CLHIA-ACCAP

19 of the total. Almost $15.7 billion was paid under insured plans and more than $13.5 billion under uninsured contracts that are administered by life insurers and not-for- profit health care benefit providers such as Blue Cross organizations. The remainder, over $1.7 billion, was paid out under individual health insurance policies. Health benefit payments by type During 2014, benefits paid under group health insurance contracts amounted to almost $15.7 billion, with 42.4 per cent for medical/ hospital benefits (including prescription drug expenses), 34.6 per cent for disability income, 18.1 per cent for dental, 3.5 per cent for creditors disability (including creditors critical illness), and remainder for accidental death and dismemberment and other benefits. About 39 per cent were indemnity benefits providing direct compensation for loss, while the remainder was reimbursement benefits, which can be paid either directly to the provider of care through an assignment of benefits or to the insured person who paid for the care. In the absence of a catastrophic drug program, the not-for-profit Canadian Drug Insurance Pooling Corporation (CDIPC) was voluntarily established by supplemental health insurers in Canada. Sharing the cost of highly expensive and recurring drugs (i.e., those in excess of $25,000 annually) through industry pooling protects the sustainability of fully-insured group plans which would otherwise be jeopardized. This has been particularly beneficial to small- and medium-sized businesses, and their employees, where fully-insured plans are more prominent. In each of 2013 and 2014, insurers in Canada paid more than 4,000 claims for prescription drugs under the new pooling mechanism. Individual health insurance benefits exceeded $1.7 billion, with 27.9 per cent for disability income, 23 per cent for medical/hospital benefits (including prescription drug expenses), 18.7 per cent for critical illness claims, 18.3 per cent for travel health insurance, 5.8 per cent for personal accident claims, and 5.4 per cent for dental care. In 2014, benefits paid under uninsured contracts administered by insurance providers amounted to over $13.5 billion. Of these, 59.1 per cent were for medical/ hospital benefits (including prescription drug expenses), 32.4 per cent for dental, and 8.5 per cent for disability income. Benefits paid under these plans have increased about one and a half times the 2004 level (of more than $9.3 billion). Policyholder dividends Dividend payments to participating Canadian policyholders of life insurance, health insurance and annuities totalled $2.5 billion in 2014. Today, about 11 per cent of all life insurance owned by Canadians is participating and, as such, qualifies for Source: CLHIA special survey (Health Insurance Benefits in Canada – 2014) Includes payments under uninsured contracts administered by life and health insurance providers *Includes Creditors critical illness coverage Total Health Payments by Benefit Type – 2014 Other benefits 3.1% Creditors disability* 1.8% Disability income 22.8% Dental care 23.7% Medical/hospital 48.6%

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