When people consider living in Canada, 'free healthcare' commonly comes to mind. If you have employees in Canada, you may wonder what free healthcare covers. You may also be interested in learning about the extended health care (EHC) benefits you can provide to your workers. This blog will teach you about extended health care benefits available in Canada.
Contrary to the belief that healthcare in Canada is free, the government doesn't cover most popular health & dental expenses. According to the Canada Health Act’s public health program, provinces must cover:
Provinces don’t cover:
So, most companies offer employer-sponsored benefits to help employees pay for these extra eligible expenses.
Remember two important rules:
Each of Canada's provinces and territories manages its healthcare, so consult their guides to understand their public health coverage.
In Canada, almost every employer-sponsored health benefits plan includes seven categories of health care coverage.
To be eligible under a prescription drug program, drugs must:
Insurance generally does not cover the following medications, even when prescribed:
Prescription costs consist of two parts: the ingredient cost and the dispensing fee. The pharmacist charges a dispensing fee for preparing the prescription.
As dispensing fees vary significantly between pharmacies, employees can choose the least expensive ones. This helps them keep the costs of their claims down, which can lower their premiums. Employers can encourage this behaviour by offering preferred provider networks and online pharmacies as options.
Two types of reimbursement methods are available for employees:
Pay-direct plans are more cost-effective and efficient for the insurer. Additionally, they are easier for employees as they do not have to organize and submit their claims.
Employer-sponsored plans include many different drug formularies. In the past, a plan would pay for brand-name drugs, no questions asked.
However, the most common formula nowadays is mandatory generic. Under this structure, the drug plan will pay for the cost of the generic drug only, except in two scenarios:
Under a mandatory generic plan, the employee still has the option to take the brand-name drug. However, they must pay the difference between the generic and the brand-name drug.
Extended healthcare coverage is a top-up to the provincial government's four-bed ward coverage. Most plans cover the cost of semi-private rooms, but you may have to pay extra for a private room out of your pocket.
The exception is the maternity ward. In many hospitals, the basic maternity ward rooms are semi-private. In that case, the extended health insurance plan would upgrade the employee to a private room if available.
Insurance plan for paramedical practitioners is a highly-valued benefit for many employees. Paramedical practitioners include:
Physiotherapists, Registered massage therapists, Acupuncturists, Osteopaths, Chiropractors, Podiatrists, Chiropodists, Naturopaths, Speech therapists, Psychologists.
As an employer, you can structure the practitioner types, but this EHC coverage includes a set list of practitioners. Most plans have an annual maximum per practitioner type, per family member. But now, to save money, some plans group together different types of healthcare providers. For example, you pay $1,000 annually for physiotherapists, massage therapists, and chiropractors.
Remember:
A practitioner must have a license from the association in the province where they work to be included in the coverage. Revenue Canada must recognize the association as valid to qualify for reimbursement.
Vision benefits typically consist of two tiers:
Although eye exams are commonly insured, analyzing the ROI on vision wear should be done. Some industries and demographics require coverage for competitive reasons; however, premiums paid over the benefit period can meet or exceed the actual value of the benefit. There may be alternate options to fund this coverage that result in more flexibility and ROI.
Medical Services and supplies are crucial parts of a typical benefits plan, yet they are among the least-used portions. This coverage is essential for those who require medical services and supplies.
The coverage typically includes a standard list of insured items. However, don't presume it's not insured if you or your employees need something missing from the list. Always consult with your advisor and insurer.
Out-of-country coverage is always second-payor to the provincial plan.
The provincial plan will still cover the costs if an employee requires hospital treatment in another country. The coverage will be the same as if the treatment were done in Canada. However, they will not pay more than they would have if the employee were treated in Canada. This is where out-of-country coverage takes over.
Policies will pay for unexpected emergency treatment but exclude treatment for pre-existing conditions (as outlined in your contract.) Most out-of-country coverage also includes travel assistance and coverage for referral treatment, whether in Canada or outside.
Dental care can be expensive, and the cost can vary depending on the dentist. Employees should ask whether the dentist charges according to the province's fee guide to avoid overpaying for dental services.
Three levels of dental coverage exist in Canada:
Coverage percentages vary from 50% to 100%, depending on the level of dental insurance. The dental or extended plans may also include dental accident coverage.
Employers usually enroll permanent, full-time employees in the employer-sponsored health benefits plan. However, part-time employees and contract workers may also have coverage. Talk to your advisor and insurer to see the flexibility available when designing the plan's eligibility criteria.
Commonly, the health plan extends coverage to employees' dependent spouses and dependent children.
Although EHC benefits are not mandatory benefits, offering them is crucial for employers with Canadian teams, filling the gaps left by public healthcare. These benefits ensure comprehensive coverage for prescriptions, dental, vision, and paramedical services, enhancing employee well-being and satisfaction. Understanding these plans' coverage, eligibility, and integration is essential for building a supportive and healthy workplace in Canada.