Chpt 7 Health Benefit in Canada

Question 1

Covered Benefits of Canadian Provincial Medicare Plans

Answer 1

1. Hospital services
   
   1. 1 room and board
   2. 2 Physicians, diagnostics, nursing, drugs
   3. 3 Room and board in nursing home
2. Physicians: general practitioner, specialist, surgeon
3. Other professional, optometrists, chiropractors
4. Prescription for social assistance recipients and over age 65
5. Prostheses and therapeutic equipment
6. Other diagnostic services
7. Dental care
8. Out-of-province coverage

Question 2

Provincial Medicare Plans and the Canada Health Act

Answer 2

1. For the federal subsidy, provincial Medicare plans comply with Act
   
   1. 1 Comprehensiveness: All necessary hospital and physician services
   2. 2 University: uniform terms and conditions
   3. 3 Accessibility
   4. 4 Portability: WP = 3 months and coverage when resident moves or travels
   5. 5 Public Administration: Non-profit basis by a public authority
2. Extra-billing and user charges discouraged by provisions reducing federal grants
3. Services not available under Medicare are the focus of group health insurance

Question 3

Canadian Medicare system concerns

Answer 3

1. Shortage of equipment, technicians, rooms, and beds
2. Demand for services exceeds the supply
3. Waiting months to see a specialists
4. Waiting for diagnostic procedures
5. Waiting for non-emergency surgery
6. Emergency rooms overcrowded
7. People who need LTC wait because of shortage of beds
8. Technology-intensive services are not available everywhere
9. Services that are essential are not covered by Medicare

Question 4

Private Medical Plans in Canada

Answer 4

1. Extended health plans include five benefits
   
   1. 1 Hospital, prescription drugs, health practitioner, miscellaneous expenses, and out-of-Canada emergency
2. Deductible apply
3. Coinsurance: hospital charges usually paid in full
4. Overall limits: Unlike US, no overall limit
5. Exclusion - Services covered by provincial Medicare generally excluded
6. Funding
   
   6. 1 Flexible benefits plans getting popular
   7. 2 Self-insured plans popular

Question 5

Canadian Tax Environment for Group Insurance

Answer 5

1. Tax on net premium in all provinces
2. GST does not apply to insurance premium but is charged on admin expenses
3. Non-Quebec provinces do not tax employer contributions to health and dental
4. Federal and provinces income tax on employers’ contributions to group life
5. Sales tax applies in Quebec and Ontario
6. Sales tax applies in Manitoba for group life, ADD, critical illness and DI