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Archive for the ‘dental insurance’ Category

Group Medical Services (GMS) Health Plans

Sunday, October 4th, 2009

Group Medical Services has proven itself to be a contender in the benefit field for Canadians. Please look closely at these plan features, and give us a call to see if they would fit your needs:

Individual Health Plans

 Information provided by GMS:

No matter what stage of life you’re in, you can ensure your family’s health care security, with supplemental health insurance coverage for everyday health needs, unexpected medical emergencies and protection from rising health, drug and dental costs.

OmniPlan®
Your premier health insurance choice. You get extensive health benefit coverage including health practitioner services like physiotherapy and message therapy, vision care, glasses and much more.

ExtendaPlan®
Comprehensive coverage with a wide range of benefits including coverage for medical emergencies, medical supplies & equipment and a variety of health specialists.

BasicPlan
Ideal coverage for unexpected emergencies including those essential health benefits not covered under your provincial health plan – like ambulance services, preferred hospital rooms and in-hospital drugs.

Additional Coverage Options
Complete your coverage with options for Prescription Drugs, Dental Care, Hospital Cash and Travel Medical.

Why Select an Individual Health Plan from GMS?

  • Comprehensive Coverage. Provincial health plans offer limited medical coverage for such things as ambulance services, casts, crutches, artificial limbs, in-hospital private-duty nursing and numerous others. Use GMS Individual Health to supplement your provincial health coverage or employer-sponsored plan.
  • Flexible Plan Design. You can customize your plan with several options such as dental care, prescription drugs, hospital cash and travel medical for one low annual premium.
  • Outstanding Customer Service. Our representatives are available to answer all or your questions and assist you whenever necessary (and, they answer your phone call in person).
  • Quick Claims Turnaround. In most cases, claims are paid within 5 working days from date of receipt.
  • Pay-Direct Service. GMS pays many health and dental providers directly. Present your GMS pay-direct ID Card at participating pharmacies and dental offices to save on out-of-pocket expenses.
  • Affordable Premiums. With several health plan choices, and a range of optional coverage, GMS provides health customers with affordable annual premiums and a choice of annual and monthly payment methods. 

Here is a basic comparison of plans that will vary by province:

