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Health And Dental Insurance Definition And Terms

Health And Dental Insurance Definition And Terms

Explaining What is Health and Dental Insurance


What is health and dental insurance? It is an insurance policy in opposition to the risk of incurring medical expenses for individuals or families. In Canada, with universal health care, these financial issues are lessened but there are still a lot of things your provincial health care plan will not handle. This is where supplemental health and dental insurance will fill up the gap and offer in depth risk protection from unforeseen and costly medical bills.

An insurance company in Canada can produce a health and dental insurance plan that will handle medically necessary assistance that are not covered in the provincial health care plan. This is carried out by viewing the entire provincial population based on age, gender, smoking status, and expected medical usage. And then pricing can be determined for people in different age groups and additional aspects. There are commonly discounts for whole families to sign-up a plan together vs each person having their own insurance policy.

Group insurance as well includes supplemental health and dental insurance. When you are part of a group insurance plan you mostly have prescription drug coverage, medical supplies and services coverage and dental insurance.Health And Dental Insurance Definition And Terms


What is not insured by your provincial health care plan?

The Canada Health Act mandates that all provinces should give free access to medically necessary services. These services are generally described as access to a physician or hospital and the nursing care in a long term care facility. There are, although, many expenses that are not covered under the provincial health care plan:

Prescription drugs dispensed through a local pharmacy (not from the hospital)

Non-emergency dental care (preventative and restorative dental treatments)

Ambulance rides

Medical services like chiropractic treatments, physiotherapy, massage therapy, psychologist, etc.

Medical equipment, like walker, canes, crutches, oxygen tanks, etc.

Vision care (eye exams and glasses)

Hearing aids

Private or semi-private hospital rooms

Outside province travel medical insurance (within Canada there are inter-provincial agreements for medical expenses)

Universal and free health care in Canada does not insure everything. Luckily for Canadians, the big medical expenses like hospital care and seeing a doctor are insured. There are also many health care subsidized services for in home care, people faced with mental illness, childhood developmental support, etc. which are also included by the provincial health care plans (to various degrees in different Canadian provinces).

The common expenses listed above can also compile to substantial monthly expense. Knowing that you will not need to pay 100% of the cost of drugs or dental care grants most Canadians peace of mind that they can access the medical treatment they need and keep within their monthly budgets.

How health and dental insurance works

A health and dental insurance policy typically works by a covered expense submitted to the insurance company for reimbursement. New technology has helped make most of these claims sooner and a lot easier. Instead of the individual paying for the expense and then mailing in claim forms (the old way of obtaining a claim) a pharmacy or dental office can electronically submit the claim on your account and the insured portion of the claim is settled directly to their business.

Some medical specialists can not yet do this, like massage therapy and physiotherapists. In this situation there is either the old mail in claim forms or now online claims processes that make presenting your claim instant.

Co-Pay: Many insurance plans do not pay 100% of the claim. They will cover 80% for instance. The 20% that the individual has to pay is called the co-pay portion. This co-pay amount is put into policies to help control expenses. The theory is that if people have to pay any amount of money, even if it is a small percentage of the total cost, they will think twice if they really need the medical treatment or not before spending money. Hopefully, the co-pay portion of your policy never holds you back from seeking the treatment and medicine your need to feel healthy again!

Maximum benefits: Another way to control costs is by having annual and/or lifetime maximums on the policy. These maximums will prevent people from incurring a huge medical expense in one year and then cancel their policy the next year and stop paying premiums. The most common place people see annual maximums is on their dental insurance coverage. The amount the insurance company is willing to pay out is based on the how old the policy is and the level of coverage purchased. A more complete dental insurance plan covers restorative dental like crowns, bridges, on lays, etc. A standard dental insurance plan will only handle standard maintenance, like cleanings, check-ups, fillings and extractions. The maximum annual payout is generally set smaller in the first year of the policy and then rises into years two and three. This lets the insurance company to collect 1 or 2 years premiums before reimbursing for the most highly-priced dental procedures.

Why you need health and dental insuranceHealth And Dental Insurance Definition And Terms


Why do you need health and dental insurance if the Canadian government pays for all main expenses such as hospital care? It is well noted that people with no supplemental health and dental insurance tend to have a lower quality of overall health. There are still large financial obstacles to getting the treatment and medication needed to operate properly without health insurance. Dental care can be suspended, allowing troubles to grow from minor preventative issues in emergency dental care treatments that requires hospitalization. People who are on a budget and cant pay for prescription drugs tend to have more medical difficulties than those who can get the medication they need to feel better.

What is Health and Dental Insurance Discover more from Life Guard Insurance

If you are without health and dental insurance and can fit this type of premium into your monthly budget, you would be encouraged to have coverage vs going without. If you are interested in finding out more about health and dental insurance in your province, don't hesitate to contact Life Guard Insurance.

by: Mitch Reynolds
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Health And Dental Insurance Definition And Terms