shorter hospital stays and more care required outside the hospital all mean one thing – you pay more. For example, my sister has to have hip surgery on both hips. Thank goodness the surgery and the time in the hospital are covered. The unlucky part is that full recovery will take months and the hospital stay is only a week. That means the care and support she will need to perform day-to-day activities like bathing, making meals and walking will either have to be paid for out of pocket or supplemented by a long-term care policy which is an income-style benefit. Obviously, she would have had to purchase the policy prior to having her condition.   

Every year you could pay thousands in unexpected medical and dental expenses if you don’t have a health plan. Using up your savings on private care because of limiting government coverage will obviously hurt your retirement plans. One thing I know is constant when it comes to our health we would all pay any sum of money to feel better or to prolong our lives. Personal health insurance offers coverage for a prescription drug, dental that includes restorative and orthodontic care, supplemental health care, paramedical practitioners, vision care, emergency travel medical and semi-private hospital room. You are not eligible for coverage if you had or have pre-existing illnesses or conditions (list provided by the insurer), you are currently awaiting doctor recommended tests or investigations or a pending surgery.

Remember, the purpose of health insurance is to ensure your family’s financial security. Although the dental, drug and vision components of a health plan are typically the most used benefits, the long-term value lies in the comfort of knowing you don’t have to worry about the uncertainties that come from relying entirely on our government health care system.

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