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The Advice Centre

What do you mean its not covered

Wednesday, October 9, 2013
Insurance Basics, Understanding plan limits / exclusions

What do you mean its not covered?

There’s nothing more frustrating than having out-of-pocket medical costs and finding out that those costs aren't covered by your health plan. After all this is Canada; we’re all are covered for our medical expenses. Right?

Your government health plan only covers basic health care services and if you have additional coverage through a private insurer there can be limits to your plan or exclusions that can prevent you from being reimbursed for certain expenses.

All plans are designed differently. Whether you’re purchasing a plan for yourself, or you have a plan through your workplace, it’s important to ask questions and learn about what is and what is not covered.

If you have a plan through your workplace, your employer may have only purchased coverage for certain benefits. They may have asked the insurance company to limit coverage for some expenses to a “set dollar amount”. Plan limits are common for things like vision care or paramedical services like massage and physiotherapy, but can also apply to other services.

A pre-existing medical condition can also prevent you from being reimbursed for expenses related to treatment for health conditions that you had prior to the start of your coverage. Some policies may provide coverage for these conditions, but on a limited basis or for an additional cost.

As Canadians, we appreciate our health care, but it’s expensive. We shouldn’t take it for granted. Employers struggle to keep costs manageable and insurers struggle to keep coverage affordable. Anyone without coverage who’s had to pay for things on their own knows just how expensive it can be.

Many of us are too young to remember when health coverage wasn’t paid for at all and we all had to pay out-of-pocket. We’re fortunate to have access to coverage options. But we all have a responsibility to share the cost and keep health coverage affordable.

The best way to protect yourself from unexpected costs is to know what’s covered by your plan. Review your coverage online. Ask your plan administrator or advisor for a booklet outlining your coverage. And ask questions; the more you know, the more you’ll benefit from your health plan.

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