Extended Health Benefits (Optional)
While some provincial health plans cover many major health costs, they may not cover certain treatments and services that are essential to a comprehensive course of medical care. EHC insurance makes it affordable for you to cover the cost of health services and supplies not paid for under Provincial plans.
Components of the EHC
· Drug coverage • Medical supplies and equipment • Paramedical services • Out-of-province coverage · Other health care benefits • Hospital coverage
Drug Coverage
Prescription drugs account for the largest item of an employer's total costs for a health care plan, typically accounting for 60-80% of the claims.
There are two basic methods for reimbursing of drug claims:
1. Reimbursement plans, where the insured pays the pharmacist for the drugs and submits the bill to the insurer for reimbursement.
2. Pay direct drug plans, where the person insured presents a drug insurance card (issued by the insurance company) to the pharmacist who, in turn, bills the insurer directly.
Deductible Options (the portion the insured has to pay): Per Prescription - $0, $2, $5 or $10, or Dispensing Fee Cap $5, $6.50, $7.50 or $8, or = Dispensing Fee, or Annual Deductible - $25/$50 single/family, or $50/$100 single/family, $250/$500 single/family.
Maximum: Unlimited or $2,000 per certificate per benefit period
Coinsurance Options (the portion the plan pays):100%, 90%,80%, 5%,70% or 60%
Medical Supplies and Equipment
Reimbursement for supplies and the rental of or purchase of durable medical equipment including: Hospital beds, wheel chairs, canes, crutches, walkers and trusses, Orthopaedic shoes and orthotics, Prostheses, braces for back, neck, arm or leg, Oxygen and oxygen supplies, Colostomy apparatus and supplies, Support hose and compression stockings, Kidney dialysis equipment, Hearing aids.
Paramedical Services
This benefit covers charges, including x-rays, for paramedical practitioners like:
Chiropractor, osteopath, naturopath, podiatrist, acupuncturist, masseur, speech therapist, psychologist, psychoanalyst (Quebec only), and physiotherapist. Reimbursement is subject to an annual maximum (commonly $300- $500 per practitioner per calendar year). Reimbursement is based on the "reasonable and customary" charges for the insured's province of residence. Most services require a physician's referral.
Out-of-Province Emergency Medical
This benefit provides coverage for out-of-province emergency medical expenses for an insured person who is traveling outside his or her province of residence. The benefit typically covers a period of up to 60 days of continuous travel. Covered expenses normally include: Hospital room and board, Hospital out-patient services, Services and supplies, Diagnosis and treatment by a physician, Ambulance, Travel Assistance
Other Health Care Benefits: Other medical expenses typically covered under an Extended Health Care plan include the following: Private Duty Nursing - Accidental Dental - Convalescent Hospital Care-Ambulance Service-Vision Care (with groups of 5 or more employees).company.
