Health Insurance options

On Friday, I spent a little time exploring some health insurance options. In case you’re wondering what the end result is, I’ll save you the trouble from scrolling down to the bottom and tell you it’s a no go.

My first call was to the Ontario Drug Benefit program/Trillium. These are the most sensible folks around. I had previously understood that Trillium was only for low-income individuals/families. This isn’t the case. The premiums are based on your net earning from the previous tax year.  For instance, if your income is 100,000 last year, your premium would be 100,000 x 4% = $4,000.  You would pay the $4,000 premium in quarterly installments. During each quarter, you pay for your own drugs until they add up to $1000.00. Once you reach that, your prescriptions cost $2 each. This coverage is for prescriptions only, excluding any dental, hospital, vision, etc.

Based on my 2009 income, the premium cost for me is too high to receive any benefit for my eldest daughter who isn’t covered for prescriptions. If it also covered dental and vision, I’d be considering it.

My second call was to Green Shield. Since daughter number one is a type 1 diabetic, they would not insure her. They would offer me a basic plan that would allow me up to $250 worth of prescriptions per year for her, but they can’t be any prescriptions dealing with pre-existing health conditions. What’s the point?

Third call was to Blue Cross. Once they realized my daughter was diabetic, they offered me their basic plan, for $63.33/month. This would cover 70% of my prescription costs up to $500. It would also cover her supplies (test strips and needles) up to $500/year. Normally, she gets her test strips for free, but we do pay for needles, which are about $60/month. This would also cover her for dental of up to $245/year.

Since my primary pressure point is prescriptions and needles for her, I’m not really sure it’s worth the hassle of paying them about $750 for $1000 in benefit. Sure, I’d come ahead $250, but honestly….

My next call was to Manulife. They offered me prescriptions of up to $504/year and dental of $400/year for a premium of $63.60. The least attractive of all the options.

Finally, I called an agent about SunLife. He said “you don’t want SunLife, they’re terrible.” I presumed he was on commission and he pitched me Manulife again. After advising him I already spoke to Manulife, he suggested I tell Manulife that my eldest was just coming off an employer plan, and that they’d charge me essentially $1,700 in premiums annually for $1,600 in drug coverage plus $500 in dental, plus semi-private hospital, plus $250 every alternate year in vision care. Although he tempted me, I can’t be filling out medical forms and telling lies about our situation. It’s just not in my hard wiring. Plus, this is almost a wash, in terms of the maximum benefit I’d get out of it.

In my research I’ve learned a few things:

  • if you’re coming off a group insurance plan, seek out private coverage within 60 days of it ending. The insurance companies don’t ask too many questions in that time period. They offer a straight transfer, and apparently sweeter deals
  • if you have to get needles through prescription, you just end up paying more in a dispensing fee
  • I’m unlikely to find an opportunity that would greatly benefit us, with pre-existing medical conditions

Next fall, if all goes according to plan, my daughter will be a full-time student again in University, and her father’s medical coverage should bring her back into the fold. This will make a big difference to my bottom line.

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3 responses to this post.

  1. I’m sorry to hear that you couldn’t find a reasonable benefit plan that would cover your daughter’s diabetic needs. This is what I find frustrating about insurance companies… if you have any pre-existing conditions, they won’t cover you. When my hubby was on contract and had no benefits, we looked into family benefits for drugs, vision and dental. Our biggest expense was hubby’s asthma and exzema meds which cost somewhere around $200/month. They would give us the basic coverage but would exclude any treatments for asthma or eczema… OR… they would cover the meds for some ridiculously high premium that actually cost significantly more than our $200/month uninsured expense. It was frustrating to say the least!

    Reply

    • At least the good news is, this situation won’t last forever. When she goes to University, she can get coverage. Following that, if she’s still living at home, I’ll charge her room and board and she’ll be able to get Trillium Drug Coverage for herself, as I won’t be supporting her anymore. Finally, hopefully once she enters into the work world, she’ll find an employer who has benefits. I’m thankful the Trillium option is there, I think it’s an excellent one. It just doesn’t fit for me as the applicant, at least not for now.

      Reply

  2. Trillium is an awesome program…as a pharmacy tech, I found a lot of people quite relieved when that option came out. Green Shield and Blue Cross are terrible plans…in my line of work, I see a lot of different plans…those are the ones I would stay away from. Now I know that Manulife isn’t that great either. Great post and tips, thanks!

    Reply

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