Chuck Groot Financial Consulting

Health Insurance — What to Look For

Just like every other type of insurance, it is never our intent to use it, but if you don’t have health insurance, you can end up with a huge expense — the proverbial insult on top of injury.

My wife, my best friend, his wife, and I were involved in a nasty head-on car crash, where the other driver was 100% at fault. Our combined injuries were severe. My friend’s wife became a quadriplegic, and my wife has ongoing PTSD and pain. My friend had his life turned upside down, becoming a full time caregiver, and I had my ankle smashed, sternum cracked, and multiple other injuries.

And then the pain came — fighting with car insurance companies to cover our basic healing costs! Whenever we went to a clinic, naturopath, massage clinic, physiotherapist, acupuncturist, and the list went on, we had to fill out forms and were asked whether our injuries were due to a life, work, or car accident. When your injuries are due to a car accident, the car insurance requires you to utilize your health care plan first, and then with much negotiation, they will pick up the rest. This may or may not come in your near future.

After speaking with many people involved in all aspects of the injury business — health care, insurance, and lawyers — they all remarked that if you don’t have money, you will ending up suffering a long time. Having a personal health care insurance package is integral.

What does health insurance cover?

In some cases, you should really ask what does this particular insurance not cover? Health insurance coverage is one area that has a never-ending assortment of coverages and costs. The added challenge occurs when you try to find out what a particular treatment or test you need will cost and the answer is “not quite sure,” or you call your carrier and ask if the treatment or test is covered and they tell you “it depends.” Either way, you end up having to pay.

In Canada, most of your basic health care costs are covered. What is not covered are treatments from alternative medicine practices, such as dentist, optometrist, naturopath, massage, physiotherapy, acupuncture, kinesiology, and, of course, cosmetic surgery.

In the States, the Medicare system is mostly for Americans 65 and over. Medicare may also extend to people who have a low income or if you are in maternity care and childbirth. Medicare has two plans: Plan A and Plan B. Plan A covers the hospital, nursing facility care, nursing home, hospice, and home health care costs. Plan B covers diagnosis, treatment, and preventative services. This includes ambulance, mental health treatment, and some drugs.

You can see that you will need many more services that what is offered by the government. This is where a private health care plan comes in. As found on the website, health insurance covers essential health benefits critical to maintaining your health and treating illness and accidents.

Depending on the plan, you could get coverage for what are called “covered services” and they could include:

  • prescription drugs;
  • alternative health modalities: naturopath, dentist, massage, acupuncture, etc.;
  • medical equipment;
  • dental coverage;
  • vision coverage;
  • certain special tests;
  • lab services;
  • special screenings; and/or
  • counselling.

What is premium, co-insurance, deductible, and coinsurance mean?

The cost of the insurance plan is usually paid on a monthly basis, which is called a premium. You will need to pay deductibles and copays after that.

When you see the term co-insurance, it means that the insurance and you will split the costs of the health care coverage. Usually, it will be divided up on a percentage basis.

Many times there can be a deductible involved as well. This deductible is a basic fee that you pay per year or specifically on certain treatments. Once you have paid your deductible, the insurance coverage kicks in with the reduced rate.

Coinsurance occurs when you have paid your deductible and the insurance company still wants you to pay for part of the services.

Blue Cross/ Blue Shield explains this very well and give a good illustration.

What steps should you take to make sure you know what you are getting?

  1. Find a qualified insurance agent and tell them that you do not understand your health and dental coverage and ask them if they will spend an hour teaching you the ins and outs about the various coverages. Ask them if they represent different companies and if there is a choice for you. If they don’t provide a choice or won’t commit to the time, move on.
  2. Check to make sure that the plan will save you money even when you are healthy.
  3. If you reside in the States, make sure that your doctor and clinic is covered by the plan.
  4. Each company provides several options of coverage. Make sure that you go through them all and understand what the costs are for each. These coverages are often called “Summary of Benefits and Coverage.”
  5. Check to make sure that the alternative therapies you want are covered.
  6. Understand what your total cost will be.
  7. Make sure the plan will follow you from province to province and state to state.
  8. Determine whether or not you will have quick response to your questions and if they offer extended contact hours.
  9. Find out if they have a dedicated doctor or nurse line.
  10. Check the reviews and see if the company you are looking at pays promptly and if there are any other areas that people like or don’t like about them.

The last thing you want after getting sick or being involved in an accident of some sort is to get another shock handed to you by your insurance company. Take the time to carefully study your options and try to get the best value for your dollar.

Just remember, this is not a place you want to skimp and save $10 or $20 a month. In North America, more than 45% of all people have no or insufficient coverage.

If you would like to discuss this click here

Top of Page