Extended Health Care Insurance
Extended health care insurance (EHC) is supplemental coverage that helps pay for medical expenses not covered by your provincial or territorial health plan. It protects you from out-of-pocket costs associated with services such as prescription drugs, vision care, medical equipment, hospital upgrades, emergency travel medical care, and paramedical services like physiotherapy or chiropractic treatments.
How It Works
Also known as supplementary or major medical benefits, extended health care fills the gaps left by provincial plans by reimbursing expenses like prescription drugs, paramedical services, medical equipment, and travel health insurance. You can get it through a group benefit program offered by an employer or as an individual policy bought directly from an insurance company, and individual plans can be customized based on age, health, and budget. Coverage is designed to reimburse you only after you have used the benefits provided under your provincial or territorial health plan or another third-party source of health care assistance you are legally entitled to. Rather than you covering the full cost of routine care yourself, these plans typically cover 50 to 80 percent of eligible expenses. After the deductible is met, co-insurance is the percentage of covered expenses you must pay; under an 80/20 plan, for instance, the plan reimburses 80 percent and you cover the remaining 20 percent, often called your co-payment.
Example:
Consider someone in Ontario whose OHIP plan does not cover prescription drugs, who holds an individual extended health care plan with 80 percent drug coverage. When she fills a prescription, the plan reimburses 80 percent of the eligible cost and she pays the remaining 20 percent as her co-payment, after first using any coverage available through her provincial plan.
What to Watch For:
Extended health insurance does not cover everything. It carries exclusions, conditions, and limitations, most underwritten plans do not cover pre-existing conditions, and charges payable under a provincial health insurance plan are not covered. Because coverage is designed to reimburse you only after your provincial or territorial plan and any other source you are legally entitled to have paid, review your plan's eligible expenses and exclusions carefully, and keep in mind that you remain responsible for your share of co-insurance after the deductible is met.
