Selecting health insurance in Canada can be a complex process. Although your BC health insurance plan covers many products and services, there are still some that are not. Individual health insurance can supplement your provincial coverage and protect you and your family from unexpected medical expenses. But where do you start after deciding to buy additional insurance?
Here are a few questions to ask an agent when buying health insurance for you and your family.
How Much Will Health Insurance Cost?
The monthly premium is not the only cost associated with health insurance. Many plans also have copayments and coinsurance, which are amounts you must pay for services rendered.
Associated costs with health insurance:
- Premium: The monthly amount you pay to maintain coverage
- Copayment: A fixed amount you pay for a covered service
- Coinsurance: A percentage of the cost of a covered service that you pay after meeting your deductible
- Deductible: The amount you must pay out-of-pocket for covered services before your insurance starts paying
When choosing a health insurance plan, it’s important to factor in all of these costs to determine how much you will actually be paying. You should also consider your budget and healthcare needs when choosing a plan.
What Is My Eligibility?
Not all health insurance plans are available to everyone. Some plans offer guaranteed acceptance, while others require you to meet certain criteria, such as being in good health or having a group health plan. Some plans also have age restrictions. Eligibility should be one of the first things you check, before spending time researching the other particulars of a health insurance plan.
In addition to meeting any plan-specific eligibility requirements, you must also have a British Columbia Services Card (or your province of residence) to qualify for private health insurance in Canada.
Does This Health Plan Cover Pre-Existing Conditions?
If you have a pre-existing medical condition, it’s important to choose a health insurance plan that covers it. Some plans cover pre-existing conditions, while others don’t. If you have a pre-existing condition that isn’t covered, you may be responsible for paying for all of the services necessary to treat it.
Considerations for pre-existing health conditions
- Some plans may charge higher premiums for people with pre-existing conditions.
- Some plans may have limits on the amount of coverage they will provide for pre-existing conditions.
- Some plans may require you to complete a medical questionnaire before enrolling in the plan. This is used to assess your health and determine your eligibility for coverage.
Read your policy carefully to understand what is and is not covered for pre-existing conditions. If you have any questions, ask the insurance company.
What Exclusions Does This Insurance Plan Contain?
No health insurance plan covers everything. When choosing a plan, be clear on what is and is not covered. Some plans cover certain services fully, while others partially cover or exclude them altogether.
Common health insurance exclusions:
- Charges to complete claim forms or for missed appointments
- Charges in excess of usual, reasonable, and customary charges in your area
- Services, equipment, and supplies provided in chronic care, transition ward, psychiatric hospital or institution, or long-term care facility
- Services covered by your provincial health insurance plan or drug manufacturer’s assistance program
- Charges for services or supplies due to sickness or injuries resulting from war, participation in any civil commotion or riot, or while serving in the armed forces
- Intentionally self-inflicted injuries
- Injuries sustained while committing or attempting to commit a criminal offense
- Drugs, medicines, services, or supplies that have been self-prescribed or prescribed by or for family members
- Cosmetic or aesthetic procedures, except for reconstructive surgery to repair tissue damaged by disease or injury
- Experimental or medically unnecessary drugs, tests, services, treatments, or supplies
- Duplicate or replacement prosthetic devices or durable medical equipment, unless the existing item is worn out or changes because of your condition
What Are The Health Insurance Plan Maximums?
Most health insurance plans have plan maximums. This refers to the highest amount the plan will pay for a particular service or set of services in a given period of time. Once you have reached the plan maximum for a particular service, the insurance company will stop paying and you will be responsible for any additional costs.
Some plans also have lifetime maximums. This is the highest amount the plan will pay for all covered services over your lifetime. If you reach the lifetime maximum, you will be responsible for all future medical costs.
Tips for choosing adequate health insurance maximums:
- Consider your current and future healthcare needs. If you have chronic health conditions or expect to use your insurance frequently, you will need a plan with high maximums.
- Compare maximums from different plans. Some plans have higher maximums than others.
- Choose a plan that has a lifetime maximum if you are concerned about incurring high medical costs in the future.
When buying a health insurance plan, evaluate the maximums and make sure they are high enough to meet your needs.
Let a Pacific Blue Cross Agent Help
As you can see there are a lot of considerations when it comes to choosing the right health insurance plan. Learn more about the Blue Cross health insurance plans for British Columbians. And don’t hesitate to call us: 1-866-597-6231