What is the health policy? How fundamental and convenient is it in Canada? What are the guarantees offered by the health policy? What is meant by restrictions and what are the limitations of health insurance? What to consider to carefully choosing the most appropriate policy for your needs?
In Canada, the national health system protects all citizens on all possible medical treatments; therefore, it is sufficient to go to any hospital to receive the necessary assistance.
When, on the other hand, health insurance is used, the purpose is quite different. In this case, in fact, the insurance premium serves to protect the insured from possible loss of money caused by the disease, or to compensate the same from the costs in case of hospitalization for specialist care in a private clinic.
Therefore, the health policy is nothing more than a contract stipulated with a company, which proposes to guarantee protection to the insured in the event of illness and medical expenses, in exchange for an annual fee to be paid, as an insurance premium.
Before signing a health policy, it is necessary to fill in a questionnaire, with which the insurance company ascertains the state of health of the insured; the latter, moreover, must correctly answer the questions posed, under penalty of losing any right to compensation.
Is It Convenient to Stipulate a Health Policy in Canada?
In our country, health policies are not very widespread, as the National Health Service allows you to take advantage of all the benefits in this regard, in fact, for this reason, for a long time, health insurance was seen as a duplication of assistance. Public, therefore useless.
Unlike what happens in other countries of the world (for example in the United States of America), where it is not possible to take advantage of public health care for everyone, therefore it is necessary to find a private alternative to this way, in Canada, it is not really mandatory or necessary: it becomes so, in the event that the illness is serious, or even forces the insured into situations of invalidity.
The health policy in Canada, in fact, useful in case urgent, specialized and private services are needed and to avoid losing large sums of money due to some illness.
Health insurance, in fact, allows you to keep your income, otherwise lost, during the period during which you are unable to continue your work.
Within the Canadian territory, health policies have not been very successful so far, as they are very expensive and not compared to national coverage, which allows you to take advantage of many more guarantees, such as, for example, the costs for preventive diagnostic tests.
What are The Advantages of Health Insurance Policies?
Health insurance distinguishes between full and partial policies.
While the former cover medical expenses for illnesses, accidents or surgery, the partial ones, on the other hand, concern illnesses and serious operations, indicated in the conditions of the policy.
Health policies can provide for three types of compensation, namely the following:
- compensation in the event that the disease has caused permanent disability
- compensation on a daily basis
- Compensation for medical expenses required at private facilities.
In the first case, the invalidity is established according to a reference table provided by the Ministry of Health; in Canada, health policies for permanent disability are already activated for damages exceeding 26%; in this case the policy is defined as complete, as it allows to cover all the expenses necessary for the care of the patient.
The second type of compensation is valid for hospital admissions, in cases of convalescence and post-hospitalization, but does not cover the costs related to the home stay.
The third indemnity, on the other hand, allows to cover the expenses foreseen for the treatment of diseases in private and specialized structures: from simple hospitalization to surgical intervention. The latter case refers to the partial coverage that companies offer for very expensive operations.
The economic advantages of insurance policies are linked to the fact that the insured can stay in private clinics with which he does not pay anything, as the costs are covered by the premium.
However, in the event that the insured goes to non-affiliated clinics, then the company will reimburse the expenses, applying an overdraft of 20% and 30%.
The health insurance can reimburse a number of expenses arising from hospital fees , the physiotherapy expenses , from interventions , to the care and the necessary medicines.
The companies also make it possible to cover the expenses for food and accommodation for the accompanying persons of the sick person, as well as for the ambulance transport of the patient .
In addition, health insurances cover all expenses that are incurred before admission (usually within 90 days before any intervention), as in the case of investigations: the treatments and analyzes must be relevant to the illness or injury that has occurred. led the insured to hospitalization. The insurance coverage is also valid for expenses incurred after hospitalization or surgery.
What Are The Exclusion Clauses Of Health Policies?
As with all other types of insurance, health insurance also includes restrictive, exclusionary clauses which exempt the companies from compensating the insured .
These cases relate to events like the abortions (non-therapeutic, then performed to protect the health of the mother), malformations, dental care (unless they are a direct result of an accident or a malignant tumor), mental illnesses and cosmetic surgery .
Furthermore, the insurance does not cover cases of alcoholism, drug addiction, AIDS or schizophrenia, but also diet-related care, vision correction, maintenance and repair of prostheses .
The termination clause of the coverage, after the settlement of the first claim , allows the company to cancel the insurance contract following the first case in which a state of illness has already been compensated.
What Does the Accident Policy Mean?
The accident policy allows you to protect the insured from any violent or unforeseen event, which causes serious physical injury .
Accident insurance can cover a variety of situations ranging from temporary disability , guaranteeing a daily contribution for each lost job, up to the most serious case of permanent disability , for which compensation is provided equal to a percentage proportional to the consequences caused by the ‘accident.
The most serious case is that of death of the insured and those who benefit from the insurance premium are the heirs of the same. This type of insurance, together with that for permanent disability, are more suitable for single-income families or for those who perform very risky tasks.
The policy for temporary disability, on the other hand, is used by freelancers or self-employed workers, who do not provide sick days during their annual work.
What Should You Evaluate to Choose The Most Suitable Health Policy For Your Case?
In order to correctly choose your health policy, it is advisable to evaluate a series of aspects and points, present within the contract, so as to take out insurance in complete tranquility, knowing all the advantages and risks that one runs.
To obtain health insurance compensation, you must submit all documentation required by your company, including certificates, medical records, and receipts of all expenses for which compensation are sought.
One of the points to be carefully considered is the ceiling, or the highest sum that a company can compensate, in the cases provided for in the insurance contract. The higher the ceiling, the higher the premium to be paid; in particular, the following indications apply:
if the ceiling refers to each individual insured, the company reimburses the amount established annually, as well as the insured parties are required to pay the proportional amount provided for in the contract;
if the ceiling refers to the family unit, the compensation (as well as the premium to be paid) will be maximum, regardless of the insured persons, members of the family unit;
In the event that the ceiling is unlimited, the insurance coverage is able to guarantee total compensation for all medical treatment and expenses.
In addition to assessing the amount of the ceiling and the proportional amount of the insurance premium to be paid, it is also advisable to pay attention to the repayment methods . In some cases, in fact, when the insured decides to be treated in hospitals agreed by his company, the latter guarantees the coverage provided for by the contract, without paying any sum, therefore the reimbursement will be direct.
On the contrary, when an insured person decides to be treated in a non-affiliated facility, it is possible that the company compensates the sick person only afterwards, therefore, forcing him to pay for all the indispensable care for the disease out of his own pocket.
Before choosing the health policy that suits your needs, therefore, it is essential to do what is listed below:
- identify your needs;
- compare as many offers as possible, evaluating the pros and cons of each, based on your requests;
- evaluate all quotes, considering not only the premium to be paid, but also all the guarantees offered by the company;
- If you have enough cash, it is always advisable to reach out for a personalized, mixed-coverage health policy.