|
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| e-News
Bulletin |
Issue
8 - June, 2007 |
In
this issue:
- Unique Major Medical Insurance Product Provides More Options to Treat Sudden Illness
- Dental Fee Increases for 2007
Unique Major Medical Insurance Product Provides More Options to Treat Sudden Illness
Most people who become critically ill never expected that it would happen to them. Those who prepared for an unlikely event may have purchased critical illness insurance for protection. This type of insurance has been offered in the market for many years but has its limitations. For example, there are often very specific definitions in critical illness insurance policy wording that limit the type of illness covered. Claims may also take a while to be settled while an illness is being diagnosed or treated. In the meantime, an individual could be left with few choices to manage and care for their health.
A new major medical insurance product now gives individuals another option to consider in the event of a personal health crisis. Offered through CAPCO Health Group, Executive Health Options (EHO) is an insurance product that covers hospital, medical expenses and more.
But how does this differ from provincial coverage? The primary difference is that you can choose the location, physician and specific hospital that are right for you anywhere in the world.
How Is the EHO Coverage Different?
Executive Health Options pays a lifetime maximum of US $5 million towards medical health coverage. Because benefits are applicable anywhere, you have the choice of where you can receive treatment for your illness.
Why Would Canadians Consider EHO?
- Depending on the illness, there may be a long waiting list for treatment. EHO covers expenses incurred outside the country.
- Treatment/drugs may not be covered under the public system.
- Treatment may not yet be available in Canada.
- More choices for care. You could go practically anywhere in the world to receive treatment.
- It offers complete coverage and does not restrict coverage for certain conditions.
- The coverage provides protection while traveling abroad.
What Types of Situations does EHO Cover?
Here’s an example of a situation that is covered under this plan:
A covered person living in Ontario is diagnosed with leukemia and the best treatment recommended by the doctor includes an infusion of rituxin. The Ontario Health Insurance Plan (OHIP) does not permit that particular treatment until all else fails in the first treatment cycle. The treatment costs about $8,000 and a Toronto clinic offers the treatment immediately. In this case, the client can go immediately for such treatments and total cost is the deductible plus co-insurance. Co-insurance is 80 % of the first $5,000 of expenses or $1,000 after the deductible.
Another example is a supposedly, simple operation like hip replacement. Waiting time in the public system in much of Canada is roughly a year. However, newer private clinics in Canada can perform this surgery almost immediately. Or, it can be done immediately in the U.S. Total cost of this surgery is the deductible and transportation. Please note that if you choose a healthcare facility outside the list of approved providers, additional out-of-pocket expenses could apply.
While this coverage does not replace critical illness insurance which pays a lump sum amount and can be used to cover any expenses while you are ill, it is a way to get access to timely care that could drive a different outcome for the individual who is sick. In fact, it might be wise to consider an insurance strategy that includes both types of insurance. Here is a sample comparison of what critical insurance and EHO premiums might look like for a qualified male between the ages of 45 and 55.
| Client |
EHO Annual Premium – ($1,000 deductible) – Lifetime benefit of $5 million U.S. |
Critical Illness Annual Premium $500,000 Coverage |
| |
|
Smoker |
Non-Smoker |
Male –
45 years |
$1,506* |
$11,550 |
$5,055 |
Male –
55 years |
$2,372* |
$23,385 |
$10,765 |
*This amount is shown in Canadian dollars, however the plan premium is payable in U.S. dollars.
** Please note that the above chart is for illustration purposes only. The numbers are only approximate as premiums may vary based on individual circumstances.
In this example, an individual might consider taking a smaller amount of critical illness insurance to lower the annual premium and budget for the EHO premium.
For those people who have chosen the return of premium (ROP) option with a critical illness policy, you may want to consider putting the premium dollars toward the EHO instead. An ROP typically costs 30% more and even though you can get your premium reimbursed after a certain amount of time if there is no claim, you don’t get the time value of that money. In other words, there is no accumulation of interest on the premium dollars paid out. An EHO is typically less expensive than an ROP.
Other Reasons to Consider EHO
If an individual decides to retire full-time or spend large amounts of time outside of Canada, Executive Health Options is another product to consider to meet your needs. There are a number of scenarios where your lifestyle needs can be covered by such a policy. As in the old adage of ‘buy it when you don’t need it’ – applying for this coverage when you are in good health ensures your best chance of being accepted.
If you would like to consider adding this insurance to your current employee benefits plan, or are interested in offering to your executives, call Don McGowan at 1-800-749-7549.
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Dental Fee Increases for 2007
The following chart is a summary of provincial increases this year. Depending on the specific design of an employee benefit plan, the increase could actually be as high as 7%.
| Province |
Overall Average Increase |
| British Columbia |
3.19 % |
| Manitoba |
3.79 % |
| Newfoundland & Labrador |
3.0 % |
| Ontario |
3.6 % |
| Quebec |
2.8 % |
| New Brunswick |
3.0 % |
| Nova Scotia |
3.46 % |
| Prince Edward Island |
2.8 % |
| Saskatchewan |
6.23 % |
* In Alberta, insurers develop their own guidelines and reimbursement limits.
If you have questions on how the 2007 Dental Fee Guide can impact your policies and employees, call Don McGowan at 1-800-749-7549.
Disclaimer:
The opinions and advice in this e-News Bulletin are provided
for the general guidance and benefit of McGowan Insurance
Services Ltd. customers based on information we believe to
be accurate. We cannot guarantee its accuracy or completeness
for individual circumstances. While we strive to provide reliable,
informative material herein, we cannot account for all industry
conditions and legislative changes that occur. |
