Myth"In Canada, we're covered by the health care system. So I'm not worried about that." |
FactCanadian families are spending an increasing share of their household income on health care.1
Many employer-sponsored plans are leaner than ever before, leaving the policyholder with more out-of-pocket responsibility. |
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About 8 in 10 Canadians have financial concerns about the government's ability to |
It starts where government coverage ends � for both routine and unexpected medical expenses.
Routine expenses: | Unexpected expenses as a result of: |
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Eligible expenses | 100% coverage per person | ||
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Vision care |
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Hospitalization | Private or semi-private hospital room in Canada | ||
Eligible expenses | 80% coverage per person | ||
Prescription drugs | Generic drug coverage (or brand-name drugs if no generic exists) | ||
Medical practitioners |
$500 per practitioner, per calendar year
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Hospitalization |
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Ambulance | Cost of land or air ambulance | ||
Nursing care | Private duty nursing: $10,000 for any one injury or sickness in any 12 consecutive months | ||
Hearing aids | $500 every 5 years | ||
Orthotics and orthopaedic shoes | $225 (combined) per calendar year | ||
Diabetic supplies | $500 per calendar year for glucometers | ||
Emergency travel assistance | Includes medical assistance, emergency medical care, ambulance services, and personal and legal services | ||
Accidental dental | $750 per tooth | ||
Miscellaneous | Includes artificial limbs and eyes; casts, crutches and braces; oxygen and related equipment; blood and plasma; wheelchairs and hospital beds; diagnostic procedures and x-rays |
Deductible: | For prescription drugs only: $50 per person, maximum $100 per family, per calendar year |
Payable: | 80% of eligible expenses, not exceeding $2,500 per family, per calendar year; 100% of eligible expenses in excess of $2,500 per family, per calendar year |
Lifetime maximum: |
If the insured is under age 65:
If the insured is age 65 and over: |
Basic Dental | 80% coverage per person |
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Diagnostic | Complete exam every 3 years, diagnostic x-rays every 3 years, 2 bitewing x-rays every 6 months |
Preventative | Recall exam every 9 months, prophylaxis every 12 months, light scaling |
Minor restorative | Fillings, pins, preformed stainless steel and plastic crowns |
Endodontic | Root canals and retreatment, pulpectomy, endodontic surgery |
Periodontic | Curettage and root planing, gingivoplasty, grafts, splinting |
Oral surgery | Extractions, biopsies, removal of cysts and tumours |
Other | Anesthesia, denture maintenance (every 24 months) |
Major Dental | 50% coverage per person |
Dentures | Denture installation, adjustment and replacement |
Crowns | Inlays, onlays, gold fillings and crowns |
Bridgework | Installation or replacement of fixed bridgework |
Deductible: | $50 per person, maximum $100 per family, per calendar year |
Annual maximum: | $1,500 per person per calendar year |
1. General Exclusions
You will not be covered for any loss, or expenses caused or contributed to by:
a) self-inflicted injury, while sane or insane; or
b) war or any act of war; or
c) active full-time service in the armed forces of any country or international organization; or
d) for services payable under any Workers' Compensation Act or Occupational Disease Law, or any Government Plan of Health or Law, or any instrumentality thereof; or
e) travel for health, periodic health examinations or examinations required for the use of a third party; or
f) for any dental treatment, appliance or expense, except as otherwise provided in your Certificate of Insurance; or
g) for cosmetic surgery, except when necessitated by injury; or
h) vitamins (unless injected), birth control devices, anti-impotence drugs, over-the-counter drugs, anabolic steroids, fertility drugs, smoking cessation products and drugs, treatment or supplies which are not approved by Health Canada or are experimental, preventative, or limited in use whether or not so approved; or
i) all types of surgery.
2. Extended Health Care Pre-existing Condition Limitation
Our underwriters base their decision to exclude a condition or conditions on the health information you declare on the application and/or information your doctor provides during the underwriting process. Excluded conditions will not be covered under the contract.
3. Out of Province/Territory and/or Out of Canada Exclusions
You will not be covered for any loss or expenses you incur while outside of your province of residence and/or Canada caused or contributed to by:
a) any treatment or surgery that does not require immediate relief of acute pain or suffering, or which could reasonably be delayed until you return to the province of residence and/or Canada; or
b) treatment you may decide to receive outside of your province of residence and/or Canada following emergency treatment or diagnosis of a medical condition which, based upon medical evidence, would not have prevented you from returning to your province of residence and/or Canada for treatment or surgery; or
c) any medical or hospital services which necessitated travel specifically to obtain them, whether or not on the advice of a physician; or
d) operation of a motorized vehicle while impaired by drugs or other toxic substances or where the level of alcohol exceeds 80 milligrams per 100 millilitres of bodily fluid; or
e) participation in a professional sport, any speed contest, SCUBA diving without a basic SCUBA designation from a certified school or other licensing body, bungee-jumping, parachuting, parasailing, mountaineering, spelunking, or any airborne activity unless you are riding as a passenger on a commercially licensed airline.
