5 Fast Facts About Employer Health Insurance Laws

Posted on November 30, 2018

Since most Canadians are covered by the national healthcare system, there aren't a lot of people who get their health insurance through their workplace. However, many employers offer supplemental insurance or separate comprehensive care. Employer health insurance laws require business owners to pay a required tax every year in some provinces to keep the system running.

Here are five facts about health insurance in Canada that every employee should know.

1. Doctors Don't Work For the Government

People outside of Canada assume that doctors in their publicly funded healthcare system must be employed by the government. This isn't the case.

Canada has a robust and publicly-funded healthcare system but only a small minority of doctors work for the government. Patients are allowed to choose their doctor and are entitled to health services no matter what. There is no charge for anyone who is in need of basic care.

However, doctors are self-employed and manage their own schedules. They choose where to set up their practices and manage their own offices. All of their overhead comes out of how much they make from billing the government for services they provide to patients.

The government has a robust system of account managers and inspectors who ensure that no doctors can take advantage of this system. Doctors earn their money fairly through a billing system laid out by the government. While the government sets the fees and rates that they'll be repaid, they don't have to worry about getting paid on time because it's publicly funded.

2. There's No Single Healthcare System

While people outside of Canada love to talk about the Canadian healthcare system like a monolith, it's not just one thing. There are actually 15 different systems operating at the same time. Every single province has it's own system and territories can operate independently.

The Canada Health Act describes the basic form of healthcare, that it's universal and accessible, but outside of that, localities fill it in. The basic tenets of the system require care to be accessible across the country, but the details are up to the provinces and territories.

Each system operates based on its own rules. What is covered and how the care is given is decided provincially based on local advisory committees and elections.

The system also ensures that there are ample Aboriginal and Veteran care. There are special rules determining how this care is administered and under what circumstances.

With the provincial rule of healthcare systems, each province is empowered to decide what's best for their residents. This gives immense power to the democratic system. However, when major overhauls or reforms are required, it takes significant effort to make it happen.

3. The Law Doesn't Require Equality

While the Canada Health Act requires those most essential care elements be provided to everyone and paid for by the government, the details are tricky. Every province gets to determine what's truly essential. They get to lay out what healthcare services they'll provide and what they'll pay for.

They even get to set the standards of who provides care and where it gets delivered. The details are all locked up by the provinces.

Quebec has a system that includes a broad range of treatments like fertility medicine. No other provinces provide this.

Some provinces pay for licensed midwives to help deliver children, while others won't pay for this. Even therapies that are linked to autism care can go unfunded depending on where you live. The issue of abortion continues to be divisive, not seen generally as healthcare, and services are not equally distributed across Canada.

While people in the United States are constantly raving about the drug prices in Canada, Canadians are still forced to pay for them out of pocket. The Canda Health Act doesn't cover them.

Home care, long-term care, and other types of end of life care aren't covered by the CHA, leaving a lot of older Canadians feeling left out.

4. Physicians Can't Charge For Covered Services

If a certain service is covered by the insurance terms of the province and the CHA, there can be no bill submitted. These so-called "user fees" are illegal when the treatment is already covered by the healthcare system.

However, some family doctors and PCPs will charge "annual fees" to cover the services they offer. While these are within the letter of the law, they can't be for anything related to essential services. They are often contained within a comprehensive package of healthcare services.

If you miss an appointment, it's up to your doctor whether or not they'll charge you. They might even charge you for any work done over the phone, like prescription refills or referrals.

Since they aren't reimbursed, they may seek some money for these services.

5. Financing is Both Public and Private

Canada doesn't have a true "single payer" system. There's a shared responsibility to pay for full care between Canadians' out of pocket fees and what they get from the government.

Across the country, more than half of all the money spent on prescription medication comes out of private funds. That means that the government isn't providing significantly more than the average resident does for their medication.

Out of all of the states the provide universal healthcare, Canada is the only one that still charges for drugs. Because the government doesn't cover full dental or eye care as well, Canadians are just as likely as Americans to have supplemental insurance.

Employer Health Insurance Laws Are Provincial

Depending on which province you operate in, employers have to pay a different amount for your employees' health care. In some provinces, employers provide supplemental care while in others they help fund the system.

If you're an employer who of provides disability insurance for your employees, check out our guide to find out more information.

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