Personal Health Insurance
The government program OHIP (free medical insurance) unfortunately does not cover all costs of treatment. Dialling 911 for an ambulance, the treatment of teeth, prescription drugs and some specialists, eye doctor visit and many other things result in financial concerns within a family in case of receiving treatment in an emergency. Its excellent that at our jobs come with benefits which helps to pay for majority of the financial expenses for these medical systems. Unfortunately not all jobs come with benefits. Some work for themselves, some have opened their own business or have a contract today. These people don’t have benefits and can only get access to them at their own expense. The government allows, those who have their own business or work under a contract to add these expenses to medical insurance.
Only a few companies work in the market of individual medical insurance. The prices of all are approximately the same. I of course can offer any company, but below I show the terms and prices of this type insurance coverage for only 1 company. This will give you idea how this plan is working
Personal medical insurance program in general consists of 3 main components: payment of prescription drugs, return of expenses spent on dental doctors and other doctor specialists, payment of medical services not covered by the free insurance.
The Manulife company offers a few directions, due to the fact that families most of the time need something specific, for example just coverage from doctors. You can choose your coverage and add as many services coverage as you want. Only coverage for doctors, only coverage for dental doctors, only coverage for prescription drugs, etc. Your package can have coverage for 1, few, some, or all of the listed above, the combinations are up to you.
I want to point out that no company exists that would offer the coverage for only dental doctors/dental work, something else would have to be added to it. In general all people use the dental services and therefore the companies don’t want to constantly pay out for dental claims and loose the insurance principle of some people use insurance and some don’t.
Below you will find the prices and listed terms/conditions of different plans in Manulife. First table shows you the prices of the plans, covering services of dental (Dental Plus) and prescription drugs (Drug Plus). Both include automatically, the coverage for services of specialized doctors (Core Benefits) which is not covered by free medical insurance. The second table shows you the prices of combined plans covering the dental doctors, prescriptions drugs, and specialist doctors which the free medical does not cover (Combo Plus).
| CORE BENEFITS | CORE PLANS (Please note: All Core Plans include the Core Benefits) |
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| DentalPlus – Basic | DentalPlus – Enhanced | DrugPlus – Basic | DrugPlus – Enhanced | |
| Vision (Basic), Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist, Psychologist, Speech Pathologist/Therapist, Physiotherapist, Homecare and Nursing, Prosthetic Appliances, Durable Medical Equipment, Health Service Navigator*, Preferred Vision Services (PVS), Accidental Dental, Ambulance, Hearing Aid, Emergency Travel Health Coverage, Accidental Death and Dismemberment, Survivor Benefits. Extended Health Care (EHC) Lifetime maximum $250,000 |
Ongoing Maintenance 9-month recall Total benefits payable: Year 1: 50% of first $1,150 Total payable per anniversary year in Year 1: $575 Year 2 and beyond: 80% of first $400; 50% of next $860 Total payable per anniversary year in Year 2+: $750 DentalPlus Basic and Enhanced have an escalating yearly maximum for Home Support, Durable Medical and Prosthetic Appliances No medical Questionnaire required. |
Ongoing Maintenance 6-month recall Total benefits payable: Year 1: 70% of first $1,200 Total payable per anniversary year in Year 1: $840 Year 2 and beyond: 100% of first $500; 60% of next $700 Total payable per anniversary year in Year 2+: $920 Combined maximum of $1,250/3 year period for: Oral Surgery, Endodontics, Periodontics: Year 1: 0%; Year 2: 60%; Year 3 and beyond: 80% Major Restorative First 2 years:0% Year 3 and beyond: 60% No medical Questionnaire required. |
Generic Drug Plan 70% of first $750 90% of next $4,972 Total benefits payable per year: $5,000 Full coverage of reasonable and customary dispensing fees* Exclusions – smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, erectile dysfunction drugs and drugs not requiring a prescription |
Brand-Name Drug Plan 90% of first $2,222 100% of next $8,000 Total benefits payable per year: $10,000 Brand-name or generic drugs, including birth control and fertility drugs Full coverage of reasonable and customary dispensing fees* Exclusions – smoking cessation drugs, over-the-counter drugs, erectile dysfunction drugs and drugs not requiring a prescription |
| AGES: Single Adults | DentalPlus – Basic | DentalPlus – Enhanced | DrugPlus – Basic | DrugPlus – Enhanced |
| <45 | $73.10 | $119.50 | $56.40 | $86.80 |
| 45-54 | $76.50 | $143.10 | $64.90 | $90.00 |
