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Personal Health Insurance

 

The government program OHIP (free medical insurance) unfortunately does not cover all costs of treatment. Dialing 911 for an ambulance, the treatment of teeth, prescription drugs and some specialists, eye doctor visit and many other things result in financial concerns within a family in case of receiving treatment in an emergency. Its excellent that at our jobs come with benefits which helps to pay for majority of the financial expenses for these medical systems. Unfortunately not all jobs come with benefits. Some work for themselves, some have opened their own business or have a contract today. These people don’t have benefits and can only get access to them at their own expense. The government allows, those who have their own business or work under a contract to add these expenses to medical insurance.

Only a few companies work in the market of individual medical insurance. The prices of all are approximately the same. I of course can offer any company, but below I show the terms and prices of this type insurance coverage for only 2 companies. They are Manulife Financial and Great West Life. These companies help answer the question in different ways and that’s why I want to show them both. It’s also the case that you might have certain preferences in the companies, based on your past work experiences where at some job you or yours friends had group insurance.

First I want to distinguish the difference between Manulife and Great West Life in terms of our current topic. Personal medical insurance program in general consists of 3 main components: payment of prescription drugs, return of expenses spent on dental doctors and other doctor specialists, payment of medical services not covered by the free insurance.

The Manulife company offers a few directions, due to the fact that families most of the time need something specific, for example just coverage from doctors. You can choose your coverage and add as many services coverage as you want. Only coverage for doctors, only coverage for dental doctors, only coverage for prescription drugs, etc. Your package can have coverage for 1, few, some, or all of the listed above, the combinations are up to you.

I want to point out that no company exists that would offer the coverage for only dental doctors/dental work, something else would have to be added to it. In general all people use the dental services and therefore the companies don’t want to constantly pay out for dental claims and loose the insurance principle of some people use insurance and some don’t.

Below you will find the prices and listed terms/conditions of different plans in Manulife. First table shows you the prices of the plans, covering services of dental (Dental Plus) and prescription drugs (Drug Plus). Both include automatically, the coverage for services of specialized doctors (Core Benefits) which is not covered by free medical insurance. The second table shows you the prices of combined plans covering the dental doctors, prescriptions drugs, and specialist doctors which the free medical does not cover (Combo Plus).

CORE BENEFITS CORE PLANS
(Please note: All Core Plans include the Core Benefits)
  DentalPlus - Basic DentalPlus - Enhanced DrugPlus - Basic DrugPlus - Enhanced
Vision (Basic), Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist, Psychologist, Speech Pathologist/Therapist, Physiotherapist, Homecare and Nursing, Prosthetic Appliances, Durable Medical Equipment, Best Doctors*, Accidental Dental, Ambulance, Hearing Aid, Emergency Travel Health Coverage, Accidental Death and Dismemberment, Survivor Benefits.
Extended Health Care (EHC) Lifetime maximum $250,000		 Ongoing Maintenance
9 month recall
Total benefits payable: Year 1: 50% of first $1,150
Total payable per anniversary year in Year 1: $575
Year 2 and beyond: 80% of first $300; 50% of next $850
Total payable per anniversary year in Year 2+: $665
DentalPlus Basic and Enhanced have an escalating yearly maximum for Home Support, Durable Medical and Prosthetic Appliances
No medical Questionnaire required. 		Ongoing Maintenance
6 month recall
Total benefits payable: Year 1: 60% of first $1,200
Total payable per anniversary year in Year 1: $720
Year 2 and beyond: 90% of first $500; 60% of next $700
Total payable per anniversary year in Year 2+: $870
Combined maximum of $1,250/3 year period for: Oral Surgery, Endodontics, Periodontics:
Year 1: 0%; Year 2: 60%; Year 3 and beyond: 80%
Major Restorative
First 2 years:0% Year 3 and beyond: 60%
No medical Questionnaire required. 		Generic Drug Plan
70% first $765
90% next $3,850
Total benefits payable per year: $4,000
Full coverage of reasonable and customary dispensing fees
Exclusions - smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, and drugs not requiring a prescription		 Name Brand Drug Plan
90% first $2,220
100% next $6,000
Total benefits payable per year: $8,000
Name brand or generic drugs, including birth control and fertility drugs
Full coverage of reasonable and customary dispensing fees
Exclusions - smoking cessation drugs, over-the-counter drugs, and drugs not requiring a prescription
AGES: Single Adults DentalPlus - Basic DentalPlus - Enhanced DrugPlus - Basic DrugPlus - Enhanced
<45 $57.00 $93.00 $43.80 $67.60
45-54 $59.60 $111.30 $50.50 $70.00
55-59 $60.20 $113.70 $57.80 $78.40
60-64 $61.80 $115.10 $63.00 $86.20
65-69 $61.40 $111.00 $45.40 $58.20
70-79 $62.00 $109.20 $50.60 $63.90
80-89 $62.40 $104.70 $56.40 $74.90
90+ $81.20 $108.00 $82.40 $104.90
Couples - per Adult        
<45 $46.90 $78.40 $36.30 $57.60
45-54 $49.30 $94.80 $43.20 $60.30
55-59 $50.00 $97.30 $49.90 $68.40
60-64 $51.60 $98.10 $54.90 $75.60
65-69 $50.80 $94.40 $38.00 $49.10
70-79 $51.70 $92.60 $43.10 $54.60
80-89 $51.60 $88.40 $48.90 $64.70
90+ $69.50 $91.40 $73.90 $93.20
1-2 Children - Per Child        
<5 $16.60 $19.10 $20.50 $30.20
5-20 $28.70 $58.90 $16.30 $22.00
3+ Children - Per Child        
<5 $15.10 $17.40 $18.60 $27.10
5-20 $25.90 $52.90 $14.60 $19.90
Seniors Adjustments        
65+
EHC Lifetime
maximum $260,000		 Travel coverage not available Travel coverage not available Generic Drug Plan
100% first $750
90% next $3,850/yr of costs not covered by the provincial drug plan

