Prevention & Recovery

Understanding your health insurance

Author: Canadian Living

Prevention & Recovery

Understanding your health insurance

This story was originally titled "Understanding Your Health Insurance" in the April 2011 issue. Subscribe to Canadian Living today and never miss an issue!

Provincial and territorial health insurance plans have their limitations, and it's important to know how far your health card will go in paying for the care you need, when you need it.

Q: Is my public health coverage (medicare) maintained if I leave my home province for extended periods?
A:
Generally, you must be a resident of your home province for at least six months of the year, though extensions may be granted for students studying in other provinces and for people who travel frequently as part of their jobs.

Q: Am I entitled to free emergency care anywhere in Canada?
A:
Emergency medical bills you accrue while travelling within Canada (with the exception of Quebec) will automatically be sent to your provincial insurance plan for processing. Just make sure you've packed your valid health card, or you'll be asked to pay for care up front.

Tip: In the event you're asked to pay for emergency care yourself, request an itemized receipt, which you can use to submit a claim with your provincial health-care plan for potential reimbursement. Only original receipts (not photocopies) are accepted when filing a claim.

Q: Does my health card entitle me to arrange tests and treatments outside of my home province?
A:
Only medically necessary procedures which are not available in your home province can be insured, and even then, your doctor or specialist will usually need to apply to your provincial insurance board on your behalf. Once the application is approved, the same billing procedures outlined above normally apply.


Page 1 of 2 – Find out what health care services may not be covered and what to do if you're denied coverage on page 2.
Q: What's missing from my provincial health insurance plan?
A:
Coverage for drugs, dental care and assistive devices such as eyeglasses and hearing aids tends to be extremely limited, and in some cases, nonexistent. Even between provinces, there's substantial variation in what's insured. This is where third-party or workplace health insurance plans come in. According to a recent report from the Health Council of Canada, 58 per cent of Canadians supplement their medicare coverage with privately funded health insurance plans. Many of these plans focus on services that are not covered by medicare, such as dental, vision care and drug plans, and emergency care while travelling outside of Canada. Some private third-party insurance providers offer flexible plans that allow you to tailor the benefits to your needs and the needs of your dependants.

Q: Does the government ever provide extended coverage?
A:
All provinces offer extended drug plan coverage for special-needs groups, including seniors and families on social assistance. Check out canadabenefits.gc.ca or inquire with your provincial health insurance provider to see if you qualify for these additional government-funded benefits.

Q: What can I do if I've been denied essential coverage?
A:
If medicare doesn't cover something that both you and your family physician feel is medically necessary, you have the right to apply for an appeal. Most provinces are equipped with a health insurance services appeal board that will handle any concerns you may have regarding your insurance coverage.

Request receipts
If you or your dependants pay out of pocket for medical services, the expenses can potentially be used to reduce your federal and provincial income taxes. Keep your itemized receipts and proof of payments well-organized, so you can find them easily at tax time. Details on claiming deductions for medical expenses can be found at cra.gc.ca.

Keep your health care current
Having a valid health card is critical to accessing medicare services. Whether you've moved between provinces, changed your name, or have a health card that's due to expire, it's important to review the application and renewal procedures in your province or territory. Visit the Service Canada website for a directory of provincial and territorial health card links.


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Understanding your health insurance

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