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Health Plus News - Higher Maximums

New Higher Maximums for Paramedical and Dental

In 2021 You Deserve a Health Plus Plan Upgrade ... 

We designed our Health Plus PRIORITY and OPTIMUM plans to provide small business owners, freelancers and contract workers with better coverage for less than the big-name company plans. To ensure we continue to meet that goal, we’ve added to our plans every single year. 2021 is no different. In an especially tough year for business owners and freelancers, we want to make sure Health Plus plans are there to help. So we made a few changes.  

Paramedical Services  

To make it even easier for plan members to get the treatment they need we’ve increased the paramedical maximum from $150 to $250 per person / practitioner / year without pre-approval. All practitioners are still covered up to $750 per person / year with approval.  

Dental  

For OPTIMUM Plan Members we’ve increased the Basic and Preventative Dental Maximum from $1000 to $1500 per year, effective after 2 years plan membership. (Annual maximums are measured on a calendar year basis and begin January 1st.) 

Always Low Rates  

We’re committed to keeping rates low. In fact, we have never raised our plan premiums. Most insurance companies raise rates every year. We know our clients trust us to provide the best value coverage.  

Wellness Resources Always There to Support You 

Health Plus plans continue to come with extensive professional wellness resources to help with life and business challenges. The Shepell EAP provides professional counselling, online health, financial and family resources and programming – all free of charge.  

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no medical questions asked health insurance, guaranteed acceptance, medically underwritten

‘No Medical Questions’ Health Insurance … when it’s the best financial choice and when it’s not

When you’re shopping for personal health insurance, you'll likely see plans encouraging you to simply sign up …no medical questions asked. Sounds appealing, of course.  While ‘no medical questions’ health insurance plans are ideal for some people in some circumstances, for others they are clearly not the best choice.  In  fact, taking a 'no questions' plan may mean you end up paying more than necessary for less coverage than you could readily get elsewhere.  Here’s what you need to know to help you get the right plan for you and the most for your money.    

When reviewing health insurance plans there are two kinds to be aware of ...

Guaranteed Acceptance 

This is ‘no medical questions asked’ health insurance.  It’s ideal for people with serious health issues (pre-existing conditions in insurance jargon), or people who have high ongoing prescription drug bills. If that’s your situation, you may not qualify for other insurance.  Or if you do, your rates will be high based on your health history and coverage for your particular condition may be excluded. A guaranteed acceptance (GA) plan which doesn’t ask anything about your health and guarantees your acceptance may well be what you need. Some of your health bills will automatically be covered and fortunately there are a few good GA plans out there.  But please read on before you come to any conclusions.  

Medically Underwritten

That’s the industry term for plans that ask questions about your health before accepting you for coverage.  To be clear, these ‘need-to-qualify’ plans can also be very easy to enrol in but will require filling out a simple health questionnaire. It only takes 5-10 minutes to provide your health profile. If you’re generally healthy, it's worth your time. Insurance companies ask health questions to reduce the level of risk they take on, which in turn allows them to offer better plans. With this type of plan you’ll get more and better coverage at much better rates. It’s an expensive mistake to settle for a GA plan if you don’t have to.    

Which type of plan is right for you?

The state of your health makes the difference. For people with certain chronic or past health issues or high drug bills, a Guaranteed Acceptance plan may be the best or even the only option.  If you’re generally healthy with no problematic history, a Medically Underwritten plan will cost you less and cover more.  And you don’t necessarily have to be in perfect health to qualify. Conditions that are considered minor or are sufficiently in the past may not hinder acceptance into a plan that is medically underwritten.      

If you’re uncertain what you qualify for, go ahead and complete a health questionnaire (here’s the easy online one for Health Plus plans).  A good advisor can quickly tell you which route makes financial sense for you.  No question, the best time to apply for health insurance is when you’re healthy.  But if you’re not, it’s not too late to put good protection in place.   

Do you need health insurance

10 Reasons You Don’t Need Health Insurance

Lire en français

You may be skeptical of whether health insurance is really necessary for you. That's understandable. If you're young, healthy, don't spend a lot on healthcare now, why is it worth it? If you're considering whether you need health insurance we're willing to bet at least one of the following reasons has crossed your mind. But how do they measure up in the real world? 

