|
Правительственная програма OHIP (бесплатное медицинское страхование) покрывает, к сожалению, не все затраты
на лечение. Вызов скорой помощи, лечение и протезирование зубов, оплата лекарств и некоторых специалистов,
посещение глазного врача и многое другое ложится финансовым бременем на семью в случае необходимости получения
таких медицинских услуг. Это замечательно, что на работе нам предоставляют бенефиты, которые позволяют
оплатить большую часть затрат, связанных с таким медицинским сервисом. Но, к сожалению, бенефиты на работе
имеют не все. Кто-то просто работает на себя, кто-то открыл свой бизнес или имеет контракт сегодня. Такие
люди не имеют бенефитов и если они хотят, то могут их приобрести за свой счёт. Государство разрешает тем,
кто имеет свой бизнес или работает по контракту, относить затраты на оплату медицинской страховки к расходам,
снижающим сумму дохода, облагаемого налогом. Обязательно проконсультируйтесь о налоговых льготах у своего
бухгалтера.
На рынке индивидуального медицинского страхования работают всего несколько компаний. Цены у всех
приблизительно одинаковы. Я, конечно же, могу предложить любую компанию, но ниже приведу условия и цены
такого страхового покрытия только двух компаний: Manulife Financial и Great West Life. Эти компании подходят
к решению данного вопроса по разному, поэтому я и хочу показать обе. К тому же, может быть, у вас есть
определённые предпочтения, основанные на вашем опыте работы с какой-то из компаний в то время, когда вы или
ваши друзья имели на работе групповые страховки.
Сначала расскажу о том, чем отличаются Manulife и Great West Life в подходе к данному продукту. Персональная
медицинская страховая программа, в принципе, включает в себя 3 главных направления: оплата лекарств,
возмещение затрат на зубного врача и тех врачей специалистов, оплата услуг которых не покрывается
бесплатной медициной.
Компания Manulife предлагает на выбор несколько направлений, исходя из того, что семье, чаще всего, нужно
что-то конкретное, например, только оплату врачей. Набор оплачиваемых услуг можно выбирать - только врачей
специалистов и оплату зубного врача или только лекарства и специалисты и т.д. Естественно, можно выбрать
комбинированный пакет со всеми услугами.
Хочу заметить, что не существует страховой программы, в которой было бы покрытие только услуг стоматолога,
обязательно ещё будет добавлено что-то. Дело в том, что, в основном, все пользуются услугами стоматолога
и компании просто невыгодно платить бесконечные dental claims, т.к. будет отсутствовать страховой принцип -
кто-то пользуется страховкой, кто-то нет.
Ниже приведены цены и перечислены условия различных планов в компании Manulife. Первая таблица показывает
вам стоимость планов, покрывающих услуги стоматолога (Dental Plus) и оплату лекаств (Drug Plus). Возмещение
затрат на врачей специалистов, услуги которых не покрываются бесплатной медициной в оба эти плана входят
автоматически (Core Benefits). Вторая таблица показывает вам стоимость комбинированного плана, покрывающего
услуги стоматолога, оплату лекаств и врачей специалистов, услуги которых не покрываются бесплатной медициной
(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.
Если же у семьи есть желание иметь план, покрывающий только врачей специалистов, без стоматолога и лекаств,
то вам нужно посмотреть следующую таблицу.
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.
Компания Great West Life считает, что семейная страховка должна включать в себя все бенефиты и поэтому её
планы включают в себя все направления с разным уровнем покрытия (Вариант 1,2 или 3). С 2007 года компания
сделала 4-ый вариант, без оплаты лекарств.
| 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. |
МЕСЯЧНАЯ ОПЛАТА В ДОЛЛАРАХ
| 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 |
К существующим вариантам в обеих компаниях можно докупать дополнительное страховое покрытие, такое как: оплата
двух или одноместной палаты в госпитале (semi-private or private room), расширенное возмещение затрат на лечение
у врачей специалистов, услуги которых не покрываются бесплатной медициной ( это существует в компании Manulife
и вы можете на одного специалиста потратить не $400, а уже $750), 100%-ое возмещение медицинских затрат в случае
путешествия за границу (travel insurance, Manulife автоматически имеет покрытие на 9 дней, но вы можете увеличить
количество покрываемых дней до 30) и т.п. Лучше будет, если вы обсудите любые дополнительные варианты вместе со
специалистом и выберете то, что нужно именно вам.
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