The good, the bad and the challenge with health insurance

By Cindy Bowden 

I know that the last thing people want to hear are stories about doom and gloom. That’s why, in my letters to you, I try to keep a light and personal approach when I talk about insurance. But today I want to switch gears and talk about something very serious. 

OHIP has been slowly but surely making changes to reduce the amounts they have to pay out in the event of a claim. They have done this to manage their government budget – which is good – because the alternative would be to raise taxes – which is bad. 

For example, OHIP has stopped covering chiropractic care, physiotherapy and eye exams. OHIP doesn’t cover treatments unless they are administered by a physician or at a hospital. But with the advance of medical technology, many drugs and treatments can now be administered at home. And now that people are sent home from hospital more quickly – which is good – we are now responsible for our own recovery treatments; including dressings, home nursing and related medicines – which is, well, a challenge. 

Medicine is advancing at such a rapid pace – which is good – especially with the advent of extremely sophisticated new drugs. The problem is that in addition to being sophisticated, many of these drugs are also expensive – which is, well, a challenge. OHIP simply can’t afford to cover everything. 

A recent article in the Globe & Mail described one patient’s situation in which he found a drug that worked – but OHIP required him to use an alternative drug that made him violently ill. Why? Because the cost of the drug that was proven to work was $23,000 per year. 

Insurance companies and their corporate clients have and are doing their best to pick up the slack, but they want to avoid raising rates for premiums – which is good. That’s why, for example, in the 1980’s most plans in Canada reimbursed health costs including drugs at a rate of 100% with no deductible. Now, the majority of plans reimburse employees 80% of the cost of drugs, and sometimes a ‘per prescription’ deductible or generic drug restriction is imposed – which is, well, a challenge. 

What this all means is that you might not be as ‘covered’ as you think, or would need. You have to be careful to read the fine print of exactly what you are covered for – and that’s a challenge for most people. 

Sometimes, all it takes to ‘fix’ a policy is to add a catastrophic benefit rider. Other times, it’s a question of blending different types of coverage between OHIP, personal and group plans. But you have to take the time to read the fine print, and understand the complexities of each type of insurance – which is a challenge. That’s what I do – which is good. And that’s why I encourage you to give me a call – because I’m serious… about taking the challenge out of insurance for my clients! And there’s nothing bad about that!

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