Health insurance cost

What is personal health insurance?
Personal health insurance products help lower your risk of being burdened by expenses for preventive care or medical bills as a result of an illness or accident. While provincial health plans provide coverage for many health expenses, there are gaps that can have a significant impact on your finances. For example, depending on the province or territory where you live, you may have to pay for:

Prescription drugs to treat a chronic or serious health condition
Emergency medical services provided in another country
Practitioners like physiotherapists to promote wellness or help with injury recovery
Medical equipment to assist with your mobility
Sun Life offers 2 personal health insurance products: Personal Health Insurance and Health Coverage Choice.

You should consider personal health insurance if:
You don’t have health benefits through your employer
You’re losing your group coverage
You’d like additional benefits not offered by your employer’s plan or your province’s health coverage. You must have provincial health coverage to apply for personal health insurance.
Learn more about eligibility requirements for this product.

Which product is right for you?
Personal Health Insurance
If you want higher coverage levels and are willing to be medically underwritten – where we review your health in greater depth through tools such as a detailed health questionnaire – then you should consider Personal Health Insurance. See plan details below.

Health Coverage Choice
If you’ve lost your group benefits coverage in the last 60 days – or will be losing your group benefits – because you are leaving your job or retiring, and you want coverage for your current health needs, you should consider Health Coverage Choice. There is no medical underwriting with this product.

Learn more about Health Coverage Choice

We offer 3 Personal Health Insurance plans:
Personal Health Insurance is for you if you don’t have adequate employer group benefits coverage. You can choose among plans with differing levels of coverage. Each person included on a Personal Health Insurance application must have provincial health coverage and will be medically underwritten.

Basic plan
Our lowest-cost plan helps you budget for basic medical and dental needs.

60% reimbursement for prescription drugs with a $750 annual maximum
60% reimbursement for supplemental healthcare expenses. 60% reimbursement with a $25 per-visit maximum on paramedical practitioner services up to $250 per year per practitioner
60% reimbursement for preventive dental care with a $500 annual maximum
Semi-private hospital room coverage is optional. No coverage for emergency travel medical or vision care
Learn more about the Basic plan
Standard plan
Our most popular plan includes catastrophic drug, emergency travel medical and optional preventive dental coverage.

For prescription drugs, 70% reimbursement for first $7,000 and 100% reimbursement for next $93,000 of annual eligible expenses
100% reimbursement for supplemental healthcare. 100% reimbursement for paramedical practitioner services up to $300 per year, per practitioner. 100% reimbursement for vision care up to a $150 maximum every 2 years
Emergency travel medical for the first 60 days of a trip and $1 million lifetime maximum on emergency travel medical claims
Optional preventive dental and semi-private hospital room coverage
Learn more about the Standard plan
Enhanced plan
Our most comprehensive coverage, with a higher prescription drug maximum than the standard plan and optional dental coverage that includes restorative and orthodontic services.

For prescription drugs, 80% reimbursement for first $5,000 of annual eligible expenses and 100% reimbursement for next $245,000 of annual eligible expenses
100% reimbursement for supplemental healthcare. 100% reimbursement for paramedical practitioner services up to $400 per year, per practitioner. 100% reimbursement for vision care up to $200 maximum every 2 years
Emergency travel medical for the first 60 days of a trip and $1 million lifetime maximum on emergency travel medical claims
Optional dental coverage for preventive, restorative and orthodontics and optional semi-private hospital room coverage
How much are you paying into your company’s health care plan? The answer is not always obvious. Thanks to the wonders of automated payroll processing, we don’t concern ourselves with the details. All we know is monies are transferred directly into accounts, deductions occur at source and income slips are indecipherable tables heavily coded with strange acronyms.

The notion that health care in Canada is free or paid by taxes might also be responsible for lulling us into a deeper state of complacency. But this too is a false comfort. The average Canadian household spends $2000 on health care costs and $4000 on private insurance premiums. 65% of Canadians have some form of private health insurance most often provided through their employers.

