Catastrophic Coverage and Health Insurance
By Krista DeKuyper | September 22, 2015 |
Introduction
Most Canadians will never go through financial hardships due to doctor’s bills or hospital stays. This is due to the nature of the Canadian healthcare system, where Canadians pay for their healthcare up front via taxes.
There is one exception to this, however, and that is prescription drug costs. Most of the time provincial healthcare plans do not cover these drug costs, even if they are medically necessary.
Just a couple of examples of medically necessary drugs that are not paid for by Canadian provincial healthcare plans are kidney replacement drugs and anti-rejection drugs for organ transplant procedures.
As a result it is possible for Canadians to get into serious financial trouble due to drug costs that must be paid for out-of-pocket.
This is where catastrophic coverage comes into play!
How Catastrophic Coverage Works
Catastrophic benefits offer coverage for prescription drugs, home care and nursing services, prosthetic appliances (e.g. artificial limbs) and durable medical equipment such as wheelchairs, crutches, etc.
Catastrophic coverage only kicks in once coverage via a health insurance plan has run out.
It is important to understand that catastrophic coverage works in conjunction with health insurance plans, either individual health insurance or employee benefits. It is designed to protect a person from huge medical bills primarily due to high drug costs as a result of sickness or an accident.
Benefits commence once the deductible limit has been reached. The insured person submits all eligible receipts, and after the deductible limit is reached the insured person starts receiving compensation.
Catastrophic Coverage via Flexcare® Health Insurance
Catastrophic coverage is available in Canada via the Flexcare® health insurance plan. Flexcare® is a very flexible plan offered by Manulife Financial that offers two types of benefits: stand-alone coverage or core plans with add-ons.
Catastrophic coverage can be added to a core plan as an add-on or it can be purchased as a stand-alone benefit.
There are also two levels of deductibles: $4,500 and $10,200. These deductibles are not paid by the insured person. Rather, they are the amounts that must be paid out by an existing health insurance plan before the catastrophic benefits start (oftentimes the existing health plan is a core Flexcare® plan).
The cost of catastrophic coverage ranges from $10/month to $24/month, depending on the age of the insured and the deductible amount.
Catastrophic Coverage Amounts
The following describes the amount of catastrophic coverage available via a Flexcare® health insurance plan:
| Catastrophic Coverage: $4,500 deductible |
Catastrophic Coverage: $10,200 deductible |
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| Prescription drug coverage | Unlimited 100% coverage when qualifying annual prescription drug expenses exceed $4,500 per person per year. | Unlimited 100% coverage when qualifying annual prescription drug expenses exceed $10,200 per person per year. |
| Coverage for homecare and nursing, prosthetic appliances, and durable medical equipment | • Additional $25,000 coverage that commences when annual claims exceed $7,500 per person per anniversary year • Lifetime maximum of $100,000 |
• Additional $25,000 coverage that commences when annual claims exceed $7,500 per person per anniversary year • Lifetime maximum of $100,000 |
Also note that if an insured person ends up in the hospital for more than 24 hours as a result of an accident then the catastrophic coverage will provide unlimited chiropractor and physiotherapist benefits for one full year following that accident!
Conclusion
Catastrophic coverage is an affordable way to protect a person’s loved ones from high prescription drug costs resulting from an illness or accident.
It costs less than a dollar a day and can be bought as either a stand-alone product or as an add-on to a Flexcare® core plan.
Affordable and easy to get!
