Explaining The Definition And Terms of Health And Dental Insurance

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What is health and dental insurance? It is an insurance policy against the risk of incurring medical expenses for individuals or families. In Canada, with universal health care, these financial concerns are minimized but there are still a lot of things your provincial health care plan will not handle. This is where supplemental health and dental insurance will fill the gap and offer substantial risk protection away from unforeseen and overpriced medical bills.

An insurance company in Canada can develop a health and dental insurance plan that will handle medically necessary services that are not covered in the provincial health care plan. This is accomplished by viewing the entire provincial population based on age, gender, smoking status, and expected medical usage. Then pricing can be calculated for people in different age groups and other aspects. There are generally discounts for whole families to sign-up a plan together vs each person having their own insurance policy.

Group insurance likewise handles supplemental health and dental insurance. When you are a member of a group insurance plan you normally have prescription drug coverage, medical supplies and services coverage and dental insurance.

What is not covered by your provincial health care plan?

The Canada Health Act requires that all provinces must render free access to “medically necessary services”. These services are basically identified as access to a physician or hospital and the nursing care in a long term care service. There are, although, many expenses that are not insured under the provincial health care plan:

  • Prescription drugs dispensed through a local pharmacy (not from the hospital)

  • Non-emergency dental care (preventative and restorative dental treatments)

  • Ambulance rides

  • Medical services like chiropractic treatments, physiotherapy, massage therapy, psychologist, etc.

  • Medical equipment, like walker, canes, crutches, oxygen tanks, etc.

  • Vision care (eye exams and glasses)

  • Hearing aids

  • Private or semi-private hospital rooms

  • Out of province travel medical insurance (within Canada there are inter-provincial arrangements for medical expenses)

Universal and free health care in Canada does not insure everything. Luckily for Canadians, the big medical expenses like hospital care and visiting a doctor are covered. There are also many health care financed projects for in home care, people coping with mental illness, childhood developmental support, etc. which are also included by the provincial health care plans (to varying degrees in different Canadian provinces).

The common expenses listed above can also count up to substantial monthly expense. Recognizing that you will not have to pay 100% of the cost of drugs or dental care provides most Canadians peace of mind that they can access the medical treatment they need and remain within their monthly budgets.

How health and dental insurance takes effect

A health and dental insurance policy usually takes effect by a covered expense presented to the insurance company for reimbursement. New technology has helped make many of these claims sooner and a lot easier. Instead of the individual paying for the expense and then mailing in claim forms (the traditional way of making a claim) a pharmacy or dental office can digitally present the claim on your account and the included portion of the claim is settled immediately to their business.

Some medical professionals can not yet do this, just like massage therapy and physiotherapists. In this situation there is either the old mail in claim forms or now online claims systems that make passing your claim a snap.

Co-Pay: Most insurance plans do not pay 100% of the claim. They will cover 80% for instance. The 20% that the individual has to pay is called the co-pay portion. This co-pay amount is put into policies to help control expenses. The theory is that if people have to pay any amount of money, even if it is a small percentage of the total cost, they will think twice if they really need the medical treatment or not before spending money. Hopefully, the co-pay portion of your policy never holds you back from seeking the treatment and medicine your need to feel healthy again!

Maximum benefits: Another way to control costs is by having annual and/or lifetime maximums on the policy. These maximums will prevent people from incurring a huge medical expense in one year and then cancel their policy the next year and stop paying premiums. The most common place people see annual maximums is on their dental insurance coverage. The amount the insurance company is willing to pay out is based on the how old the policy is and the level of coverage purchased. A more complete dental insurance plan covers restorative dental like crowns, bridges, on lays, etc. A standard dental insurance plan will only handle standard servicing, like cleanings, check-ups, fillings and extractions. The maximum per annum payout is normally set lesser in the first year of the policy and then grows into years two and three. This allows the insurance company to collect 1 or 2 years premiums prior to paying it back for the most pricey dental procedures.

Why you need health and dental insurance?

Why do you need health and dental insurance if the Canadian government pays for all major expenses like hospital care? It is well recorded that people not having supplemental health and dental insurance are likely to have a lower quality of overall health. There are still vital financial boundaries to getting the treatment and medication needed to function properly without health insurance. Dental care can be suspended, allowing issues to grow from minor preventative issues in emergency dental care treatments that requires hospitalization. People who are on a budget and can’t bear prescription drugs tend to have more medical difficulties than those who can get the medication they need to feel better.

What is Health and Dental Insurance – Discover more from Life Guard Insurance

If you are without health and dental insurance and can suit this type of premium into your monthly budget, you would be advised to have coverage vs going without. If you are interested in finding out more about health and dental insurance in your province, feel free to contact Life Guard Insurance.


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