Insurance plans vary in quality and price just like any product in a free market. Health plan and provider are selected at the discretion of employer. As the employee you’re stuck paying for it out of your salary. The difference to your bottom line could be hundreds of dollars every month. Inquire on these points when you’re going over the contract and before you sign. As with anything predetermined for you, it is in your best interest to avoid the rude awakening I just experienced doing recon for this article. Apparently my last job’s health benefits cost $409 per month and my former employer contributed only 10%.

I consulted with Farrah Press, VP of Sales and Marketing at Executive Link to take a look at my pay slip and help me understand the cost breakdown. She wasn’t nearly as incredulous as I. According to Press, “the company’s health plan included extras. Life insurance and dental. If life insurance and dental are on the plan the cost can double.”

Another good reason to be picky about your job, companies can be widely different in the scope of the plans they can offer. “A large public company can offer a more competitive plan than a small private company because it can afford to and because it has a larger base of employees.”

“All companies must pay into their employee’s health plans, but the minimum can be extremely low,” said Press. “In my experience, if they’re paying more of a contribution, such as fifty percent of the cost of the health plan, they usually balance that cost with a fifty percent deductible for prescriptions and health care services. More generous plans will cover eighty percent of direct costs.”

In an effort to curb costs, many companies are replacing high health benefit top up payments with perk programs that are less expensive to implement such as matching RRSP contributions.

“One of the company’s employees used to pay $300 out of her monthly paycheck for health benefits at her last job, excluding life insurance,” said Press. “Her employer at the time paid the bare minimum required to qualify for the plan, which was $20. She took a private plan when she went on maternity leave. She saved $200 a month and got better benefits.”

Private Health Insurance

Unless your employer’s insurance plan is priced right, private health insurance is more competitive in both cost and services, whether you’re buying as an individual or family. Coverage in this example includes prescription drug plan, eyeglasses and eye examination, and health professional services such as visits to a massage therapist and psychologist.

Here are some average prices I found by calling different private health insurance providers:

Type of Coverage Monthly Cost
Family $157
Single Parent -Father $78
Single Parent -Mother $110
Individual Male $47
individual Female $80

You like the price? But wait…
Let’s say you wanted to pay for your health insurance privately. Or simply use the government provided plan. You’re out of luck if your employer offers health benefits. According to health law in Canada you’re legally obligated to get with the program. You can purchase supplemental health coverage privately, but the only way to opt-out of your company plan is to physically not be there by leave of absence such as disability or maternity.

The only other exception is spousal/ common-law coverage. If your spouse pays less out of pocket with access to more services and lower deductibles, you can opt-out of your company’s plan in favor of your spouse’s employer’s plan.

I leave you with this to ponder. Ask about your contribution and your employer’s contribution when you are ironing out the details of your hire. If you’re passed that stage, read your pay slip and ask questions. And if the calculation still smarts, why not consider getting hitched?
Are you getting government subsidies to help cover the cost of your health insurance premiums? If you qualify for subsidies, it can really help you keep your monthly expenses in check.

But what does health insurance cost without a subsidy?

Let’s look at some data on health insurance costs and shopping trends from the 2016 open enrollment period, which ended January 31, 2016.

Average premiums and deductibles nationwide unsubsidized shoppers:
Premiums for individual coverage averaged $321 per month while premiums for family plans averaged $833 per month.
The average annual deductible for individual plans was $4,358 and the average deductible for family plans was $7,983.
Average monthly premiums for individual plans by metal level were:
$153 for catastrophic plans
$315 for bronze plans
$362 for silver plans
$420 for gold plans
$498 for platinum plans
Average monthly premiums for individual plans by age group were:
$152 for people under age 18
$177 for people age 18-24
$239 for people age 25-34
$303 for people age 35-44
$400 for people age 45-54
$580 for people age 55-64
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The figures above are from eHealth’s Health Insurance Price Index Report for 2016, based solely on eHealth shoppers who selected individual or family health insurance plans during the 2016 open enrollment period (between November 1, 2015 and January 31, 2016) and who did not utilize a government subsidy.

eHealth is one of the few organizations with national source health insurance data that broadly reflects consumer buying patterns and purchase prices in the self-purchased individual and family health insurance market. eHealth’s report provides insights into the large segment of the individual and family health insurance market which may not qualify for or elect to use government subsidies, and which may shop for coverage through sources other than government exchanges.

Now that you’re informed, let’s get started.
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