CLHIA-ACCAP

Canadian Life and Health Insurance Facts, 2014 Edition

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13 due to accidental bodily injury. Half the amount may be payable for the loss of a single hand or foot. This coverage is available on a group or individual basis for a variety of timeframes and activities, ranging from scheduled aircraft coverage for the duration of a trip to full 24-hour coverage for all types of accidents. At the end of 2013, some 96,000 group contracts in Canada covered 18.7 million people. An additional 2.1 million Canadians were covered under individual personal accident contracts. Many life insurance policies also include accidental death benefits. ❖ Extended health care plans reimburse the insured person for a variety of hospital and medical expenses not covered by provincial government plans. They typically pay for extra charges for semi-private or private hospital rooms, prescription drugs, special duty nursing and other paramedical services, ambulance services, crutches, artificial limbs, prostheses and medical appliances, wheelchair rental and vision care. Frequently, the individual is responsible for a small dollar amount, called the deductible, and a percentage of the costs, called coinsurance. At the end of 2013, 124,000 group contracts covered nearly 10.4 million workers and their 13.8 million dependants for extended health care benefits. Beyond this, group contracts also provided 635,000 workers and dependants with supplementary hospital expense insurance only, and 748,000 workers and their dependants with prescription drug expense insurance only. Individually purchased contracts covered 1.8 million people for extended health care and an additional 108,000 for supplementary hospital care benefits. With the ongoing modifications to provincial funding for health care programs, private insurers have designed new benefits and expanded the existing benefits offered under health care plans in order to meet the needs of many Canadians. For example, coverages under travel health insurance were redesigned to fill the void created by provincial health plan cutbacks. During 2013, in addition to travel health coverage included as part of extended health care plans, 10 million Canadians were also provided with travel health protection as a separate benefit. ❖ Dental plans reimburse a variety of expenses depending on the contracts, but coverage typically helps to pay for preventive and maintenance services and root canals, periodontal cleanings and scalings. It may also extend to major restorative procedures, such as crowns, bridges, dentures, braces and orthodontic services. By the end of 2013, 100,000 group insured contracts provided over 15 million workers and dependants with dental care benefits. An additional 314,000 were covered under individual policies. Dental coverage has grown steadily over the years. ❖ Critical illness insurance is a product introduced to meet the evolving health care needs of Canadians. These policies pay a lump sum if the policyholder is diagnosed with a serious illness (such as cancer, heart disease requiring surgery, heart attack or stroke) as listed in the policy. At the end of 2013, more than 1.5 million Canadians were covered under critical illness plans on either a group or an individual basis. ❖ Long-term care insurance is a product that provides financial support for people who become unable to care for themselves because of a chronic illness or disability. Services may be provided on an inpatient (e.g., rehabilitation facility, chronic care facility, nursing home, etc.), outpatient, or at-home basis. At the end of 2013, 350,000 Canadians were covered under long-term care insurance plans, with almost 75 per cent through group arrangements. ❖ Uninsured plans are those where a plan sponsor (usually an employer) provides benefits to a group of people (typically employees) outside of an insurance contract. These plans are often administered by insurance companies or another outside firm. Because these plans are not insured, however, the insurance company does not guarantee benefits. The plan sponsor is responsible for providing the funds to pay claims. At the end of 2013, uninsured health plans provided 1.9 million workers with short-term disability income protection; 926,000 workers with long-term disability income protection; almost 4.2 million employees and their 6.3 million dependants with extended health care benefits; and nearly 4 million workers and their 5.8 million dependants with reimbursement of dental care expenses. Coverage under these contracts has increased substantially during the past decade.

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