Personal Health Insurance

The government program OHIP (free medical insurance) unfortunately does not cover all costs of treatment. Dialling 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 1 company. This will give you idea how this plan is working

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, Health Service Navigator*, Preferred Vision Services (PVS), 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 $400; 50% of next $860
Total payable per anniversary year in Year 2+: $750
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: 70% of first $1,200
Total payable per anniversary year in Year 1: $840
Year 2 and beyond: 100% of first $500; 60% of next $700
Total payable per anniversary year in Year 2+: $920
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% of first $750
90% of next $4,972
Total benefits payable per year: $5,000
Full coverage of reasonable and customary dispensing fees*
Exclusions – smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, erectile dysfunction drugs and drugs not requiring a prescription
Brand-Name Drug Plan
90% of first $2,222
100% of next $8,000
Total benefits payable per year: $10,000
Brand-name 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, erectile dysfunction drugs and drugs not requiring a prescription
AGES: Single Adults DentalPlus – Basic DentalPlus – Enhanced DrugPlus – Basic DrugPlus – Enhanced
<45 $73.10 $119.50 $56.40 $86.80
45-54 $76.50 $143.10 $64.90 $90.00
55-59 $77.40 $146.00 $74.20 $100.60
60-64 $79.40 $147.80 $80.90 $110.60
65-69 $78.90 $142.70 $58.20 $74.70
70-79 $79.60 $140.20 $65.00 $82.20
80-89 $80.10 $134.50 $72.50 $96.20
90+ $104.20 $138.80 $105.90 $134.70
Couples – per Adult        
<45 $60.30 $100.60 $46.60 $74.00
45-54 $63.30 $121.70 $55.50 $77.50
55-59 $64.10 $124.90 $64.00 $87.70
60-64 $66.40 $125.90 $70.60 $97.10
65-69 $65.30 $121.20 $48.90 $63.10
70-79 $66.50 $119.00 $55.40 $70.20
80-89 $66.40 $113.50 $62.90 $83.00
90+ $89.50 $117.40 $94.90 $119.70
1-2 Children – Per Child        
<5 $21.30 $24.60 $26.20 $38.70
5-20 $36.90 $75.70 $21.00 $28.30
3+ Children – Per Child        
<5 $19.40 $22.40 $23.90 $34.70
5-20 $33.30 $67.90 $18.90 $25.50
Seniors Adjustments        
65+
EHC Lifetime
maximum $260,000
Travel coverage not available Travel coverage not available Generic Drug Plan
100% of first $750
90% of next $4,722/yr for costs not covered by the provincial drug plan

Travel coverage not available

Brand-Name Drug Plan
100% of first $750
90% of next $10,278/yr for 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, Health Service Navigator*, Preferred Vision Services (PVS), 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 $575
Total benefits payable per year: $400
PRESCRIPTION DRUGS:
Generic Drug Plan
70% of first $750
Dispensing Fee Cap: $6.50*
Total benefits payable per year: $525
Exclusions per DrugPlus Basic
Escalating yearly maximum for Home Support, Durable Medical and Prosthetic Appliances
No medical Questionnaire required.
DENTAL:
Ongoing Maintenance
9-month recall

80% of first $400
50% of next $860
Total benefits payable per year: $750
PRESCRIPTION DRUGS:
Coverage as outlined in DrugPlus Basic
DENTAL:
Ongoing Maintenance
6-month recall

100% of first $500
60% of next $700
Total benefits payable per year: $920
Combined maximum year 1: $400 and combined maximum of $1,250/3 years:
Oral Surgery, Endodontics, Periodontics:
Year 1 & 2: 60%
Year 3 and beyond: 80%
Major Restorative:
Year 1 & 2: 0%
Year 3 and beyond: 60%
PRESCRIPTION DRUGS:
Coverage as outlined in DrugPlus Enhanced
AGES: Single Adults ComboPlus – Starter ComboPlus – Basic ComboPlus – Enhanced
<45 $76.70 $87.20 $144.60
45-54 $92.30 $108.10 $174.20
55-59 $98.10 $114.10 $187.00
60-64 $103.40 $121.20 $195.10
65-69 $88.70 $96.30 $156.70
70-79 $95.00 $102.00 $157.30
80-89 $98.80 $100.00 $157.80
90+ $131.50 $129.00 $158.70
Couples – per Adult      
<45 $65.90 $76.30 $131.20
45-54 $80.60 $95.90 $159.60
55-59 $86.10 $101.10 $171.70
60-64 $90.60 $108.20 $179.70
65-69 $76.90 $84.40 $142.90
70-79 $82.90 $90.00 $143.20
80-89 $86.60 $88.20 $144.10
90+ $118.00 $116.60 $144.70
1-2 Children – Per Child      
<5 $32.70 $34.20 $45.20
5-20 $38.50 $44.10 $82.70
3+ Children – Per Child      
<5 $29.40 $31.10 $40.60
5-20 $34.30 $39.50 $74.50
Seniors Adjustments      
65+
EHC Lifetime
maximum $260,000
Generic Drug Plan
100% of first $750/yr for costs not covered by the provincial drug plan.
Full coverage of reasonable and customary dispensing fees.*
Travel coverage not available
Generic Drug Plan
100% of first $750
90% of next $4,722/yr for costs not covered by the provincial drug plan

Travel coverage not available

Brand-Name Drug Plan
100% of first $750
90% of next $10,278/yr for costs not covered by the provincial drug plan

Travel coverage not available

*Subject to applicable co-payment.
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, 2014, and are subject to change without notice.

Along with the plans you can add extended coverage for additional money like: coverage for semi-private or private room when staying at hospital, bigger expenses coverage at the specialist doctors, 100% credit back on medical expenses in case of a trip abroad (Travel Insurance, Manulife automatically has coverage for 9 days but you can increase the amount of days up to 30). Now, it’s better to discuss the extra additions with a specialist and choose exactly what’s right for you. We are always ready for you.