Turning 65 is a milestone birthday and an age at which many individuals consider retirement. Unfortunately, the same time many people think of retiring is the same time needs for health care services such as prescriptions, physiotherapy, and other medical costs increase. Without a strategy for covering increased health care costs during retirement, many individuals put their personal savings at risk.

We are fortunate in Canada to have a publicly-funded health care system. While there are many services to take advantage of throughout our lifetime, many of the services we have become accustomed to accessing through employee benefits become less affordable in retirement. Medical prescriptions are often at the top of the list.

At the age of 65, the Ontario government covers some prescriptions; approximately 30% of the available drugs. Starting August 1 of each year, individuals must satisfy a $100 deductible towards prescription medications, after which individuals pay a dispensing fee for each prescription. This works well provided the medications are covered. What happens when the medications are not covered? Those prescriptions must be paid for out of the individual’s pocket.

Individuals can protect themselves from increasing drug costs through personal insurance. Even with pre-existing conditions, retirees can have a portion of prescription costs paid for by purchasing an insurance plan for themselves and/or their family. Personal insurance plans can also cover semi-private hospital rooms, ambulance transportation, out-of-country travel insurance, medical equipment, paramedicals (physiotherapy, massage therapy, acupuncture, podiatrist, psychologist, etc.) and much more.

Doucett Insurance offers a variety of personal insurance plans to individuals in Carleton Place, Almonte, Perth, Carp, Stittsville, Smiths Falls, and beyond that accommodate every budget. Contact us today to learn how we can help take the shock out of hidden health care costs for your retirement years.

If your family has access to more than one health and/or dental plan you can use what is called coordination of benefits to have more of your expenses covered.  All insurance companies follow the same procedures, which are set out in the Canadian Life and health Insurance Association’s (CLHIA) Coordination of Benefits Guidelines.

The plan that pays first pays as though there is no other coverage.

The plan that pays second pays the lesser of:

1. The amount they would have covered if they were the first plan, or
2. The full amount of eligible expenses minus the amount paid by the first plan

You go for an eye exam that costs $100, and submit the claim to your plan which covers $75. The remainder ($25) is submitted to your spouse’s plan and would be paid.

The Rules:

The plan which covers you as a member pays before the plan which covers you as a dependent.

If you have coverage as a member with your employer and as a dependent with your spouse’s plan:

• Your plan pays your claim first
• Your spouse’s plan pays the claim second

When children are covered as dependents on 2 plans, the plan of the parent with the earlier birth date in the calendar year pays first.

• Mom’s birthday – April 17
• Dad’s birthday – February 2

Dad’s plan pays first as his birthday is earlier in the year.

If Mom and Dad’s birthday are on the same date, the parent with a given name earlier in the alphabet pays first.

• Mom’s given name is Julie
• Dad’s given name is Tom

Mom’s plan pays first – the name Julie comes first alphabetically.

If one parent has custody of the child(ren), the plan of the parent where the child lives pays first.

• Child lives with their father and his new spouse

1.      Father’s plan pays first
2.      Father’s spouse’s plan pays second
3.      Mother’s plan pays third
4.      Mother’s spouse’s play pays fourth.

Your insurance carrier or broker will be able to help you to determine where claims should be sent.

Why is it important to keep employee information up-to-date?

If you have short- or long-term disability on your plan, the amount of coverage a plan member is eligible for is based on their reported income.  If employee salaries aren’t being updated, your employees will not have the disability income they are entitled to.  For example: When Mary was added to the plan she was earning $30,000 annually, for a monthly disability income benefit of $1,600.  If Mary’s income increases to $40,000 she would then be eligible for a disability income benefit of $2,050.  If Mary goes off on disability without her salary having being updated with your benefit company she will only receive $1,600 in monthly income.

When adding new employees, you will generally have a waiting period – 3 months is most common.  You then have a 31 day grace period to submit their application to the insurance company.   Submitting their application in a timely manner guarantees them health and dental benefits, and at least the minimum amount of disability insurance (if you have disability on your plan).  If you submit their application outside of this window, they will be considered a ‘late entrant’ and their entire family will be subject to medical underwriting (health questionnaires) for all benefits.  This can have many outcomes – from having exclusions for current medications and being declined a drug card, to being declined for coverage entirely.

It is also important to be sure that employees report changes in family status i.e. new spouse, or children.  Only family members named on the plan are covered by the plan.  Children can be added to some plans at birth, and some plans when they are 14 days old.  If you wait to add them, it is possible that there could be a problem as they will be subject to medical underwriting (health questionnaires).  We have seen young children declined coverage due to health issues.  Imagine going on a family trip and discovering that someone in the family doesn’t have travel coverage because they weren’t added to the plan.

These things can, and do, happen.  They are avoidable by keeping employee information up-to-date.

When we meet with organizations to discuss group benefits, they are often surprised at how broad the health care coverage is.  Many people who have never had a group health plan think they only cover prescription medications.  This is far from true.

Some of the areas covered by a group benefit health plan:

• Prescription medication
• Home Care Nursing
• Paramedicals – chiropractor, massage, physiotherapy, psychologist, registered dietician, naturopath, osteopath, acupuncture, etc.
• Orthotics / Orthopaedic shoes
• Travel Insurance (out of country emergency medical treatment)
• Diabetes, ileostomy, colostomy supplies
• Dental repairs resulting from an accident
• Semi-Private hospital room
• Medical Equipment (rental / purchase) – wheelchairs, crutches, oxygen, etc.
• Eye Exams / Eye glasses
• Ambulance transportation
• Hearing aids
• Speech aids
• Diagnostic x-rays and lab tests
• Respirator and oxygen
• And more!