1. Chapter 9 In-Class Notes

2. 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 government  To 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 Act 1.Public administration 2.Comprehensiveness 3.Universality 4.Portability 5.Accessibility 9-2Copyright © 2009 Pearson Education Canada

3. 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 9-3Copyright © 2009 Pearson Education Canada

4. 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 9-4Copyright © 2009 Pearson Education Canada

5. 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 9-5Copyright © 2009 Pearson Education Canada

6. 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 9-6Copyright © 2009 Pearson Education Canada

7. 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 have 9-7Copyright © 2009 Pearson Education Canada

8. 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 provision 9-8Copyright © 2009 Pearson Education Canada

9. 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 9-9Copyright © 2009 Pearson Education Canada

10. 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 9-10Copyright © 2009 Pearson Education Canada