Benefit         Omni                Extenda                Basic
Goods & Services Goods and services may be purchased anywhere in Canada. Goods can be purchased anywhere in Canada. Services must be received in your province of residence. Goods can be purchased anywhere in Canada. Services must be received in your province of residence.  
Eye Exam $75 / 2 most recent policy years N/A N/A  
Eye Glasses, Contacts, or Laser Eye Surgery $200 / 2 most recent policy years N/A N/A  
Health Practitioners Maximum $35 per visit to a maximum of $300 per specialty, per person, per policy year Maximum $35 per visit to a maximum of $250 combined per person, per policy year N/A Acupuncture, chiropractic, chiropody/podiatry, clinical psychology, speech therapy, massage therapy, naturopath and physiotherapy treatments.
Hearing Aids $800 / 5 years $500 / 5 years N/A One year waiting period.
Health Supplies & Equipment $500 / person / year $500 / person / year N/A See policy wording for a complete list of eligible items. Requires a Physician’s written prescription.
Diabetic Supplies & Equipment $300 / person / year $300 / person / year N/A Diabetic supplies and equipment, including testing devices when ordered in writing by a Physician. One year waiting period on testing devices.
Oxygen Supplies & Equipment $500 / person / year to a lifetime maximum of $2,500 $500 / person / year
to a lifetime maximum of $1,500
N/A Does not cover the cost of oxygen. One year waiting period on CPAP supplies.
Blood Pressure Monitors 1 in a 5 year period 1 in a 5 year period N/A Require Physician’s written order.
Custom Foot Orthotics 80% - 1 per 3 years per adult and 1 per year for children under 16 80% – 1 per 5 years per adult and 1 per year for children under 16 N/A  
Therapeutic Shoes $200 / person / year $200 / person / year N/A Require a Physician’s written prescription.
Mobility Aids $300 / policy / year $300 / policy / year N/A Canes, reaching aids, raised toilet seats, grab bars, bath safety rails and transfer benches when accompanied by a Physician’s letter of necessity.
Ostomy Supplies & Equipment $300 / person / year $300 / person / year N/A  
Accidental
Death
$4,000 for funeral expenses in the case of accidental death N/A N/A  
Out-of-Province Referral $50,000 / lifetime $50,000 / lifetime N/A Requires prior written approval from GMS.
Ground Ambulance Unlimited Unlimited $2,000 / person / year 100% emergency transport to hospital; 50% return of bedridden patients.
Air Ambulance $8,000 / person / year $5,000 / person / year $3,000 / person / year Transport within your province of residence.
Casts and Crutches Unlimited Unlimited Unlimited Fibreglass casts and the purchase or rental of crutches.
Preferred Hospital Rooms 45 days up to $3,500 / person / year $1,000 / person / year $500 / person / year Private or semi-private hospital room costs
Private Duty Nursing 80% to $2,500 per person per year for in-hospital or in-home as palliative care nursing. 80% to $2,500 per person per year for in-hospital or in-home as palliative care nursing. 80% to $1,500 per person per year for in-hospital nursing. In-home nursing is for palliative care only; must be prescribed by a Physician.
In-Hospital Prescription Drugs $2,000 / person / year $1,000 / person / year $1,000 / person / year  
Accidental Injury to Natural Teeth $5,000 / injury $2,000 / injury $500 / injury Services over $300 must be pre-approved. 
Wheelchairs, Motorized Scooters & Adjustable Beds 100% of purchase or rental to a maximum of $1000 / 5 years 100% of purchase or rental to a maximum of $750 / 5 years 100% of purchase or rental to a maximum of $500 / 5 years These benefits have a one year waiting period and require a Physician’s written order.
Artificial Limbs, Eyes & Larynx $5000 / person / year $5000 / person / year $5000 / person / year  
Patient Walker 80% of purchase or rental to a max. of $300 / 5 years / policy 80% of purchase or rental to a max. of $300 / 5 years / policy 80% of purchase or rental to a max. of $300 / 5 years / policy This benefit has a one year waiting period, and requires a Physician’s written order.
Breast Prosthesis $325 / 2 yrs lateral
$650 / 2 yrs bilateral
$325 / 2 yrs lateral
$650 / 2 yrs bilateral
$175 / 2 yrs lateral
$350 / 2 yrs bilateral
Excludes surgical brassieres.
Additional Coverage Options
Prescription Drugs 
Coverage for prescription drugs listed under your provincial drug formulary (as detailed under your province’s drug or pharmacare plan/program) up to $3,500 per person, per year. Pay only $4.00 for each eligible prescription. Use our convenient pay-direct card and reduce your out-of-pocket expenses. Prescriptions for pre-existing medical conditions are not eligible for coverage.
Prescription Drugs - Enhanced
Coverage for prescription drugs and oral contraceptives up to $5,000 per person, per year. Includes up to $500 coverage per person, per year for prescription medications for pre-existing medical conditions and legal prescriptions for medications not listed under your provincial drug formulary. Pay only $4.00 for each eligible prescription. Use our convenient pay-direct card.
Dental
1st yr - 75% to $500; basic services
2nd yr - 80% basic, 50% major to $750
3rd yr - 80% basic, 50% major to $1,000A three month waiting period applies to all dental services. Services over $300 must be
pre-approved by GMS.
Hospital Cash $100 / day, up to 30 consecutive days.Begins on the 4th day of hospitalization and on the 7th day if hospitalization is due to maternity. 30 day waiting period.
Travel
$2 Million coverage3 options:
15 days per trip
30 days per trip
48 days per tripSubject to exclusions for pre-existing conditions. GMS indiv policy wording for complete detail.


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Blue Choice (Ontario Blue Cross) Benefit Plan

Sunday, October 4th, 2009

Were you looking for Blue Cross Tangible Disability Plans? – - click here!

Blue Cross in Ontario offers comprehensive medical and dental coverage, “Blue Choice” is a great choice for several reasons, if it fits your needs. Here are the details:

Core Health Benefits

If you’re not covered by a company health plan, Blue Choice is the cost-effective way to ensure you’re protected. It provides coverage that compliments your provincial health plan, with a wide range of extended health care benefits like vision care, hearing aids, nursing care, dental, prescription drugs and hospital coverage at an affordable monthly premium.

Benefits based on a yearly schedule commencing from the effective date of your policy.
Coverage for residents of Ontario only. Limitations may apply, see contract for details.

All Blue Choice contracts with Core Health Benefits include the following:

Blue Cross Assistance Program

We are pleased to provide our clients with the Blue Cross Assistance Program. This new program includes Health Consulting and Support Services, Information and Prevention Services, and Partner privileges and discounts.

When you enroll in a health plan from Ontario Blue Cross, you automatically have access to these services 24 hours a day, 7 days a week.

Our staff will provide you with:

• Access to a Registered Nurse to answer your questions and provide advice and guidance on your health related questions
• Home Support Services following a hospital stay
• Referrals to specialists and health organizations in your area
• and much more

Blue Cross Assistance offers exclusive benefits with our health care partners and as part of this essential program, you also have access to quality services at discounted rates through Ontario Blue Cross partnerships.

