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A Brief Overview of the Canadian Health Care System

A Canadian Group Benefit package typically includes the same kinds of coverage as benefits plans for U.S. employees. Examples include:

  • Basic, optional and dependant life insurance
  • Accidental death and dismemberment insurance
  • Short-term disability
  • Long-Term disability
  • Critical Illness insurance
  • Health Insurance
  • Dental Insurance
  • Out-of-country medical/travel insurance
  • Group Retirement & Savings Plan

However, due to the different legal and regulatory environment in Canada, the level of coverage and plan design is quite different than in the U.S.

The group benefit programs are generally integrated with and subject to a variety of statutory requirements.

The Canadian Constitution establishes,

Issues of a national interest like income tax and Employment Insurance (EI) are regulated by the federal government.

  • Contribution to EI and CPP (Canada Pension Plan) are mandatory contribution elements for Employers and Employees.

The provinces have jurisdiction over property issues such as healthcare, employment/labour standards, workers compensation and human rights.

  • Provincial health coverage in Ontario, for example, falls under OHIP. If your employees are involved in manual/physical labour WSIB (also known as Workers Comp) is necessary coverage.

Provincial Health Care

Each province has its own health insurance statute. Provincial health insurance programs primarily provide hospital, GP and moderate paramedical services.

However, the Canada Health Act (CHA) adopted in 1984, specifies the conditions and criteria with which the provincial and territorial health insurance programs must conform in order to receive federal transfer payments under the Canada Health Transfer mandate. The Canadian healthcare system, therefore falls under a check-and-balance system where Federal transfers to Provincial programs must conform.

The Key features of the CHA are that provincial programs must be:

  • Publicly Administered
  • Comprehensive
  • Universal
  • Accessible, and
  • Portable

Private Employer-Sponsored Group Benefit Coverage

Employer-sponsored plans that “wrap around” and supplement provincial health care programs are not permitted to cover any services available under public plans.

That said, procedures covered and levels of coverage vary significantly from one province to the next. Furthermore, over the last few years most provinces have delisted services, potentially shifting costs to employer-sponsored plans. For example, in 2005 the Ontario health Insurance Plan eliminated physiotherapy coverage (in most cases) for residents between ages 19 and 65.

Some level of prescription drug benefits is available to all seniors (over age 65) and people on social assistance, but only British Columbia and Quebec have more extensive coverage.

Contact us today to see how we can add value to your program.

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