4. General Limitation
You will only be reimbursed eligible expenses not covered by a provincial or territorial plan. You will not be reimbursed expenses covered by any government program or other program of health insurance. Manulife will be entitled to the reimbursement of any amounts it pays which are recovered from a third party. In addition, you will not receive benefits for that part of any expense in excess of those considered reasonable and customary.
5. Out of Province and/or Canada Limitation
The coverage period of this insurance for any one trip outside of province of residence and/or Canada is limited to the first 60 consecutive days. The coverage period of this insurance for all trips in any six-month period is limited to the first 75 days in the aggregate. This insurance does not cover any loss or expenses you incur while outside of your province of residence and/or Canada for any period beyond the coverage period.
6. Out of Province and/or Canada Pre-existing Condition Limitation
This insurance does not cover any loss or expenses you incur while outside of your province of residence and/or Canada caused or contributed to by any injury or sickness or related condition for which you received treatment or required the use of medication during the 90 days prior to the date you left your province of residence and/or Canada. However, any condition which has been controlled by the consistent use of medication prescribed by a physician is covered, provided that during the same 90-day period the condition was stable and there had been no change in the medication or dosage.
7. Out of Province and/or Canada Pregnancy and Childbirth Limitation
This insurance does not cover any loss or expenses incurred for the treatment or confinement of mother or child(ren) as a result of pregnancy, miscarriage, childbirth, or complications of any of these occurring within two months of the expected date of birth.
1. Exclusions
No amount will be paid for charges for:
a) recalls occurring more frequently than once every 9 months;
b) dental services or appliances which were assessed, arranged, ordered or obtained prior to the effective date of your coverage;
c) white fillings on molars;
d) completion of claim forms;
e) dental care which is cosmetic;
f) broken appointments;
g) self-inflicted injury;
h) dental care covered under a medical plan provided by an employer or government;
i) replacement of a lost or stolen prosthesis;
j) expenses for which, in the absence of coverage, there would be no charge;
k) stainless steel crowns on permanent teeth;
l) protective athletic appliances;
m) any expense incurred after termination of coverage;
n) a full mouth reconstruction, for a vertical dimension correction, or for diagnosis or correction of a temporomandibular joint dysfunction.
2. Limitations
The plan will pay for reasonable and customary charges for the expenses charged by a dentist, but not exceeding the limit for that service listed in the Provincial General Practitioners Dental Fee Guide. When two or more covered dental procedures are suitable for the dental care of a specific condition, and both are consistent with good dental care, you will receive benefits for the least expensive service. The plan does not reimburse for expenses covered by any government program or other program of insurance. Manulife is entitled to reimbursement of any amounts recovered from a third party.