Travel coverage not available		 Name Brand Drug Plan
100% first $750
90% next $7,500/yr of costs not covered by the provincial drug plan
Travel coverage not available
CORE BENEFITS CORE PLANS
(Please note: All Core Plans include the Core Benefits)
  ComboPlus - Starter ComboPlus - Basic ComboPlus - Enhanced
Vision (Basic), Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist, Psychologist, Speech Pathologist/Therapist, Physiotherapist, Homecare and Nursing, Prosthetic Appliances, Durable Medical Equipment, Best Doctors*, Accidental Dental, Ambulance, Hearing Aid, Emergency Travel Health Coverage, Accidental Death and Dismemberment, Survivor Benefits.
Extended Health Care (EHC) Lifetime maximum $250,000		 DENTAL:
Ongoing Maintenance
9 month recall
70% of first $350
Total benefits payable per year: $245
PRESCRIPTION DRUGS:
Generic Drug Plan
70% of first $430
Dispensing Fee Cap: $6.50
Total benefits payable per year: $300
Excludes Vision Care
Escalating yearly maximum for Home Support, Durable Medical and Prosthetic Appliances
No medical Questionnaire required.		 DENTAL:
Ongoing Maintenance
9 month recall
80% of first $300
50% of next $850
Total benefits payable per year: $665
PRESCRIPTION DRUGS:
Coverage as outlined in DrugPlus Basic		 DENTAL:
Ongoing Maintenance
6 month recall
100% of first $500 of examination, scalings, diagnostic services
90% of all other Ongoing Maintenance services
60% of next $700 of all Ongoing Maintenance services
Total benefits payable per year: $920
Oral Surgery, Endodontics, Periodontics:
Year 1 & 2: 60%
Year 3 and beyond: 80%
Maximum payable first year: $400
Major Restorative:
Year 1 & 2: 0%
Year 3 and beyond: 60%
Ongoing maximum of $1,250/3 years
PRESCRIPTION DRUGS:
Coverage as outlined in DrugPlus Enhanced
AGES: Single Adults ComboPlus - Starter ComboPlus - Basic ComboPlus - Enhanced
<45 $57.90 $67.20 $112.70
45-54 $69.70 $83.50 $135.70
55-59 $74.10 $88.00 $145.60
60-64 $78.10 $93.60 $152.00
65-69 $67.00 $74.30 $121.90
70-79 $71.90 $78.70 $122.50
80-89 $74.70 $77.10 $123.00
90+ $99.30 $97.70 $123.60
Couples - per Adult      
<45 $49.80 $58.80 $102.20
45-54 $60.90 $74.00 $124.30
55-59 $65.10 $78.00 $133.70
60-64 $68.60 $83.60 $139.90
65-69 $58.10 $65.20 $111.20
70-79 $62.60 $69.30 $111.40
80-89 $65.40 $68.10 $112.20
90+ $89.20 $88.20 $112.80
1-2 Children - Per Child      
<5 $24.70 $26.40 $35.20
5-20 $29.10 $33.90 $64.40
3+ Children - Per Child      
<5 $22.20 $24.00 $31.60
5-20 $26.00 $30.50 $58.00
Seniors Adjustments      
65+
EHC Lifetime
maximum $260,000		 Dental
No Change
Prescription Drugs
100% of first $430
Travel coverage not available
 Generic Drug Plan
100% first $750
90% next $3,850/yr of costs not covered by the provincial drug plan
Travel coverage not available		 Name Brand Drug Plan
100% first $750
90% next $7,500/yr of costs not covered by the provincial drug plan
Travel coverage not available