1. I don't take drugs 

That's fantastic. Hopefully, that won't change. However, most people who require medication didn't plan on needing it. While some conditions can be managed holistically through lifestyle changes, others cannot, and the cost for prescription drugs in Canada is rapidly rising. New specialty medications costing over $10 000 per year make up 30% of overall drug spend by working-age people1. Of those meds, most are for chronic, ongoing conditions. We bet you can think of better ways to spend your money. 

2. I'm healthy

Again, that's great. You likely have a combination of genetics and your own effort to thank. Keep up the good work. Despite what you might have heard about insurance people, we don't like to be all doom and gloom, but we've seen enough to know that even with your best efforts, good health is not guaranteed. 

3. I'm young

Oh to be young! It's true that the likelihood of serious physical illness is lower at a younger age. And you're more likely to recover well if you're injured. But adolescents and young adults also have higher prevalence of mental illness. One in two Canadians have had or will have a mental illness by the time they reach 402. It's a good idea to have support in place. Plus, insurance rates are lower for most plans the younger you are because you're considered lower risk. (Health Plus plans have equal low rates across all ages but we're special) We hate to break it to you, but you're not getting any younger. 

4. I'm active 

Physical activity is repeatedly shown to have many health benefits, from reducing the likelihood of heart disease to stress management. That said, if you strain your knee training for a marathon or break a bone hang gliding, you likely want to get back  to those activities as quickly and pain-free as possible. Registered therapists paid for by your insurance can help with that. 

5. I don't spend that much now.

It's reasonable to be concerned about spending money you might not get back. But, insurance isn't a chequing account that you put money in and take money out of to pay your bills. It's a safety net that protects you against risk. While the chance of break ins, floods, and fire are all relatively low, you still insure your home or apartment because you value your belongings and know the cost of replacement would be both financially and emotionally taxing. Your personal health is the same.  

6. Provincial coverage will pay

While we're lucky to have a lot covered by provincial healthcare plans, unfortunately there's still a lot lacking. The bills for out-of-hospital medication, rehabilitation and care are completely up to you. Coverage also varies from province to province, which means that even if you're travelling within Canada, you may be surprised with a bill you wouldn't expect at home. 

7. It doesn't cover pre-existing conditions

It is true that medically underwritten plans (plans with a health questionnaire to apply) require evidence of good health and may deny or limit coverage due to a pre-existing health issue. However, there are other options available. Depending on your condition, you may still qualify for coverage with an adjusted rate, or you can apply for a guaranteed acceptance plan. These 'no medical questions asked' plans will automatically cover a portion of your expenses, regardless of what you're spending now. 

8. I'll get benefits when I find a new job/career

Getting benefits through an employer is ideal. Plans typically offer good coverage and your employer foots at least a portion of the bill. However, with the rise of contract positions, benefits are no longer guaranteed. Even if your new gig comes with insurance, companies often require a waiting period of at least 3 months before you're eligible. Personal health plans can always be cancelled if your new job comes with benefits, or once they kick in. Meanwhile, you're protected. 

9. I'm rich

Lucky you. Any secrets to share? If you're independently wealthy, and can afford to self-insure, insurance might not be necessary for you. Just be sure you have a healthy enough emergency fund to get you through even the worst-case scenario. 

10. It won't happen to me

If you have a crystal ball, can we have a peek too? Of course, you don't want to think of a health crisis or serious injury befalling you or a loved one, no one does. But because you can't be 100 percent confident, why not prepare?

The insurance industry often gets a bad rep for pushing sales. We aren't going to do that. Our job is simply to make sure you understand your options, including the risks of being uninsured. The choice is always up to you. 

Sources:
1. Telus Health 2020 Drug Data Trends & National Benchmark Report
2. The Canadian Alliance on Mental Illness and Mental Health 

health insurance financial goals

How health insurance helps you meet your financial goals

How health insurance helps you meet your financial goals

New year, new $ plan ... but are you missing a key piece?