Please note:
Alberta monthly premiums | |||
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Extended Health Care | Dental Care | ||
Under 40 | 40 to 64 | 18 to 64 | |
Member Only | $68.49 | $90.90 | $77.67 |
Member and Spouse | $153.00 | $190.17 | $148.50 |
Member and Children | $142.47 | $160.92 | $159.39 |
Family | $223.65 | $257.22 | $189.90 |
British Columbia monthly premiums | |||
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Extended Health Care | Dental Care | ||
Under 40 | 40 to 64 | 18 to 64 | |
Member Only | $56.88 | $74.61 | $77.67 |
Member and Spouse | $126.36 | $156.42 | $148.50 |
Member and Children | $116.91 | $132.21 | $159.39 |
Family | $183.15 | $210.51 | $189.90 |
Manitoba monthly premiums | |||
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Extended Health Care | Dental Care | ||
Under 40 | 40 to 64 | 18 to 64 | |
Member Only | $55.17 | $72.45 | $77.67 |
Member and Spouse | $121.77 | $150.93 | $148.50 |
Member and Children | $113.58 | $127.71 | $159.39 |
Family | $177.21 | $203.58 | $189.90 |
New Brunswick, Newfoundland, Prince Edward Island & Saskatchewan monthly premiums | |||
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Extended Health Care | Dental Care | ||
Under 40 | 40 to 64 | 18 to 64 | |
Member Only | $74.88 | $99.00 | $77.67 |
Member and Spouse | $167.04 | $207.63 | $148.50 |
Member and Children | $155.61 | $175.41 | $159.39 |
Family | $244.08 | $280.80 | $189.90 |
Northwest Territories, Nunavut & Yukon monthly premiums | |||
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Extended Health Care | Dental Care | ||
Under 40 | 40 to 64 | 18 to 64 | |
Member Only | $90.54 | $120.24 | $77.67 |
Member and Spouse | $201.78 | $251.10 | $148.50 |
Member and Children | $186.84 | $211.86 | $159.39 |
Family | $295.74 | $339.75 | $189.90 |
Nova Scotia monthly premiums | |||
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Extended Health Care | Dental Care | ||
Under 40 | 40 to 64 | 18 to 64 | |
Member Only | $74.88 | $99.00 | $77.67 |
Member and Spouse | $167.04 | $207.63 | $148.50 |
Member and Children | $155.61 | $175.41 | $159.39 |
Family | $244.08 | $280.80 | $189.90 |
Ontario monthly premiums | |||
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Extended Health Care | Dental Care | ||
Under 40 | 40 to 64 | 18 to 64 | |
Member Only | $97.78 | $129.86 | $83.88 |
Member and Spouse | $217.92 | $271.19 | $160.38 |
Member and Children | $201.79 | $228.81 | $172.14 |
Family | $319.40 | $366.93 | $205.09 |
For residents of Ontario an 8% sales tax is included.
Quebec monthly premiums | ||||
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Extended Health Care Plan (includes Prescription Drugs up to age 65) | ||||
Under 40 | 40 to 49 | 50 to 64 | 65 and over | |
Member Only | $101.04 | $200.81 | $292.73 | $252.92 |
Member and Spouse | $207.97 | $405.74 | $589.78 | $536.51 |
Member and Children | $183.84 | $340.60 | $495.70 | $363.95 |
Family | $299.79 | $557.80 | $811.09 | $643.14 |
Prescription Drug Plan | |||
Under 40 | 40 to 49 | 50 to 64 | |
Member Only | $61.61 | $121.35 | $176.78 |
Member and Spouse | $126.45 | $245.25 | $356.10 |
Member and Children | $112.42 | $206.30 | $299.30 |
Family | $182.27 | $336.68 | $488.24 |
Dental Only Plan (optional) | |
18 to 64 | |
Member Only | $84.66 |
Member and Spouse | $161.87 |
Member and Children | $173.74 |
Family | $206.99 |
You must be a Canadian resident covered by government health insurance, and under age 66 if applying for Extended Health Care or under age 65 if applying for Dental Care. You must also fall under one of the following:
If you are applying or are already covered under Extended Health Care and/or Dental Care, you may also apply for your spouse and eligible children who are covered by government health insurance. Children must be under age 21 at the time of application and, once insured, benefits will be extended to age 25 for full-time students. Covered children who are incapacitated and dependent on you for support will be covered up to any age.
In all cases, you will be contacted, and a professional advisor will review your application to ensure proper completion.
After the application:Once the application has been completed, a medical professional from a third party paramedical service may call you to arrange a home visit at your convenience. The insurance company may also contact your doctor to request medical records.
Throughout this process, Garrett Agencies will be communicating with you to keep you up to date on progress and may request additional information from you.
Once the insurance company has received and reviewed all the information required, they will issue an offer for insurance which you may choose to either accept or decline.
To apply, please choose one of the following options:
I only see rates to age 65 on the website. Does this mean that Extended Health Care coverage ends at 65?
Coverage under Extended Health Care can be maintained past age 65. Please contact us for the rates that apply to those over 65 years of age.
What is the annual limit per practitioner under medical practitioners (such as chiropractors, massage therapists, psychologists, etc.)?
There is an annual limit of $500 for each practitioner
What are the limits per eligible expense, per person?
Eye exams - $50 every 24 months
Prescription eyewear - $200 every 24 months
Medical practitioner - $500 per practitioner, per calendar year
Private duty nursing - $10,000 for any one injury or sickness every 12 months
Hearing aids - $500 every 5 years
Orthotics and orthopaedic shoes - $225 (combined) per calendar year
Glucometers - $500 per calendar year
Accidental dental - $750 per tooth
Prescribed vaccines (required for out-of-Canada travel) - $250 per calendar year
Repatriation - $15,000 per injury or sickness
Dental care - $1,500 per calendar year