Upon enrollment, all customers will receive a booklet detailing the benefits of this exciting new program along with an Assistance Program card. Simply present your card, and enjoy quality products and services at a preferred rate.

Blue Cross Assistance. Another unique and valuable feature added to your health care plan.

Extended Health Care

(The following benefits are reimbursed at 80%, up to specified maximum. Amounts refer to each covered person.)

  • Hearing Aids (3 month waiting period) – up to $300 every 5 calendar years
  • Orthopaedic shoes up to $175 per calendar year
  • Accidental Dental – up to $2,000 per calendar year
  • Medical Equipment and Supplies – up to $2,500 per calendar year
  • Nursing Care – up to $2,500 per calendar year
  • Ambulance Services – amount not covered by OHIP
  • 24-hour Toll-Free Health Assistance Hotline

(The following benefits are reimbursed at 100%, up to specified maximum. Amounts refer to each covered person.)

  • Vision Care (3 month waiting period) – up to $150 every 2 calendar years
  • Emergency Out-of-Province Travel Coverage – up to $5 million (available up to age 75)

Registered Therapists and Specialists

Costs and number of appointments vary for visits to an Acupuncturist, Chiropodist, Chiropractor, Massage Therapist, Naturopath, Osteopath, Physiotherapist, Podiatrist, Psychologist and Speech therapist.

Specialist Initial Visit Subsequent Visit Max. Number
Acupuncturist $20 $20 25
Chiropodist $20 $20 25
Chiropractor $20 $20 25
Massage Therapist $20 $20 20
Naturopath $20 $20 25
Osteopath $20 $20 25
Physiotherapist $20 $20 25
Podiatrist $20 $20 25
Psychologist $75 $60 20
Speech Therapist $60 $40 12

Benefits are payable only after the yearly maximum allowed under the Ontario Health Insurance Plan (OHIP) has been reached.

A written recommendation from a physician is required for massage therapy.

Travel Insurance – 15-day medical coverage (Available only to persons under 75 years of age)

Enjoy a 15-day annual travel plan with all Blue Choice Core Health Benefit Plans

Our plan provides emergency medical coverage while travelling outside the province and includes:

  • Benefits paid at 100%
  • An unlimited number of trips per year (15-day maximum per trip)
  • Emergency hospital and medical expenses
  • Worldwide Assistance Service
  • No deductibles
  • Available Top-up coverage
  • Emergency financial assistance
  • Up to $5 million in coverage

Accidental Death and Loss of Use (available only to persons under 75 years of age)

Maximum payable amount:

  • $25,000 per applicant
  • $25,000 per spouse
  • $5,000 per child

Prescription Drug Benefit (optional)
  • Available up to age 64
  • Ontario Blue Cross pays 80%
  • Pay Direct Drug Card
  • $10,000 per person, per year maximum

Dental Benefit (optional)

 

  • Available for purchase  up to age 75
  • Current ODA Fee Guide
  • Year 1 – 70% Basic, $750 per calendar year
  • Year 2 – 75% Basic, $1,000 per calendar year
  • Year 3 – 80% Basic, $1,250 per calendar year including 50% Major Restorative, up to $500/calendar year

Hospital Benefit (optional)

Blue Choice with Optional Hospital Coverage includes:

  • $200 per day
  • 90 days per year
  • Semi-private/private room

Benefits are not paid for hospitalization due to pregnancy or pregnancy-related conditions during the first eight-months following the effective date of coverage.

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Benecaid Plans and the self-employed

Friday, October 2nd, 2009

 

Shopping for Benefits? Have you done the math on Individual, Family, and other money hungry plans?

Benecaid plans fit nicely…

(click here to see the original article)

One of the biggest obstacles to self-employed people is the dilemma of buying expensive medical and dental insurance.

Until recently, I advised most of my self-employed clients to put their money in the bank, and only buy catastrophic medical coverage, as you never win with conventional insurance.

What do I mean by that?

Have you ever taken a good look at individual coverage policies, with their inherent co-payments (you pay a percentage of each bill) and their limits (the insurance company pays up to a set maximum amount per year per person, with lifetime maximums)?

If you have had experience with this, you no doubt tried doing the math….“if I pay this a month, and claim this a year, with these maximums am I ahead or losing money?”

The likely answer is you are losing money just to be able to say you have coverage. Not a good situation, and it makes little sense.

Until Now….