​By now, most of us have​ started work on our 2020 resolutions (unless we’ve already tossed them). Often, those intentions involve money especially if you’re self-employed or freelance. That’s great. But sometimes, the financial picture is missing a critical piece ... one that can support your other goals or when it's not in place, put your entire plan at risk. Not so great.  Let us explain.   
 
You already know it’s smart to keep an emergency fund, avoid debt, set regular savings goals, invest wisely.  What could possibly go wrong?   
 
The strategy that’s missing is health insurance. Yes we know…not an exciting topic. Much  less fun than visions of income breakthroughs and new projects. But insurance is key to good planning and risky to neglect. And if you do have insurance but don’t pick the right plan, you’re spending more than you need to for less protection than you want.  So how does that happen?  
 
When you’re thinking about health insurance, watch out for these traps:  
 
#1  Settling for the first plan you come across from any big company you recognize. Instead, it’s smart to look further to compare options, and easier than you think. Check out the plans from people who specialize in benefits designed solely for small business; they’re almost always much better value.  See how Health Plus plans compare.  

#2  Counting on an emergency fund (or worse, a line of credit or lottery win).  Assuming you’ve stuck to your plan to keep a rainy-day account, do you seriously want to spend it on health bills?  What if you just paid for a big-ticket business need or unexpected personal expense when, as luck would have it, an even bigger medical bill comes along.  Or you need the money to manage routine bills when a health issue takes you out of action.    
 
The fact is that even if you’re the best of savers, an emergency fund may simply not be enough to cover rehab physio, high-priced prescription drugs, or major dental work. Even if it is, we’re guessing you have more appealing plans for your funds. Why pay bills you don’t have to? What’s more, if you don’t have the cash for a surprise health expense, there goes your ‘avoid debt’ strategy.  The ripple effect can do a lot of damage to your entire financial plan.    

#3  The problem with good health ...  Of course, there’s never a problem with good health.  It’s what we wish for everyone. But there is a problem when we take good health for granted.  While you may be lucky, with good genes and healthy habits, the fact is accidents happen and serious illness can strike out of the blue.  An ‘invest wisely’ plan includes investing in insurance. You cover healthcare costs now and in future without derailing the rest of your goals.    

#4  ‘Planning’ to save.  Setting goals for regular saving is smart.  But too often the follow-through takes a back seat to more ‘urgent’ spending. From retail therapy to essential system upgrades, a lot can come between you and your best intentions. With insurance, you can budget a predictable, affordable monthly amount, tax-deductible if you’re self-employed. Less than a latté a day buys serenity and confidence knowing your healthcare funds are solidly in place, and your insurance can save you big money in the long term.    

“The best time to plant a tree was twenty years ago”.  To paraphrase the proverb…the best time to buy insurance is when you’re healthy.  If you wait until you ‘need it’ you may not qualify at all or you’ll pay much more.  Please consider a second look at your financial picture.  And best of luck with all of your resolutions this year.       
 
Health Plus Insurance plans are designed for business owners, freelancers, contract workers and self-employed people.  For more options and better, more affordable coverage plus complimentary professional Wellness Resources that come with our plans, contact Health Plus Insurance.    

best value health insurance

How to get the best value health insurance

How to get the best value when you shop for health insurance

Shopping for health insurance isn't anyone's idea of a good time but it is part of a smart financial plan. It allows for one monthly budgetable bill that covers both routine health expenses and protection in case of unforeseen expenses from illness or injury. Because as much as we like to think we're invincible, we're probably not. But, how do you choose a plan that offers the best bang for your buck? When it comes to insurance, it's not just the sticker price (or overall monthly premium) that you should look at. You also want to know what you're getting for your money. Here are 4 factors to help evaluate a plan when shopping around to get the best value health insurance. 

Overall Maximums

This is the most straightforward. It refers to the maximum coverage amount for each type of service. Pay attention to whether a plan offers a separate maximum for each service or a combined maximum for a group of services. Maximums are often on an annual basis, but can be longer or shorter depending on the service. Some plans also include overall lifetime maximums or the total amount you can claim the entire time you are on the plan.  