| 55-59 | $77.40 | $146.00 | $74.20 | $100.60 |
| 60-64 | $79.40 | $147.80 | $80.90 | $110.60 |
| 65-69 | $78.90 | $142.70 | $58.20 | $74.70 |
| 70-79 | $79.60 | $140.20 | $65.00 | $82.20 |
| 80-89 | $80.10 | $134.50 | $72.50 | $96.20 |
| 90+ | $104.20 | $138.80 | $105.90 | $134.70 |
| Couples – per Adult | ||||
| <45 | $60.30 | $100.60 | $46.60 | $74.00 |
| 45-54 | $63.30 | $121.70 | $55.50 | $77.50 |
| 55-59 | $64.10 | $124.90 | $64.00 | $87.70 |
| 60-64 | $66.40 | $125.90 | $70.60 | $97.10 |
| 65-69 | $65.30 | $121.20 | $48.90 | $63.10 |
| 70-79 | $66.50 | $119.00 | $55.40 | $70.20 |
| 80-89 | $66.40 | $113.50 | $62.90 | $83.00 |
| 90+ | $89.50 | $117.40 | $94.90 | $119.70 |
| 1-2 Children – Per Child | ||||
| <5 | $21.30 | $24.60 | $26.20 | $38.70 |
| 5-20 | $36.90 | $75.70 | $21.00 | $28.30 |
| 3+ Children – Per Child | ||||
| <5 | $19.40 | $22.40 | $23.90 | $34.70 |
| 5-20 | $33.30 | $67.90 | $18.90 | $25.50 |
| Seniors Adjustments | ||||
| 65+ EHC Lifetime maximum $260,000 |
Travel coverage not available | Travel coverage not available | Generic Drug Plan 100% of first $750 90% of next $4,722/yr for costs not covered by the provincial drug plan Travel coverage not available |
Brand-Name Drug Plan 100% of first $750 90% of next $10,278/yr for costs not covered by the provincial drug plan Travel coverage not available |
| CORE BENEFITS | CORE PLANS (Please note: All Core Plans include the Core Benefits) |
||
| ComboPlus – Starter | ComboPlus – Basic | ComboPlus – Enhanced | |
| Vision (Basic), Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist, Psychologist, Speech Pathologist/Therapist, Physiotherapist, Homecare and Nursing, Prosthetic Appliances, Durable Medical Equipment, Health Service Navigator*, Preferred Vision Services (PVS), Accidental Dental, Ambulance, Hearing Aid, Emergency Travel Health Coverage, Accidental Death and Dismemberment, Survivor Benefits. Extended Health Care (EHC) Lifetime maximum $250,000 |
DENTAL: Ongoing Maintenance 9-month recall 70% of first $575 Total benefits payable per year: $400 PRESCRIPTION DRUGS: Generic Drug Plan 70% of first $750 Dispensing Fee Cap: $6.50* Total benefits payable per year: $525 Exclusions per DrugPlus Basic Escalating yearly maximum for Home Support, Durable Medical and Prosthetic Appliances No medical Questionnaire required. |
DENTAL: Ongoing Maintenance 9-month recall 80% of first $400 50% of next $860 Total benefits payable per year: $750 PRESCRIPTION DRUGS: Coverage as outlined in DrugPlus Basic |
DENTAL: Ongoing Maintenance 6-month recall 100% of first $500 60% of next $700 Total benefits payable per year: $920 Combined maximum year 1: $400 and combined maximum of $1,250/3 years: Oral Surgery, Endodontics, Periodontics: Year 1 & 2: 60% Year 3 and beyond: 80% Major Restorative: Year 1 & 2: 0% Year 3 and beyond: 60% PRESCRIPTION DRUGS: Coverage as outlined in DrugPlus Enhanced |
| AGES: Single Adults | ComboPlus – Starter | ComboPlus – Basic | ComboPlus – Enhanced |
| <45 | $76.70 | $87.20 | $144.60 |
| 45-54 | $92.30 | $108.10 | $174.20 |
| 55-59 | $98.10 | $114.10 | $187.00 |
| 60-64 | $103.40 | $121.20 | $195.10 |
| 65-69 | $88.70 | $96.30 | $156.70 |
| 70-79 | $95.00 | $102.00 | $157.30 |
| 80-89 | $98.80 | $100.00 | $157.80 |
| 90+ | $131.50 | $129.00 | $158.70 |
| Couples – per Adult | |||
| <45 | $65.90 | $76.30 | $131.20 |
| 45-54 | $80.60 | $95.90 | $159.60 |
| 55-59 | $86.10 | $101.10 | $171.70 |
| 60-64 | $90.60 | $108.20 | $179.70 |
| 65-69 | $76.90 | $84.40 | $142.90 |
| 70-79 | $82.90 | $90.00 | $143.20 |
| 80-89 | $86.60 | $88.20 | $144.10 |
| 90+ | $118.00 | $116.60 | $144.70 |
| 1-2 Children – Per Child | |||
| <5 | $32.70 | $34.20 | $45.20 |
| 5-20 | $38.50 | $44.10 | $82.70 |
| 3+ Children – Per Child | |||
| <5 | $29.40 | $31.10 | $40.60 |
| 5-20 | $34.30 | $39.50 | $74.50 |
| Seniors Adjustments | |||
| 65+ EHC Lifetime maximum $260,000 |
Generic Drug Plan 100% of first $750/yr for costs not covered by the provincial drug plan. Full coverage of reasonable and customary dispensing fees.* Travel coverage not available |
Generic Drug Plan 100% of first $750 90% of next $4,722/yr for costs not covered by the provincial drug plan Travel coverage not available |
Brand-Name Drug Plan 100% of first $750 90% of next $10,278/yr for costs not covered by the provincial drug plan Travel coverage not available |
*Subject to applicable co-payment.
All benefits are based on Anniversary year maximums except for Vision and Hearing Aid benefits, which are based on Benefit year. Rates are effective May 1, 2014, and are subject to change without notice.
Along with the plans you can add extended coverage for additional money like: coverage for semi-private or private room when staying at hospital, bigger expenses coverage at the specialist doctors, 100% credit back on medical expenses in case of a trip abroad (Travel Insurance, Manulife automatically has coverage for 9 days but you can increase the amount of days up to 30). Now, it’s better to discuss the extra additions with a specialist and choose exactly what’s right for you. We are always ready for you.