Issue link: http://clhia.uberflip.com/i/369328
12 Health Insurance Coverage W hen most Canadians think about health insurance, they think of the government programs that cover basic physician and hospital expenses or help them out financially if they are unable to work because of disability. Yet the majority of Canadians are also protected from financial loss by health coverage provided by life and health insurers, Blue Cross, non- profit insurers, uninsured employer arrangements and other organizations. While most people are covered through group plans provided by employers, unions or professional associations, many Canadians also supplement government and group protection with individual plans. Supplementary health insurance takes over where government coverage ends. This partnership of supplementary health insurance and government programs contributes to the quality of life and health of Canadians. With health and living costs rising steadily, many Canadians could be devastated financially by unexpected illnesses or accidents. Insurance coverage is crucial to their financial well-being and peace of mind. ❖ Disability income insurance plans help replace lost income, often supplementing benefits from the Canada/Quebec Pension Plans, Workers' Compensation and Employment Insurance. They pay a periodic cash amount (e.g., 70 per cent of normal earnings). Benefits from group or individual plans often are integrated with those from government plans so that benefits do not exceed a certain percentage of normal earnings. Short-term plans commence benefits the first day off work or soon after and continue payments for a limited number of weeks (e.g., 17 or 26 weeks). Long-term income replacement plans normally start benefits at the end of a specified period (e.g., 90, 120 or 180 days) after the onset of disability and continue payments for a stated term or to a stipulated age (e.g., age 65). When short- and long-term plans are coordinated, long-term benefits begin immediately after payments end from the short-term plan. At the end of 2013, some 41,000 group contracts in force in Canada provided nearly 2.6 million workers with short-term income replacement; about 103,000 group contracts gave more than 10 million workers long-term coverage; and 910,000 contracts were purchased individually. Coverage has risen significantly over the past decade. ❖ Accidental death and dismemberment benefits provide a lump-sum payment if the insured person dies as a result of an accident. Usually, the same sum is paid on the loss of both hands, both feet, one hand and one foot or the sight of both eyes ❖ Supplementary health and disability income insurance plans protect Canadians against financial loss due to unexpected illnesses or accidents. ❖ At the end of 2013, insured plans 1 provided 11 million people with disability income protection, 26 million people with extended health care 2 coverage and 15.4 million people with reimbursement of dental care 2 expenses. ❖ Uninsured plans 1 provided 926,000 people with disability income protection, 10.4 million people with extended health care 2 coverage and 9.8 million people with reimbursement of dental care 2 expenses. 1 Including provincial Blue Cross organizations and other not-for-profit health care benefit providers 2 Data include some double counting when families are covered under separate plans for each spouse or when insured benefits are provided in conjunction with supplementary protection under an uninsured contract. In total, almost 24 million Canadians have supplementary heath benefit coverage through private plans 2003 2013 Insured Contracts Disability income (long term) 8,361 10,953 Extended health care 1 17,276 25,999 Dental care 1 9,586 15,351 Uninsured Contracts 2 Disability income (long term) 816 926 Extended health care 1 9,256 10,410 Dental care 1 8,307 9,797 Source: CLHIA special survey ("Health Insurance Benefits in Canada" Data for companies, representing 99 per cent of the insured business in Canada, were adjusted to approximate industry totals for all providers. For 2013, figures consist of all providers, including insurance companies, provincial Blue Cross organizations and other not-for-profit health care benefit providers. For 2003, data are for insurance companies only.) 1 Data include double counting when family members are covered under separate benefit plans for each spouse or when health benefit packages are designed to provide certain coverage(s) under an insured plan, in conjunction with supplementary protection under an uninsured contract. After eliminating duplicate coverage, the number of Canadians protected through these plans and similar coverages provided by provincial Blue Cross organizations and other not-for-profit health care benefit providers are estimated at almost 24 million with private supplementary health benefits and nearly 20 million with dental care benefits 2 Administrative services only are provided for these plans (persons covered – thousands) Health Coverage by Benefit Type Insured and Uninsured Plans