I'm sure you've already figured out that in general, higher maximums are better. But, remember to consider not only maximums for services you may already be using (e.g. your dental visits) but all maximums weighed against real world costs. Most of us hope to never need expensive medication but a high prescription drug maximum is still a good idea. With the development of new groundbreaking medication, drug prices are on the rise. More than 1 in 100 Canadians will require prescription medication costing more than $10 000 per year, not something you want to pay out-of-pocket. 

Per-visit Maximums

A lot of insurance companies also choose to limit the amount covered for one visit to a practitioner, even before you reach you reach your overall maximum. They do this so they can control claims expenditures. Low per-visit maximums can mean you end up paying a lot of out pocket for a covered service. For example, if your plan has an overall maximum of $500 for paramedical services such as massage therapy or chiropractors but a $25 per-visit limit you'll pay the difference every time you go. Obviously most professional services don't cost just $25, so this isn't too great of a deal. 

You may see the words "reasonable and customary" in a policy instead. This is just the insurance company's way of saying they'll cover your treatment up to a set amount, meant to reflect the typical cost of a service. Some plans, like Health Plus plans, require an approval step for services beyond a dollar limit instead of placing a low per-visit limit. While the initial step of getting approval may seem annoying, ultimately it means if you need it you're covered. Our advice is to avoid plans with low per-visit maximums. When you're already paying high premiums they aren't good value. 

best value health insurance
best value health insurance
best value health insurance

Reimbursement Levels

Just because something is included in the plan doesn't mean the insurance company is covering 100%. The reimbursement level, also known as co-pay is the percentage of a claim, up to the maximum, the insurance company will pay. Plans vary widely. While some pay 50%, others pay 90%. This consideration goes hand in hand with maximums. A plan that pays 100% isn't worth much if low per-visit limits mean you'll be paying out-of-pocket regardless. 

Rate Increases

This is an important one and not usually highlighted in the brochures. Plan rates may increase over time due to factors such as increasing healthcare costs or an increase may be written into your terms. For example, most plans have an automatic increase with age (Health Plus plans don't). This means every 5 years, after age 40 or 45, your monthly premium will automatically go up, something you'll definitely want to budget for. While no plan can guarantee its rates will never rise, you can try to choose a plan with relatively stable rates. And as you work health insurance into your budget it's a good idea to gauge how much of an increase you might be facing. Don't be afraid to ask whether premiums were recently increased and whether another increase is expected.

Health insurance is not an insignificant purchase. Making sure you get a plan where your money goes the farthest and you have the security you need is important. A little extra research beyond the basics and marketing slogans can go a long way. Whether you're working with a broker to help navigate the options available to you or going to companies directly, asking questions and knowing exactly what you're getting for your money will help you feel more confident in your decision. 

Insurance Jargon

Insurance Jargon in Plain Language

Insurance Jargon in Plain Language ... it's not you, it's them

 Here’s a pitch we hear too often. “I have just the plan for you.  Guaranteed issue, no deductibles, high maximums and good co-pay. Great coverage at a great premium because it includes generic substitutions. Underwritten by Befuddle Insurance Co.”     

Ready to sign?  Probably not.  Confused?  You’re not alone.  The insurance world often forgets we’re mere mortals, not insurance bots, and gets carried way using industry jargon instead of plain language.    
 
Insurance is an important financial decision, especially if you’re self-employed or own a business, and choosing the best option takes effort.  Deciphering dense terms should not be part of the chore, so we’ve decoded some common insurance jargon to help clear the fog.    

Insurance Jargon
Premium

Premium may sound like something insurers are pitching as the “best” but actually, premium refers to what you pay your insurer. In other words, the monthly rate for your coverage.   Be careful taking the number at face value though.  Low premiums often mean the plan covers much less.   

Deductible

You're probably somewhat familiar with this piece of insurance jargon.  Commonly tossed around as a plan feature, deductible is the dollar amount you must pay out of pocket before the insurer will begin to pay any portion of your bill.  Deductibles are good for the insurance company because in theory they help mitigate risk.  The idea is that if we’re paying the first bill ourselves we might think twice before incurring an unnecessary expense because “it doesn’t matter, my insurance will cover it”.  The insurer wants to avoid a deluge of minor claims which can really add up.  

