Extended Health - Medical Insurance

Extended Health plans give you coverage for everyday health needs and medical emergencies. These plans can supplement or top up your provincial health plan or employer plan. This includes a wide variety of services, such as dental care, prescription medication, vision, chiropractors, and more! Please read the benefits section for a summary of the available coverage.

2. What is not covered?

Extended Health insurance does not cover everything. This insurance has exclusions, conditions, and limitations. Please read and understand the policy before you purchase a plan. Most underwritten plans do not cover pre-existing conditions. Some benefits are limited by an amount per year and/or co-insurance. Any charges for medical expenses or supplies which are payable under any provincial health insurance plan are also not covered.

3. What is co-insurance?

After your deductible is met, co-insurance is the percentage of the covered medical expenses that you, the insured person, must pay. For instance, if your health plan has an 80/20 co-insurance rate, your insurance plan pays for 80% of your eligible medical expenses and you are responsible for the remaining 20%.

4. Can I go to any doctor/hospital or am I limited to specific medical practitioners?

There are no restrictions where you seek medical service, as long as the amount charged by the providers is Usual, Customary and Reasonable for a particular service, treatment, or supply.

5. What is the meaning of Usual, Customary and Reasonable?

Usual, Customary and Reasonable charges represent the average or most common amount charged by medical providers for a particular service, treatment, or supply in the same geographic area. Typically, information on rates for procedures is compiled into a data bank and updated periodically. So when a claim is submitted for a plan with UC&R benefits, the insurance company before making the claim payment reviews the UC&R rate and double checks that hospitals, doctors, and dentists are not billing excessively for the particular service or procedure.

6. Can I receive instant coverage?

Many benefits like massage therapy and prescription medication can be covered as soon as your plan starts. Certain benefits like dental care may have a waiting period. Please speak with one of our representatives for more information.

7. Do you offer group Extended Health policies?

We do not offer group Extended Health policies. The plans we offer are for individuals, couples, or families looking for additional coverage to supplement their provincial health insurance plan or in addition to their group plan.

8. Can I apply for Extended Health if I have a group plan?

Yes! Extended Health insurance is a great way to complement your group plan. By purchasing an Extended Health Plan, you may cover benefits that are not included in your group plan or medical expenses that are in excess of what your group plan covers.

9. I have a group plan that covers 80%, can I use Extended Health to cover the other 20%?

Yes! Your Extended Health plan will be the second payor to your group plan. This means any eligible expenses not paid by your group plan can be claimed through your Extended Health plan. For example, if your group plan covers 80% of the cost of your prescription medication, then the remaining 20% can be covered by your Extended Health plan.

10. I am a student/visitor/worker without provincial healthcare. Can I apply for Extended Health?

No. All applicants must have valid provincial health coverage from your province of residence and must be a resident of Canada at the time of application to be eligible. If you do not have provincial health coverage, you can visit our website www.visitorsinsurance.ca for information on emergency medical insurance.

11. Can I cover a pre-existing medication?

Depending on the policy you choose, pre-existing medication can be covered. You can provide us with the Drug Identification Number (DIN) so that we may determine if a specific drug will be covered. Contact us at 1-877-838-0020 to speak with one of our representatives.

12. What is a DIN number?

The Drug Identification Number is the number assigned to a specific drug formula and dosage by Health Canada. You should be able to find the number on your prescription, or by contacting your pharmacist/physician. To confirm if you have the right DIN, you can check the website below:

https://health-products.canada.ca/dpd-bdpp/index-eng.jsp

13. I only want drug coverage, why should I buy a plan with other benefits?

Extended Health plans are designed to provide an overall coverage for preventative care and medical emergencies. These plans are built to include core benefits, such as ambulance transportation, medical equipment, and private duty nurses. Prescription medication and dental care can be included in addition to these benefits. Including these core benefits will minimize your risk of paying for unexpected emergencies.

14. For the travel insurance coverage, how do I know if my medical condition is stable before I travel?

For a pre-existing condition to be covered during your travel, it must be stable for a certain period (specified in the policy wording) before departure from your province or territory of residence. Be aware that a simple change in medication can mean that the medical condition is not considered "stable". Policy definitions are critical, and the rules vary depending on the age of the policyholder. It is up to each policyholder to make sure they qualify. You can contact us at 1-877-838-0020 to speak with one of our representatives if you have questions regarding travel insurance coverage.

15. How do I purchase this insurance?

You can purchase the insurance online through our website extendedhealthcanada.ca or by phone at 1-877-838-0020 with one of our representatives.

16. What information is required at the time of purchase?

-The name of any prescription medication you are taking, the drug identification number (DIN), dosage, the medical condition being treated, date prescribed, length of time used, and the number of authorized refills.

-Your doctor's contact information and address.

-The Government Health Insurance Plan (GHIP) numbers of everyone applying for coverage.

-If you have or recently had group insurance, the name of the insurer, your group plan, subscriber ID, and the date the benefits end.

-Your credit card information or bank information for a pre-authorized payment plan.

17. How is the premium billed?

Depending on the company, the premiums can be billed either monthly, semi-annually, or annually with a credit card or pre-authorized debit card.

18. Is there a medical test required before I can purchase Extended Health insurance?

Guaranteed Issue plans do not require a medical exam. A medical report from your doctor may be required for the underwritten plans. Details of your medical history will be required at the time of application.

