Health And Dental Insurance in Ontario. Affordable Health Insurance
Medical Health Insurance Advisor in Ontario
Looking for Better Control Over Employee Health and Dental Insurance Costs?
Health insurance is a way to help pay for your medical expenses. If you have health insurance, your insurance company will help pay for some or all of your medical bills. This can be really helpful if you have a lot of medical expenses.
Depending on your company’s size, demographics, and claims history, one way to gain control is by implementing an Administrative Services Only (ASO) program to cover predictable claims, with Stop Loss coverage to protect the group against catastrophic health and dental insurance claims. And/or Health care spending accounts (HCSA) forming part of a hybrid benefits plan.
The self-employed, small business owners, and freelancers who do not have access to employer-sponsored health insurance will find this blog post most useful.
Thus, Offering Choices to the Small and Mid-Sized Business
There’s a growing trend for some small business employers to use a health care spending account (HCSA) in addition to or in lieu of certain health and dental insurance benefits. Here, we’ll look at the benefits and challenges of traditional benefits plans as well as HCSAs.
The importance of health insurance cannot be overstated. It is one of the most important things you can have in order to protect yourself and your family.
Traditional Benefits Plans of Affordable Individual Health Insurance
A significant benefit of traditional plans is that they typically offer a full suite of benefits. In addition to health and dental insurance coverage, there are pooled risk products, such as life insurance, accidental death and dismemberment, dependent life, critical illness, and short- and long-term disability. Many plans also offer a pay-direct option for prescription drugs, as well as vision care.
With these defined benefits plans, the benefits are defined by the policy. For example, 80% coverage for drugs, 80 % coverage for dental care, $500 annual maximum for chiropractic care or physiotherapy, etc.
What isn’t defined is how much a traditional plan will cost each year. Because insurers set their rates based on the volume of anticipated claims, they’re prospectively setting rates based on a retroactive analysis of plan use plus their estimates of inflation. That’s the first challenge of a traditional plan, particularly for small business employers who have smaller benefits budgets to work with.
Another challenge is the one-size-fits-all approach. Given that there may be four or five different generations working at the same organization, providing a benefits plan that appeals to all employees can be a significant challenge for employers. Flex benefits may address this concern, but for smaller employers, the administrative requirements of running a flex plan can be onerous.
HCSAs – Health Care Spending Account
A key benefit of HCSAs is that they can provide enough choice to allow all generations of employees to find elements that appeal to them.
Another benefit is that employers can control their benefits costs. HCSAs are defined contribution plans that an employer funds. In other words, the employer sets the rate they can afford (for example, $1000 to $5000 per employee per year), and the employees get maximum choice on how to spend their health care dollars. The employer may continue to sponsor pooled risk products (such as life insurance, accidental death and dismemberment, dependent life, critical illness, and short- and long-term disability) to provide financial protection for their employees. Health and dental claims are reimbursed 100% up to the annual limit specified by the employer.
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Unlike a traditional benefits plan, an HCSA isn’t an insurance contract, although it may have catastrophic insurance to deal with out-of-country travel claims and high-cost drug claims in Canada.
One challenge associated with HCSAs is setting the funding to match the average employee’s claims. It can take some effort to find the right amount.
Another challenge exists for employees with large families or with chronic illnesses, because an HCSA likely won’t stretch far enough to cover their benefits need. This challenge may be partially offset by public drug plans in some provinces, but not in others.
Dental Plans, Dental Insurance and Benefits
There are two types of dental insurance, dental coverage through an employer and private dental insurance. Dental coverage through an employer is usually part of a larger health insurance plan and may have limitations on what is covered and how much.
Private dental insurance plans can be purchased through insurance companies. These plans typically have more comprehensive coverage and greater reimbursement rates than those provided by employers.
Dental insurance plans cover preventive, diagnostic, and treatment services such as routine teeth cleanings, X-rays, fillings, crowns, bridges, and orthodontics. Most Plans also cover major procedures such as extractions, periodontal treatments, and dental implants.
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Dental Care Insurance in Canada
1. Dental Insurance Coverage in Ontario
Dentists in Ontario are not required to provide dental services without any type of dental insurance. If you have no dental insurance, then you may need to pay out-of-pocket for dental care services.
2. Dental Benefits
The government provides two types of dental benefits. These benefits are called OHIP (Ontario Health Insurance Plan) and OSP (Ontario Superplan). Both of these plans cover dental procedures including fillings, crowns, root canal therapy, extractions, implants, and orthodontics. The only difference between the two is that OSP covers additional services and treatments such as dentures, periodontal surgery, and cosmetic work.
3. Dentist’s Fees
If you do not have dental insurance, then you should expect to pay $200 to $300 per visit for a dentist consultation, plus any necessary treatment costs. You might also be charged for X-rays and laboratory tests. Your dentist will determine what type of service he/she recommends based on your medical history and current condition.
4. Dental Care Services
You can find many different dental clinics throughout Ontario. However, if you want to receive proper dental care, then you should go to a clinic where they specialize in oral hygiene and oral health.
The Benefits of Dental Insurance
Seeing the dentist on a regular basis is important for maintaining good oral health. However, dental care can be expensive, which is why dental insurance is such a valuable benefit. Dental insurance is insurance that helps pay for dental care. Dental coverage is the actual benefits covered by the insurance policy. Most dental insurance policies cover preventative care, such as cleanings and X-rays, as well as basic services, such as fillings, crowns, and root canals. Some policies also cover more expensive procedures, such as orthodontics (braces) and oral surgery.
Dental insurance is an important way to help offset the cost of dental care. Regular dental visits are essential for good oral health, and dental insurance can make those visits more affordable.
Making the Choice
Whatever choice a small business employer makes, they should understand the health and Dental insurance benefits and challenges of each option and take a close look at the strategic purpose of their benefits plan. Is the plan designed to match the average employee’s claims experience, or is it meant to provide financial protection to those employees that have significant health care expenses?
For some small businesses that routinely face upwards of 10% to 20% increases in their premiums each year, an HCSA may be the right option. It can be a way to cap their benefits costs at a fixed dollar amount or percentage of payroll. Other small business employers prefer to offer employees the convenience of a drug card, electronic dental claims and other aspects of traditional benefits plans. These employers are willing to pay for the premiums for they and their employees have this type of coverage.
The Hybrid plan is a combination of the high-risk coverage (life, LTD & AD&D) of the traditional plan and the HCSA for the health and dental insurance coverage
Now you have a choice and can minimize the annual premium increases.
Let’s have a chat over a coffee to review your Health and Dental Insurance needs today!
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Contact Glenn Stewart at 519-896-9970 for Quote
Health and Dental Insurance broker available in Kitchener, Waterloo, Guelph, Milton, Mississauga, Toronto, Elora, Elmira, Listowel, Mitchell, Stratford, New Hamburg, Brantford, Hamilton, Burlington, Fergus, Oakville, and Cambridge area.