There is a rule in the Income Tax Act that allows self-employed individuals and their employees to either have the company pay the medical and dental expenses as a non-taxable benefit, or the owner of a non-incorporated business can reduce his/her income by the amount he/she puts into the health account (similar to an RRSP deduction). These are called Health Spending Accounts (or H.S.A.’s). You can also elect the Cadillac version of the plan which includes Catastrophic Coverage, eye glasses, prescription drugs, and professional services, called the Premiere Plan.

So, without losing a cent, the company and/or self-employed can cost-effectively pay for the costs of medical and dental with “pre-tax dollars”, effectively lowering their cost by up to 40%.

Now that makes good economic sense!

I now have clients telling me they have enough in their accounts to cover their kids’ orthodontics! You too can save $1000′s and have $1000′s to show for it. Why give up all that money to the profit thirsty insurance companies?

Send me a note and I can arrange to show you how this plan can benefit you and your employees. No employees? No problem, you are eligible to get your own plan even if it is just you!

And, you cannot be refused or declined for coverage as long as you are self-employed, or an employee of a company that has this plan in place!

Benefit Survey & Request form: If you complete our survey, it can also be used as a ‘quote request’, that will give us a good idea what your needs are…we check them regularly.

 

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Blue Cross plans in Ontario & Alberta , Canada

Wednesday, September 30th, 2009

How to decide which Benefit Plan may be right for you    

 

Note regarding Blue Cross Ontario:

We are an experienced and authorized BLUE CROSS Brokers, located in Ontario and Alberta, able to offer the full line of benefit plans and other unique products and quality solutions through our specialists in Ontario and Alberta. Blue Cross in Ontario utilizes the broker force to bring you good benefit advice, and the quoted cost is the same through a qualified Blue Cross Broker.

Blue Cross Service Issues on existing plans outside our office:

If you have been trying to reach Blue Cross directly for service issues on existing plans you have purchased elsewhere, please call our local or long distance numbers, or email us and we will be happy to direct you to the appropriate department. If however, you have lost your agent or would like us to service your plan, you have come to the right place!. We are driven to present to you all the appropriate solutions to your benefit needs.

 

Why should I speak with a Broker and not directly with each insurer?’

 

Let’s try to avoid the bungled ‘bundle’!

How are benefit plans like TV services? Have you ever frowned at your cable TV or satellite TV provider because the only way you can get the channels you want is in a bundle with other channels you don’t want? This adds to your cost, and the likelihood you will not cost-effectively cover your needs. Your money is best kept in your pocket, and you should buy the best combination of coverage that makes the most sense, with the least amount of wasted money.

We know the market, the company plans, and we know how to help you sort it out!

Why should you pay more for the coverage you need than you have to? 

Insurers market only the plans they offer, and they bundle their products. They also don’t take a very important aspect into consideration – YOUR HEALTH!

You should be shown plans that give you higher drug limits when you are in exceptional health. Don’t accept low limit plans that the insurer is at low risk for.

We are not tied or biased by one company, and can suggest solutions based on what you need. This saves you time, and does not waste money!

And, why shouldn’t you be exposed to all the options in the benefit market that make sense. Benefits you need may not be exactly the same as your neighbor, and trying to find the right plan is difficult to say the least.  We continually monitor the benefit market and can make your experience a positive one.

Here are some things we consider when discussing your benefit needs:

       To save money, if you are in exceptional health, you deserve to be shown plans that fit you best – some plans have unlimited annual and lifetime maximums on drugs. Your good health will qualify you for these programs, and you need to look at this as the most important aspect of the program.

        If you develop a medical condition that could financially devastate, will your benefit plan come through and pay all the expensive bills?

       If you are already in a position that drug costs are a huge financial burden and are living in Ontario, please see the Ontario Trillium Drug Program page. We want to help you with this process, and discuss if you would likely qualify. Please speak with us.

       If you are self-employed, there are cost effective, tax saving options

 

Call us today! We are here to answer your questions, and we do not charge for advice!

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Benefits: “There is so much people need to know”

Friday, September 25th, 2009

BY: NANETTE GOZUTOK (PARTNER, INTEGRITY INSURANCE PLANNING)

There is so much to say that people really need to know.  I have just spoken to a person who has $800 in drugs costs each month.  Trillium does not work for her and she has nowhere to turn to help with the costs.  Her pharmacist is actually trying to get the drugs company to provide her with the drugs free of charge

 There are several issues here:
 
The majority of Canadians do not understand that Group Benefits are temporary.  They can be taken away at any time and if you have medical costs you are then left to cover them yourself.
 
Not all drugs are covered by the government, I am getting more and more calls from retirees whose drugs are not on the provincial formulary list and therefore not covered by the government.
 
