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All Your Questions Answered About Health Insurance Benefits in Canada

on 29 Dec, 2018

Every year, Canadian emergency departments cater to millions of patients. In fact, between 2014 and 2015 alone, there were over 10 million patients who visited EDs!

Although reasons for the visits vary, many of them share a common denominator. That similarity is that many patients enjoyed free healthcare services.

It’s all thanks to the public health insurance benefits in Canada. Mind you, that’s only one of the many other benefits of Canada’s health insurance. Which is why if you haven’t applied for one yet, there’s no other better time than now to do so.

Navigating the country’s healthcare system shouldn’t be a pain, but it can be confusing. If you’re confused about what health insurance is, what’s covered and what’s not, this post is for you.

What Public Health Insurance Plan Options are There in Canada?

The U.S. News and World Report ranks Canada’s public healthcare system third best in a list of 10. Even Nordic Business Insider acknowledges it as one of the best in the world. That’s because the Great White North does have one of the best public healthcare plans.

For instance, in Ontario, there’s the Ontario Health Insurance Plan (OHIP). With this insurance, the province will cover you for many health services you need. You need to sign up for it though and go through a three-month waiting period first.

Once your application receives approval, you’ll then get your Ontario health card. This card serves as proof you’re OHIP-insured, so be sure to bring it with you always.

OHIP benefits are almost the same as other provinces, such as BC’s Medical Services Plan (MSP).

What Do these Health Insurance Plans Cover?

Again, this depends on the exact provincial insurance plan. In general, they cover most “medically necessary” services.

For instance, OHIP coverage includes paying for most, if not all doctors’ visits. The medically-necessary rule once again applies in these cases. But whether it’s your family doctor or one from another clinic, OHIP covers the fees for these visits.

Most public plans also cover diagnostic services required by hospital doctors. These include as x-rays and blood tests. The insurance also covers the costs of seeing hospital doctors and nurses.

What About Hospital Stays?

Since most hospital stays are doctor-required, public health insurance pays for them too. The same goes true for the meals during your hospital stay. The in-patient medications required by your doctors are also covered.

Are Dental Services Also Covered?

If the dental surgeon needs to perform the procedure in a hospital, your public health plan may cover it. These surgeries are often more complex in nature, which is why they’re done in hospitals.

Some examples are dental fracture repairs and tumor removal. Public health insurance also often covers medically necessary reconstructive surgery.

You may also get coverage if your dentist deems tooth removal medically-needed. Although some provincial healthcare systems, such as OHIP, need to pre-approve them first.

Can I Also Get Eye-Health Services for Free?

This depends on which provincial insurance you have. For instance, those with OHIP can get a free major eye exam every year. But this only applies to people who are 19 years old or younger, as well as 65 years or older.

What about those between 20 and 64 years old? You may get coverage if you have a specific eye condition that needs constant monitoring. OHIP pays for one major eye exam every year, as well as required follow-up appointments.

Under OHIP, this coverage is for those who have diabetes, glaucoma, and cataract. Corneal disease and retinal disease among several others are also covered.

Are There Covered Foot Health Services?

Most public health insurance plans also cover some podiatry services. For instance, if you see an OHIP-registered podiatrist, your insurance covers up to $16 of the visit. The total coverage for an entire year has a $135 cap.

OHIP also provides up to $30 coverage for x-ray services. Any excess to these, you’ll have to pay on your own.

What are the Exclusions of Provincial Health Insurance Plans?

Public health insurance doesn’t cover any other healthcare service not considered necessary. Again, this may vary from province to province, but they share almost the same exclusions.

For example, most plans don’t pay for tests like annual complete body examinations. There are the excluded dental restorations too, like fillings, caps, crowns, and bridge. Dental services that you get from a dentist’s office are also considered exclusions.

How about prescription medicines outside of a hospital? Let’s say your family doctor prescribed antibiotics, your insurance won’t cover it.

You’d also have to pay for eyeglasses, contact lenses, and laser eye surgery. If you need these medical appliances or procedures, you need to shell out your own money for them. To avoid these out-of-pocket expenses, you should consider getting private insurance.

What is Private Health Insurance?

As awesome as the Canadian healthcare system is, it is still quite limited. Especially when it comes to dental services. Since dental services are not what you’d called cheap, many choose to skip dentist’s visits.

No wonder then that almost all Canadian adults (96%) have had dental cavities! Kids aren’t doing any better, with dental ailments causing them to miss 2.26 million school days each year.

The good news is, many private health insurance plans offer dental coverage. They help pay for most or at least some of what public insurance doesn’t.

Great news, right? But that’s only one of the many other benefits of extra health insurance.

It covers many other preventative services, most of which public insurance doesn’t cover. These treatments are those that can help you keep your health in check. Plus, a private health plan can also help you pay for prescription medications.

In essence, private health insurance bridges the gap left by public health insurance. You’d have to pay for it, of course, but it’ll help bring your healthcare costs down considerably.

Enjoy Greater Peace of Mind with the Health Insurance Benefits in Canada

Granted, public health insurance benefits in Canada already helps reduce healthcare cost. But because it’s not all-inclusive, you may find it inadequate for your health or that of your family. That’s why you should still consider getting private health insurance.

Once you’re ready to start looking for a private health insurer, check this list of tips out. It’ll help make finding the best insurance provider less stressful. Also, be sure to pay our site’s Health Insurance section a visit for more guides and how-tos!

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