Durable Medical Equipment and Personal Health Insurance Plans

When people think of health insurance they usually think of prescription drug coverage, dental coverage and maybe coverage for paramedical services such as physiotherapists and chiropractors.

However, there is another very important type of benefit offered by individual health insurance plans: coverage for durable medical equipment.

What Is Durable Medical Equipment?

Durable medical equipment, also known as durable medical supplies, simply refers to medical devices that are durable and used in some sort of medical capacity.

The following is just a partial listing of durable medical equipment:

• Wheelchairs (and accessories)

• Walkers, canes and crutches

• Oxygen equipment (tents, etc.)

• Patient lifts

• Diabetic medical supplies (blood glucose monitors, pens, needles, etc.)

• Bed positioners

• Scooters

• Hospital beds

• Insulin pumps

• Traction equipment

• Sleep apnea and CPAP (Continuous Positive Airway Pressure) devices

Personal Health Insurance versus Employee Benefits

Before we get into DME (Durable Medical Equipment) coverage we should first explain what personal health insurance (aka “individual health insurance”) actually is.

Personal health insurance is private health insurance that is obtained on an individual or family basis. It IS NOT employee benefits. Employee benefits (aka “group insurance”) are obtained through an employer, do not require any underwriting* and offer relatively high amounts of coverage often paid out at 100%.

Personal health insurance plans tend to have less coverage compared to group plans. They are also cheaper than group insurance and are medically underwritten if they are not guaranteed issue.

Durable Medical Equipment Coverage

All personal health insurance plans offer coverage for durable medical equipment. Oftentimes DME coverage is offered as part of the core coverage, which means that it is not optional.

Both renting and purchasing of medical equipment is covered.

Diabetic medical equipment is of particular interest. There are guaranteed issue health insurance plans that almost pay for themselves once you take into account the diabetic medical supplies that they cover such as test strips, needles, and pens.

Please refer to the following table for DME coverage amounts offered by these common personal health insurance plans that we offer:

Flexcare (Manulife)

• DentalPlus and ComboPlus (Starter) plans

  • $3,500 per year for under age 65

  • $4,000 per year for age 65-plus

    • NOTE: $225 max. per anniversary year for Orthotics, which is part of Durable Medical Equipment.

• DrugPlus and ComboPlus (Basic and Enhanced) plans

  • Maximum per anniversary year is as follows:

    • Year 1: $1,000

    • Year 2: $1,300

    • Year 3: $1,500

    • Year 4: $1,700

    • Year5+: $3,000

• Catastrophic add-on (optional)

  • Additional $25,000 in coverage when annual claims exceed $7,500 per anniversary year. Lifetime maximum of $100,000.

Blue Vision (Ontario Blue Cross)

• Express and Global plans

  • Eligible expenses covered at 80% without deductible:

  • Surgical stocking: up to a maximum of $100 per calendar year.

  • Orthopedic shoes or podiatric ortheses: up to maximum refund of $175 per calendar year for both combined.

  • Purchase or rental of equipment up to a maximum refund of $2,500 per calendar year.

Personal Health Insurance (Sun Life Financial)

• Basic plan

  • Medical equipment and in-home nursing: $2,500/yr max. $20,000 lifetime max combined with medical equipment and services

• Standard plan

  • Medical equipment and in-home nursing: $5,000/yr max. $25,000 lifetime max combined with medical equipment and services

• Enhanced plan

  • Medical equipment and in-home nursing: $10,000/yr max. $30,000 lifetime max combined with medical equipment and services

Sonata (Great West Life)

• Core plan

  • 100% to plan maximum, $100 max. per year for orthotics

• Core Plus and Elite plans

  • 100% to plan maximum, $300 max. per year for orthotics

Conclusion

We hope you found this article about personal health insurance coverage for durable medical equipment helpful.
If you have any questions please contact us. As experienced, licensed Canadian insurance brokers we are here to help!

* “Underwriting” means that the insurance company will investigate the applicant’s medical history and also ask medical and life style questions. Based on the underwriting results a health insurance application is either approved, declined or there is a counter offer.