Not all plans have deductibles, and amounts can vary, so you’ll want to look into plan details to make sure you’re getting the coverage level that’s important to you. 

Co-insurance / Co-pay

These terms simply refer to what percentage of the bill you’re responsible for paying, after any deductible is taken off the top, and what the insurance company pays. For example, Health Plus Optimum Plan covers 90% of health services such as prescription drugs.  That means if you have a $100 bill, Health Plus would pay $90 and you would pay $10.  (With Health Plus, there’s no deductible).   

Maximum

Even the best benefit plans have limits on what’s covered.  Maximums refer to the maximum dollar amount a plan pays for claims during a specific time period.  Maximums may apply for a specific type of service (e.g. massage or physiotherapy) or for all services combined (e.g. an overall dental maximum). The time period in which a maximum is applied may differ as well. It is common to see per year or per visit maximums.    

Maximums are important to look at when comparing plans because they can affect how you'll actually be able to use your coverage and how much of your bills are paid. For example, even if your plan has a high overall maximum for the year, if there is a very low per visit maximum for a service, such as physiotherapy, you will end up having to pay out of pocket for treatment.  

Underwriter

Although this term sounds rather ominous (it’s a little too close to undertaker) it actually refers to the money guys,​ the people who pay your claims, usually a large insurance company. The underwriter reviews your application and assesses risk based on factors such as current health, age, previous health history, or sometimes lifestyle if you happen to be a stunt sky-diver to try to determine how likely it is you will have expensive claims. The underwriter then decides to take you on or denies coverage because they think you pose too big a risk to the plan. They may also approve your insurance coverage but adjust the monthly premium to account for higher risk.  
 
The bottom line, look for a plan that's underwritten by established, reputable insurers. And it's best to apply when you’re healthy.   

Guaranteed Issue

No doubt you’ve heard the ads  “acceptance guaranteed, no medical info required”.  Sounds easy, doesn’t it.  And in fact it is straightforward, on the surface. It refers to coverage that is guaranteed to be issued to you regardless of your age or the state of your health. That’s the upside.  The downside is that because these plans don’t involve health questionnaires, the underwriters can’t assess the risk involved in insuring you. So they set the rates high.  You should assume that guaranteed issue plans offer significantly less coverage and tend to be more expensive than plans that require information about your health.     
 
Guaranteed issue plans can be a good option if you don’t qualify for anything else due to a chronic or serious medical condition. But make sure you do your homework so you know exactly what you’re getting.  You don’t want to lose out on coverage you’re counting on.   
 
And if you’re currently healthy, don’t rely on guaranteed issue as a fallback for future.  If you become ill or injured, there’s a good chance these plans won’t offer the coverage you need.  We’ll say it again: the time to buy insurance is when you’re healthy.  

Generic Substitution

Think of this simply as brand-name and non-brand.   Generic drugs have the same active ingredients as their brand name counterparts so they carry the same health benefits.  But they’re sold under a generic label at a significantly lower price.  Substituting a lower cost generic alternative for a brand name drug is a way to keep claims costs lower for the insurance company.  And since your rates are based on the cost of claims made by everyone in your plan, generic substitution saves you money too. But if the generic drug doesn't work for you good plans, such as Health Plus, will substitute the brand name drug.   

So here’s to simplicity.  If you come across terms you don’t understand, don’t be shy.  The problem’s not you.  It’s up to your insurance company and advisor to translate insurance jargon and make things clear.   Don’t hesitate to ask.   

personal insurance, health insurance

Personal Insurance 101

Personal Insurance 101 ... what to know and where to start 

Let's face it, learning about insurance is no one's idea of light weekend reading. But it is important to understand what you have, what you need, and what's out there to consider. There are a myriad of different types of insurance, covering everything from natural disasters to Great Aunt Mable's pearls. For now, let’s stick to the basics of health and life. Here's a breakdown of five types of personal insurance you should consider as part of a smart financial plan.

health insurance

Health insurance

First up, health insurance, which covers some or all of your medical bills if you're injured or ill. Think of how important your health is to your work, your personal life, your family. Think of how pricey even routine health expenses can be, let alone nasty surprises.

