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The Canadian’s Guide to Green Shield Health Insurance Zone 5

on 14 Oct, 2018

It’s not a secret. Health insurance in Canada is the envy of the world (or at least our neighbours to the south.) Our simple single-payer system sees that good health is a priority. Provincial health services provide basic care for everyone.

But did you know that 75% of all Canadians also carry supplemental health insurance? But what about special or sudden large medical expenses? For expenses beyond basic care, what are your options?

Do you or your family members need assistive devices? Prescriptions? Surgery? What about dental work?

There are insurance choices for your home, your car, your life. What are your options when it comes to health?

Read on to learn more about Green Shield Health Insurance for your family.

Green Shield Health Insurance

Green Shield is a Canada not-for-profit company. It reinvests all profits right back into the health of Canada through research, community health programs, and education. Founded as Canada’s first pre-paid prescription drug program, it has expanded to offer a menu of health and dental plan benefits.

Choices in Coverage

Green Shield coverage varies with your needs and budget. You choose your own benefit eligibility, dollar maximum and frequency limits based on your plan selection. Look for your best combination of benefits.

  • Prescription drugs
  • Dental care
  • Extended health
  • Vision care
  • Private/semi-private and preferred hospital accommodation (optional)
  • Emergency ambulance coverage

There are more than 10 different options to meet your requirements. For families with moderate or growing needs, Green Shield offers competitive coverage.

If your family has no existing medical conditions, the Zone 5 plan has a full menu of benefits to explore.

Zone 5 Benefits

ZONE 5 offers extensive comprehensive coverage for prescription drugs and dental care, vision care, extended health care and emergency travel coverage. It requires a health survey questionnaire.

If there are pre-existing medical conditions, your coverage offer may exclude prescriptions or treatments for your specific pre-existing condition. The survey is as simple as possible and only asks questions needed to evaluate your health.

Prescription Drugs Benefit

The Zone 5 plan offers coverage for generic prescription medications approved for use in Canada. The drugs must be approved by the government and have a DIN. Of course, they require a prescription by an authorized doctor or medical professional.

Coverage exists for brand-name prescription medications if there is no equivalent generic treatment. There are some exceptions, however. Examples of excluded products are: aids to quit smoking, medicines to treat obesity, infertility or erectile dysfunction.

Plan Features

  • Maximum $5,000 per person per year
  • Paid at 90%

Zone 5 plan for Quebec residents requires coverage by the RAMQ (Regie de l’assurance maladie du Quebec) plan first. In Quebec, submit prescription drug claims to RAMQ before Green Shield.

After RAMQ reimburses their portion of the drug cost, unpaid balances may be reimbursed up to 100%. This includes co-payments and deductibles. If the drug is not covered by RAMQ, the standard co-pay applies.

Family Dental Care Benefits

Maintaining good oral health is more than just a pretty smile. It is essential to the quality of life. Dental benefit highlights for the Zone 5 plan are:

  • Maximum Year 1 $700
  • Maximum Year 2 $900
  • Maximum Year 3 and beyond $1,100 per person per year
  • Recall Frequency 9 months
  • 80% paid preventive cleaning
  • 80% paid routine examinations, x-rays
  • 80% paid fillings and extractions
  • 80% paid fluoride treatment for children

For more comprehensive services like Endodontic treatment, Periodontal treatment and Denture repairs the coverage is:

  • Year 1: Paid at 60%
  • Year 2: Paid at 70%
  • Year 3+: Paid at 80%

Major Dental Services are available in Year 3. This includes 50% coverage of:

  • Crowns and onlays
  • Dentures
  • Bridgework

Accidental Dental Maximum is $10,000 per person per year

Obtain more detailed information about dental care insurance and the Zone 5 plan from your advisor.

Health Care Beyond Basic Provincial Services

Professional services by registered therapists to treat certain conditions may be covered.

  • Acupuncturist
  • Chiropractor
  • Chiropodist/Podiatrist
  • Massage Therapist
  • Naturopath
  • Osteopath
  • Physiotherapist

$25 per visit maximum, $500 per person per practitioner, per year.

Other highlights of the plan include:

  • Visits to a Psychologist/Registered Social Worker $500 per person per practitioner, per year maximum.
  • Speech Therapist have a $500 per person per practitioner, per year maximum.
  • Ambulance (land and air) $500 per person every 4 years maximum
  • Hearing Aids maximum $500 per person every 4 years
  • Medical diagnostic tests and x-rays $2,000 per person per year maximum
  • Dialysis equipment $2,000 per person per year maximum
  • Laboratory tests $2,000 per person per year maximum

Zone 5 coverage includes Emergency Medical Travel Coverage Out-of-province or Country. The maximums are 30 days per trip, $5,000,000 per person per year

Extended health services cover the gaps in necessary medical care left by basic provincial services.

Vision Care

Your sight is protected by Zone 5 insurance. If you require correction, the maximums for prescription eyeglasses, contact lenses, laser eye surgery are:

  • Year 1-2: $150 per person every 2 years
  • Year 3-4: $200 per person every 2 years
  • Year 5+: $250 per person every 2 years

Regular eye examinations are covered to a maximum of $80 per person, every 2 years.

Medical Assistive Items and Home Support Services

Medical items for daily living like diabetic supplies, mobility aids, oxygen tanks, braces or hospital-style beds may be covered. Separate maximums for Medical Items and Home Support Services apply.

The maximums are:

  • Year 1: $2,000
  • Year 2: $4,000
  • Year 3+: $6,000 per person per benefit category, per year

Preferred Hospital Accommodation Option

The optional benefit pays for the difference in cost between standard ward charges and semi-private and/or private accommodation in a public general hospital. The optional maximum is up to 30 days per person per year.

All of these benefits and more are available without a waiting period. Coverage begins on the first day of the next month after your application approval.

Need Help to Find the Right Insurance?

We’re here to assist you. Green Shield Health Insurance has more than 10 options to choose from.

Whether you’re a looking for affordable insurance plans for yourself or for a family group – Insurdinary can help find the right company for you. Insurance consumers in Canada are able to browse, compare, and select insurance plans based on premiums and policies.

Have questions or comments? Feel free to contact us.

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