Chapter 9

In-Class Notes

Background on Health Insurance and Canada Health Act • Health insurance includes:

Medicare, private health care, disability insurance, critical illness insurance, and long-term care insurance

• Role of the federal governmentTo ensure that universal coverage for medically

necessary services is provided to eligible residents on the basis of individual need, rather than on the ability of the individual to pay.

• Principles of the Canada Health Act1. Public administration2. Comprehensiveness3. Universality4. Portability5. Accessibility

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Role of the Governments

• Provincial/territorial governments• Responsible for the administration and delivery

of insured health care services

• May offer and fund supplementary benefits for certain groups (seniors, children, social assistance recipients)

• Supplementary benefits may include drugs prescribed outside hospitals, ambulance costs, hearing aids, vision care, home care, and chiropractic services

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Role of Private Health Insurance• Provides additional coverage beyond what is

available under the Canada Health Act and provincial/territorial plans

• Provides coverage for individuals who may not otherwise be insurable

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Contents of Health Care Insurance Policies• Identification of insured persons

• May be an individual or a family

• Location

• Typically, full health insurance benefits are confined to the local area of the beneficiary

• Benefits are reduced or eliminated for non-emergency health care received outside of that area

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Contents of Health Care Insurance Policies (Continued)• Pre-existing conditions

• Prevents people form buying insurance just to treat existing illnesses or injuries

• Cancellation options

• Some contracts allow the insurance company to cancel the contract at any time

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Contents of Health Care Insurance Policies (Continued)• Determinants of Non-reimbursed Medical

Expenses• Deductible

• Requires that the insured bear the cost of the health care up to a level specified in the policy

• Coinsurance• Specifies the proportion of the health care expenses that will be

paid by the insurance company

• Coordination of benefits• Benefits depends on the benefits that would be paid by other

policies you have9-7Copyright © 2009 Pearson Education Canada

Disability Insurance• Purpose

• Ensures that you are still able to provide for your family adequately, even though you are unable to work

• Understand your definition of disability• Own occupation

• Regular occupation

• Any occupation

• Terminology• Waiting period, benefit period, non-cancellable

provision, renewable provision9-8Copyright © 2009 Pearson Education Canada

Critical Illness Insurance• Provides a lump-sum benefit in the event

that you suffer a life-altering illness listed in the policy

• In order to receive benefits, you must survive a covered life-altering illness for at least 30 days

• Benefits received may be used in whatever manner you choose

• Three major critical illnesses: stroke, life-threatening cancer, heart disease

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Long-Term Care Insurance• Long-term car insurance: covers expenses

associated with long-term health conditions that cause individuals to need help with everyday tasks

• Benefits may include nursing care, rehabilitation and therapy, personal care, homemaking services, and supervision by another person

• Premiums quite expensive

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