Health and Dental insurance, and more importantly, disability insurance needs to be purchased when you are healthy.  This lady I have just been speaking to cannot work due to her illness, she did not have disability and therefore has no income to assist with her drugs costs.
 
The average cost for cancer drugs which usually need to be taken for up to 5 years is $500 per month.  Some Canadians are under the impression that they are covered by the government and they are not.
 
Disability is so important, we need to make people understand that.
 
Let’s see if we can help some of these people.  Put into perspective, the cost of your disability insurance could be the price of a couple of meal out each month and no one seems to think twice about that!

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Self-Employed? You need a proper protection ‘priority’ plan

Friday, September 25th, 2009

If you are self-employed, and looking for benefits, what should be your priorities and why?

Insurance Priorities for the Self-Employed family

For the self-employed family without a traditional benefit plan, what should be the priority sequence of coverage choices, as the income of the business and the family increases?

If you were an employee of a corporation, you would likely be provided a benefit plan that includes some levels of

  • Life Insurance
  • Disability Insurance
  • Medical coverage (Health Spending Accounts & catastrophic medical coverage)
  • Dental Coverage

With our Integrity planning process, there are ways to help us address all these areas, while maintaining your budget.

Many self-employed families are extremely budget conscious, and we tend to look at solutions for “what is hurting now”, seeking pieces of the benefit puzzle only as the need arises. This is a very dangerous way to go about the process.

What if we were to take out a dental plan only, and in six months, we become disabled?

Without income, will the dental plan replace the money the family needs to live on?

We don't know what can happen, and the devastating effect on our savings

We don't know what can happen, and the devastating effect on our savings

Will there in fact, even be money available to continue to pay the premium even for the dental coverage?

Without income, all the hard work we did to grow our business can be lost in a short time. Therefore, it is very important to look at the big picture at the outset! Discussing these areas with a qualified Insurance Planner is vital to protecting you and your family.

Insurance Planning must be done with integrity – that is completeness, honesty, and with your budget in mind! All issues must be addressed from the start, with several plans and insurers considered, and the most appropriate solutions examined.

Please contact us at 1-866-856-6799 (extension 201 for Craig, and 204 for Nanette) to discuss your needs further.

Craig Ferguson


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Please call us to discuss your needs!

Monday, September 21st, 2009

With 20 years experience, Craig Ferguson operates Craig Ferguson Insurance Services, and Integrity Insurance Planning. Please feel free to visit these sites for comprehensive information. You can complete a Contact Form & benefit survey located on this link if you wish. But the best thing you could do right now is call us!

We won’t steer you wrong!

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If you have reached this site for disability insurance, life, medical, dental or travel insurance, we can help you.

 

 

 

Contact request forms:

 

We serve Ontario and Alberta, Canada, representing several companies, including:

  • Manulife
  • Blue Crosshealth-insurance
  • Benecaid
  • GMS
  • Desjardins
  • Canada Life
  • AXA
  • Empire Life
  • Sunlife

We are interested first in what your specific situation would be, and from there, we want to advise you on the best course of action to cover off the issues that hold the greatest financial risk.

How to reach us!:

Nanette Gozutok can be reached at extension 204. She is a professional that can assess your needs. And, if you want to speak to me directly, I am at extension 201.

Thank you!

Craig Ferguson

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Sorting out the dilemma of what to buy, and why…

Wednesday, September 16th, 2009

So, you have become self-employed, or you no longer have benefits at work, or you have never had benefits, and maybe that root canal is pending at the dentist?

Ok, so what to do?

That is the issue, isn’t it?

What to do and who to trust?

Well, I like to consider myself a kind of ‘tell it like it is’ kind of guy. You might already know me…..if you are a hockey fan in Hamilton or the GTA. I run the site, Make it Eight, eh?.

I saw where injustice and greed had beaten out common sense and compassion. Put those things together, and I’m there. Much to the chagrin of others around me that might think my time better spent making money.

Oh well, sometimes the causes are the justification.

But back to benefits.

You are not sure what your greatest risk is, and if it is truly a good idea to put a good chunk of change into medical and dental insurance.

To make a long story short, you are unique, but the principles of insurance – whether life, disability, or medical and dental – are the same.

Where is the greatest financial risk to you and your family? If we cover off this risk in an effective, common sense manner, our goal is to ensure you are not suffering from an illness or other unfortunate event that made you consider insurance benefits in the first place.

If you live in Ontario or Alberta, Canada, we are a call away : 1-866-856-6799. Or email us at integrityinsuranceplanning@gmail.com.

Give us a call, and see if we are what we say we are…..caring people that don’t mince words.

Oh, we represent several insurers so you know we will find the cost effective solutions, not biased or driven to promote one company only.

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