All benefits are based on Anniversary year maximums except for Vision and Hearing Aid benefits, which are based on Benefit year. Rates are effective May 1, 2007 and are subject to change without notice. If a family wants to have a plan covering only services by specialized doctors without drug and dental coverage then you should take a look at the next table.

 

INDIVIDUALS
Cost per Month per Adult

 

STAND-ALONES Without a Core Plan
<45 45-54 55-59 60-64 65-69 70-79 80-89 90+
Extended Health Care (EHC) Basic $15.00 $16.00 $16.20 $16.80 $18.30 $19.00 $22.30 $46.60
Extended Health Care (EHC) Enhanced $22.80 $23.60 $23.90 $25.10 $28.00 $29.60 $33.50 $67.40
Hospital
Basic		 $17.10 $15.50 $17.00 $22.40 $28.40 $39.00 $54.00 $68.90
Hospital
Enhanced		 $20.10 $18.30 $20.40 $27.90 $34.70 $48.60 $68.30 $88.00
Hospital
Cash		 $13.50 $14.10 $18.80 $20.00 $28.50 $33.50 $38.70 $45.30
Lifeline $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00
Catastrophic Coverage $16.00 $17.20 $18.30 $19.50 + + + +

 

COUPLES
Cost per Month per Adult

 

STAND-ALONES Without a Core Plan
<45 45-54 55-59 60-64 65-69 70-79 80-89 90+
Extended Health Care (EHC) Basic $11.50 $12.30 $12.70 $13.90 $14.60 $15.30 $18.20 $40.00
Extended Health Care (EHC) Enhanced $18.80 $19.60 $20.20 $21.60 $23.70 $25.10 $28.30 $59.40
Hospital
Basic		 $13.80 $12.10 $13.70 $18.80 $24.40 $33.80 $47.70 $61.50
Hospital
Enhanced		 $16.60 $14.80 $17.10 $22.60 $30.00 $42.40 $60.90 $79.20
Hospital
Cash		 $10.50 $11.30 $15.80 $17.00 $25.20 $29.70 $34.20 $40.30
Lifeline $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00
Catastrophic Coverage $13.70 $14.80 $16.00 $17.20 + + + +

 

CHILDREN
Cost per Month per Child

 

STAND-ALONES Without a Core Plan
Families with one or two children Families with three or more children
0-4 5-20 0-4 5-20
Extended Health Care (EHC)
Basic		 $5.20 $5.70 $4.80 $5.20
Extended Health Care (EHC)
Enhanced		 $9.50 $11.40 $8.70 $10.40
Hospital
Basic		 $7.40 $5.70 $6.30 $5.20
Hospital
Enhanced		 $8.70 $6.60 $7.90 $6.20
Hospital
Cash		 $4.20 $3.40 $3.70 $3.20
Lifeline - - - -
Catastrophic Coverage $9.10 $9.10 $9.10 $9.10

Rates are effective May 1, 2007 and are subject to change without notice. No Travel or Vision Add-Ons are available with the ComboPlus Starter plan. Note: For pregnant applicants, please see Important Notice.

+ Available as a renewal. Please contact Manulife Financial for rates. *Only one Lifeline unit needed per household; rates may be lower depending on location of program administrator. The company Great West Life thinks that a family medical insurance should cover all the services talked about combined. That’s why all plans include all the benefits but with different level of coverage (type 1, 2 and 3). In the year 2007 the company made a type 4, excluding coverage of prescription drugs.

