Canada Health Benefits Flashcards
Canada Health Benefits
Canadian Health Act
Objective
- Protect, promote, and restore wellbeing of residents
- Facilitate reasonable access to health services without barriers
Canada Health Benefits
Canadian Health Act
Federal Subsidy Compliance Requirements
- Comprehensiveness
- Universality
- Accessibility
- Portability
- Public Administration
Canada Health Benefits
Provincial Medicare Plans
Covered Benefits
- Hospital
- Physician
- Other Professionals (Chiro, optometrist)
- Rx (For social assistance recipients and 65+)
- DME
- Diagnostic services
- Dental
- Out-of-Province coverage
Canada Health Benefits
Provincial Medicare Plans
Financing Methods
- General revenues
- Payroll taxes
- Resident premiums (via income tax)
- Transfer payments from federal government
Canada Health Benefits
Provincial Medicare Plans
Medicare System Challenges
Demand for Services > Supply
- Shortages (beds, equipment)
- Long wait times (specialists, LTC, ER)
- Overcrowded ERs
- Technology-intensive services not available everywhere
- Essential services not covered
Canada Health Benefits
Provincial Medicare Plans
Responses to Challenges
- Scope
- Philosophy = Focus on patients over services
- Delivery = More choice
- Administration = Guaranteed access within timeframe
- Research
- Treatment
- Funding
Canada Health Benefits
Provincial Medicare Plans
National Pharmacare
- 2019 report showed that many Canadians had barriers to prescription drugs
- Recommended creation of program
- $2 copay for essentials; $5 copay for national formulary
Canada Health Benefits
Canadian Drug Insurance Pooling Corporation
Purpose and Eligibility
- Purpose = protect small-medium plan sponsors from financial hardship of catastrophic drug costs
- Eligibility = Fully insured plans
Canada Health Benefits
Canadian Drug Insurance Pooling Corporation
6 Underlying Principles
- Availability
- Affordability
- Transferability
- Viability
- Participative
- Competitive
Canada Health Benefits
Private Medical Plans
Covered Benefits
- Hospital Room & Board
- Rx
- Health Practitioner
- Mix. Expenses
- Vision
- Out-of-Canada emergency
Canada Health Benefits
Private Medical Plans
Cost-Sharing Provisions (List and describe)
- Deductibles (lower than US; $25-100 per person)
- Coinsurance
- No overall limit because they aren’t exposed to catastrophic claims
Canada Health Benefits
Private Medical Plans
Eligible Expenses
- Incurred in Canada
- Not payable under provincial plan
- Medically required
Canada Health Benefits
Dental Plans
Covered Benefits (List and Define)
- Basic = Diagnostic and Preventive
- Minor Restorative Care = Fillings, Extractions
- Periodontal and Endodontal = Root canals
- Major Care = Crowns, Dentures
- Orthodontia
Canada Health Benefits
Dental Plans
Cost-Sharing
- Deductible
- Coinsurance
- Annual Maximum
Canada Health Benefits
Dental Plans
Cost Controls (List and Define)
- Pre-Certification = ensure service is covered under plan before
- Alternate Treatment Clause = Insurer pays only cost of LEAT