In Canada, health insurance is split between the province and private insurers. Most of you know that in Ontario, residents are covered by OHIP (the Ontario Health Insurance Plan), but OHIP’s limitations often come as a surprise. While it’s great news for families that the government recently expanded OHIP to cover some prescription drugs for children, for most adults coverage is limited to visits to the doctor, some diagnostic tests, and in-hospital stays. You’re on the hook for everything else.

For this reason 24 million Canadians have opted to buy additional health insurance through private insurers. These plans cover basics like dental and vision care and routine prescription drugs. They also protect you in case of more serious accident or injury that can involve big, unmanageable bills.

Group vs. Individual Health Plans

The holy grail of health insurance is a good group benefits plan through an employer. Count yourself lucky if you have one of these. Good benefits are a huge draw to employees because the employer is required to pay at least part of the cost and all full-time employees are eligible, regardless of pre-existing health conditions.

However, if your company doesn't offer benefits, you still have options. Individual health plans such as Health Plus are available. Just make sure you look past the ads. While you obviously want a good price,  make sure you also consider the coverage maximums and limits for the services that are important to you. Some plans look good on the surface but coverage is actually quite inadequate and their rates keep going up. Look for a plan that balances good coverage and stable, reasonable rates.

Marketing of Health Spending Accounts is also on the rise. These are usually pitched as an alternative to group insurance for small business because they provide reimbursement for a wide variety of health expenses to a predetermined amount (e.g $1000-$2500). Employees/employers pay into an account to cover the claims. The flexibility of HSAs for routine expenses can be appealing but the biggest pitfall? They aren't insurance. If you're faced with a serious medical issue, they don't measure up. 

life insurance

Life insurance pays a tax-free lump sum of money to family or other beneficiaries named in your policy. It can protect your loved ones in the event of your death by providing money to pay funeral costs, debts, or simply to continue paying everyday expenses. Policies are available as term life insurance, which covers you for a specific time period, or permanent life insurance, which as the name suggests, covers you as long as the premiums are paid. Permanent life insurance may also accumulate cash value you can use, should you live to a ripe old age or want the money sooner.

disability insurance

If you become sick or injured and unable to work, disability insurance provides a monthly tax-free payment to replace some of your lost income. Not only can health bills take a toll but so can everyday expenses. Disability insurance helps you maintain your standard of living, even if you’re ability to work has changed.

critical illness insurance

Different than disability insurance, critical illness insurance provides a tax-free lump sum payment if you’re diagnosed with a serious illness such as cancer, heart attack, or stroke. The money is yours to use as you see fit, whether that’s on additional medical treatment or supplies, living expenses, household help, or even a vacation.

long term care insurance

Long term care insurance pays cash to help cover the costs of care in your home or a healthcare facility. Anyone who has helped care for an aging or disabled relative will know good care can be expensive and sometimes too hard to find. Canada's aging population, with seniors making up 15% and projected to rise to 25% within the next 20 years, makes having a plan in place all the more important. With this strain on the system, insurance gives you more control and choice in where and how you live.  

Travel insurance

Although it's not exactly in the same category of benefits, travel insurance gets an honourable mention as sixth on our list because it can be confusing to sort out. It’s also part of smart planning. When looking it's especially important to be clear on what you need and what a plan covers. Out-of- Canada emergency health coverage, a very good idea to protect yourself in case of illness or injury while you’re away, is included in some but not all health insurance plans. And some plans limit the activities covered. Additional travel insurance is also available to cover risks such as trip cancellation, delay, or lost baggage. All of these mishaps can put a serious damper on an otherwise great trip so why not plan ahead. 

So that’s the list of personal insurance to help protect your cash now and for the long run. And that’s not just our view. In a recent Globe and Mail article "Forget falling stock markets. These are the things in life you really should be worried about" Rob Carrick includes insurance as part of sound money management.