COVERED SERVICES SCALE 1 SCALE 2 SCALE 3 SCALE 4
Prescription Drugs 70% for both generic and brand name prescriptions* 75% for both generic and brand name prescriptions* 90% for both generic and brand name prescriptions* No coverage
$750 maximum per person each calendar year $10,000 maximum per person each calendar year $10,000 maximum per person each calendar year
$5 maximum dispensing fee per prescription $5 maximum dispensing fee per prescription $7 maximum dispensing fee per prescription
Ambulance 100% 100% 100% 100%
Dentalcare
Waiting Period
Deductible**
Routine
Major
Dental Accident Treatment
 
3 month no claims waiting period		  
3 month no claims waiting period		  
3 month no claims waiting period		  
3 month no claims waiting period
$25 per person to a maximum of $50 per family per calendar year $25 per person to a maximum of $50 per family per calendar year $25 per person to a maximum of $50 per family each calendar year $25 per person to a maximum of $50 per family each calendar year
70% for selected routine services 50% for endodontic, periodontal and oral surgery services 60% for endodontic, periodontal and oral surgery services 60% for endodontic, periodontal and oral surgery services
$350 maximum per person each calendar year 75% for other covered routine services 80% for other covered routine services 80% for other covered routine services
$500 maximum per person each calendar year $750 maximum per person each calendar year $750 maximum per person each calendar year
No coverage for major services No coverage for major services 50% for major services 50% for major services
$500 maximum per person each calendar year $500 maximum per person each calendar year
100%
 		 100%
 		 100%
 		 100%
 
Visioncare No coverage 100% to a maximum of $100 per person every two years for lenses and frames, contacts or laser eye surgery 100% to a maximum of $200 per person every two years for lenses and frames, contacts or laser eye surgery 100% to a maximum of $200 per person every two years for lenses and frames, contacts or laser eye surgery
$50 every two years for eye exams  $50 every two years for eye exams  $50 every two years for eye exams 
Paramedicals 70% to a maximum of $300 per person each calendar year for all practitioners combined 80% to a maximum of $400 per person each calendar year for all practitioners combined 90% to a maximum of $500 per person each calendar year for all practitioners combined 90% to a maximum of $500 per person each calendar year for all practitioners combined
In-Home Nursing Benefits and Home Care 100% to a maximum of $2,500 per person each calendar year 100% to a combined maximum of $3,500 per person each calendar year for in-home nursing and home care 100% to a combined maximum of $5,000 per person each calendar year for in-home nursing and home care 100% to a combined maximum of $5,000 per person each calendar year for in-home nursing and home care
Home care not included
Medical Supplies 100% 100% 100% 100%
Hearing Aids No coverage 100% to a maximum of $400 per person every five years 100% to a maximum of $500 per person every five years 100% to a maximum of $500 per person every five years
Preferred Vision Services (PVS) Discount on prescription eyewear at participating outlets Discount on prescription eyewear at participating outlets Discount on prescription eyewear at participating outlets Discount on prescription eyewear at participating outlets

 

* The plan pays for the lower cost alternative - generic or brand name prescription drug, unless the physician has directed that a particular brand name prescription drug not be interchanged.
** The deductible is the dollar amount which must be paid by you before certain benefits are payable under your policy.

 

MONTHLY PAYMENT (Dollars)

 

AGE SCALE 1 SCALE 2 SCALE 3 SCALE 4
Single Couple Single Couple Single Couple Single Couple
< 45 52.96 93.93 74.76 137.52 116.65 222.05 93.32 177.63
45-54 60.37 107.08 85.22 156.78 139.32 265.13 111.45 212.11
55-59 64.47 114.37 91.01 167.44 152.30 289.81 121.84 231.85
60 67.37 119.54 95.12 175.01 161.69 307.63 129.35 246.11
Children < 5 19.84 per child 27.53 per child 36.10 per child 28.89 per child
Children 5+ 21.89 per child 32.37 per child 56.52 per child 44.87 per child

 

 

Along with the plans in both companies you can add additional coverage for additional money like: coverage for semi-private or private room when staying at hospital, bigger expenses coverage at the specialist doctors (this is only in Manulife and that allows you to spend not $400 but already $750 on an individual specialist doctor), 100% credit back on medical expenses in case of a trip overseas (Travel Insurance, Manulife automatically has coverage for 9 days but you can increase the amount of days up to 30). Now, its better to discuss the extra additions with a specialist and choose exactly what’s right for you.

 

 

 

 

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