19. Can I downgrade or upgrade my coverage?

Most plans can be downgraded or upgraded. Please speak with one of our representatives for additional information. For plans that can be downgraded, you may do so at the time of renewal. For plans that can be upgraded, you may do so at any time, but may be subject to underwriting.

20. Can I remove benefits from my plan or apply maximums to other benefits?

The benefits under the plans are fixed and cannot be changed.

21. When will my benefits reset?

For most plans, the benefits will reset on your plan's anniversary year.

22. Can I cancel the policy and receive a refund?

You may terminate your policy at any time by giving written notice. Please, notify us at least 10 business days before the next bill date to avoid being charged. After cancelling a policy, you may be subject to a two year waiting period before re-applying.

23. What happens if I move to a new province?

Premiums are determined, in part, by the province in which you reside. If you move to a different province, you must notify the insurance company with your new address. Premiums will be adjusted according to the new province's rates. Benefits and limitations may vary.

24. What should I do when I need to make a claim?

For many health care services covered by your plan, you may not need to fill out a claim form. Health care providers like hospitals, pharmacies, and many dentists bill the insurance company directly for services covered by your plan, meaning you don’t need to submit a claim form. If your pharmacist, dentist, or hospital does not bill directly, you must pay the provider and then submit your claim for reimbursement.

To submit a claim, you will need to complete a claim form and attach the original medical bills, receipts and invoices (always make a copy for your record). You can either submit a claim online or by mail.

Eligible claims must be received within 12 months of the date the eligible expense was incurred.

For more information on how to make a claim, please, check our "Claims" page.

25. How long do claims take to be paid?

Depending on the plan, claims may take 5 to 20 days to be paid.

26. What if the insurance company does not pay my claim?

Insurance policies are legal documents and insurance companies are obligated to follow the conditions of the contracts. If you disagree with an insurance company's claim decision, you may: 1. Request in writing from the insurance company to review your claim; 2.If not satisfied again with the second decision, you have the right of arbitration in accordance with the law governing arbitration proceedings in the province in which your policy was issued. Legal action to recover a claim must start within 12 months of the date of bodily injury or the date on which you first received any emergency medical service; 3. You also have the option of contacting the following regulating bodies: Better Business Bureau - www.bbb.org (enter your Canadian postal code to find the nearest office) Canadian Life and Health Insurance OmbudService - www.olhi.ca

27. Why do I need Extended Health insurance?

Extended Health insurance lowers the risk of being burdened by expenses for preventive care or medical bills as a result of an illness or accident. These plans provide coverage for unexpected costs that your provincial or employer plan does not cover. Expenses such as prescription drug treatments for a chronic or critical illness, nursing care provided at home, and medical equipment to assist with mobility. Without Extended Health insurance, unexpected expenses could have a significant impact on your finances.

28. Why do I need to use a broker?

Insurance premiums are the same whether the plan is purchased directly from an insurance company or through a broker like extendedhealth.ca. Working with a broker gives you some advantages:

- We offer comparative one-stop shopping for Extended Health Insurance.

- We work for our clients, not for an insurance company.

- We offer claim support for our clients.

- We offer experience and knowledge to help you make the right decision.

29. Are there any discounts?

The published premiums from the insurance companies are the only rates available. Offering discounts from these prices initiated by an insurance broker or travel agent is strictly forbidden under the Codes of Conduct that apply to our operation. Any agent caught doing this could lose their license.

30. Is there any tax advantage?

Extended Health premiums may be claimed as a business expense for self-employed workers. Please speak with a financial advisor or with the Canada Revenue Agency (CRA) for more information.

31. I'm covered through my provincial health card. Isn't that enough?

Provincial health plans don't cover all medical expenses. This means there are gaps that can leave you financially devastated. Extended Health plans cover services and health care items your provincial health plan does not. These benefits include vision care, dental exams, and massage treatments. When the unexpected happens, it can cover the costs of ground or air ambulance, in-home nursing, medical equipment, and more! You may visit the websites below to determine what is covered by your provincial health plan.

32. Should I read the official policy wording booklet?

Yes! The official policy wording booklet includes the terms and conditions of your insurance policy as well as the important contact information you will need. As with any insurance, some of those terms may limit the benefits payable. It is important to read your policy wording carefully.

33. Is it safe to purchase Insurance online?

Yes. The application forms are in a highly secure ordering environment so you can enroll in the insurance plans with confidence. The insurance providers use Secure Socket Layers (SSL), for transferring information to process your orders. The SSL encrypts or translates, your order information into a highly indecipherable code, which is processed immediately. You will remain in this secure zone for the entire purchase process.

34. Is my personal information protected?

The protection of your personal information is very important to us. Our high standards for privacy protection comply with Canada's privacy laws. Policyholder information and medical information are gathered at the time of application to determine the premium and appropriate coverage. The information is used only as needed and is maintained securely for the period required by law. You may also view our Privacy Policy.

Disclaimer:

All questions on this website have been answered to the best of our knowledge. Since insurance companies can change their policy wording and premium rates at any time without notice, we cannot guarantee the accuracy of the information on this page. We will not be held liable in any case, for any problem arising from reading these questions and answers. Please, use this information at your own risk.