Derby36

Hi

Anyone got advice or recommendations for health / dental insurance providers for Ontario?
Myself, wife and kids over 16 years old have PR status and we have our Ontario health cards. We have been in Ontario for a few months from the UK and now looking for jobs. In the meantime we have no additional medical cover until we become eligible for employers benefits. We are aware of the additional costs, especially for prescriptions and dental treatment.
Any advice please.
Thanks

not2old

Health and Dental Insurance Plans - CoverMe

BristolUK

Stinkypup

Or:
Teeth.. Gaga

SchnookoLoly

A friend of mine used Blue Cross a number of years ago when she was between jobs. Though I think it was because they were one of the few that covered diabetes equipment and they weren't that cheap. But she didn't have any issues with them.

DandNHill

We're with Sun Life through hubby's work. They're very good too. No idea how they compare when purchasing their cover privately.

SchnookoLoly

Mr Schnooks also has coverage with Sun Life. We like them.

My coverage is with Manulife. They are GODAWFUL.

ann m

I'd be interested to hear the differences. I have Manulife through work and hubby has Green Shield. They are very similar but we can upload docs and receipts to Green Shield which can be super useful.

I'm also an administrator for our benefits at work and hear various complaints which are usually very easy to resolve (it's employee education rather than the provider doing something wrong).😉

SchnookoLoly

Things I hate about manulife:
-Nearly nothing can be claimed online, nearly everything has to be mailed, even for me as the employee
-Even less can be claimed for my husband or daughter online, all has to be mailed in
-Their coverage is very, very specific and very limited. For example, I needed orthotics so was referred to a chiropodist. Cost me $60 for the appointment (total cost $71, OHIP pays $11). Manulife rejected the $60 claim - they only pay out for appointments after the patient has maxed out their OHIP claim, which is $150/year... but they only cover $11 per appointment. So I'd have to go see the chiropodist 14 times before they'd start covering the cost of appointments. Completely stupid and frustrating. Even more infuriating was that it took me 4 phone calls and a lot of arguing to work out that that was the reason the claim was rejected - they first said it was just because the chiropodist didn't write the OHIP portion on his receipt, so I resubmitted - on paper - to have it rejected again, and then got passed around a load of different people trying to understand why the claim was rejected.
-No coverage for hospital rooms
-Their website isn't available 24/7! it actually has 'business hours'
-We had to go through a fertility clinic when we were trying to get pregnant. One of the things we wanted to know is what fertility coverage I had - any caps, whether fertility meds were covered, etc. For my husband with Sun Life, he could type in the DIN and it said if the drug was covered, and his claim clearly stated there was a lifetime cap of $10k on fertility-related claims. For Manulife I couldn't find anything online or in the benefits booklet, so I emailed the, and they said the doctor had to write a prescription and I had to file it to find out if the drug would be covered or not. And I had to do it one at a time - the clinic had given me a list of 12 possible drugs they might use, and Manulife wouldn't say at all if things like IVF or IUI would be covered. We ended up deciding to just go with it and would just HOPE that Manulife would cover stuff. They mostly did.

That was the gist of it.

BristolUK

Any stamps?

SchnookoLoly

Yeah. Exactly.

JonboyE

For a short period of time I would just self-insure.

Actually, for a long time I do self-insure. To date I am quids in.

DandNHill

Hubby is diabetic so every month were benefitting. In fact his employer pays 100% of the premium so it would be crazy not to have it.

I think in a lot of instances it depends on the level of cover the employer signs up for. I worked for td insurance for a while and got 75% on everything and higher on a couple of things. With hubbys policy we get 100% cover. I have had to have two root canals this year and it cost me absolutely nothing!!!

SchnookoLoly

Yeah, self-insuring is decent if you can guarantee you aren't going to get sick or anything. It also depends what premiums the employer is charging. My work has 3 levels of coverage. For the lowest level, the employer pays the entire premium. The employee pays premiums for the higher two levels. I've been on the lowest since I started at this job, but actually just doing the math to see if it's worth upgrading to the middle level or not. My husband's setup is similar.

Of course if you have some kind of condition like diabetes then paying the premiums is nearly always worth it. (I'm not diabetic, but I did develop gestational diabetes while I was pregnant and between our two insurance companies everything was covered - that otherwise would have cost me quite a lot. I also had full coverage of all my fertility drugs in the end (total cost $483).

My mom had to have a root canal, and in the end the tooth had to be pulled completely. She had an implant done to replace it. The whole procedure (root canal, extraction, prep work for implant, installing implant, etc) cost her about $9000, of which insurance covered I think $7000-7500 or so.

I do, however, do self-insurance for my mobile phone, lol. My brother, on the other hand, pays for insurance because he is AWFUL with his phones... in the last 24 months he's on his 4th phone. (Nexus 4 dropped and broke, replaced with a Nexus 5 which broke when his idiot housemate tackled him, housemate paid for a repair, brother broke the screen 3 weeks later, replaced with a One Plus Two which was stolen while on vacation, currently on another Nexus 5. Only the current phone is insured, lol.)

JonboyE

Agreed.

Obviously, if your employer is paying most or all of the premiums then you would be mad not to sign up.

It is a different calculation if you are not in an employer sponsored scheme. The insurance companies are in it to make money. They expect to keep at least 35% of the premiums you pay so limit both what you can claim and the amount you can claim. If you claim more than they like they will just put up the premiums.

You can mitigate this to some extent by joining a pooled plan. The Chambers of Commerce operate a reasonable pooled plan. In a pooled plan the premiums are set on the claims experience of all the policy holders rather than your family's so you do not get penalized so much if you claim more than the insurers expected.

I have mentioned this before but it was a while ago. When I became self-employed in 2009 I had the option to continue with the extended benefits program of my ex-employer. I would have to pay the premiums myself. I looked at the cost of the premiums and what they covered and (more importantly) what they did not. I opened a savings account and deposited an amount equivalent to the premium each month. Any medical/dental expenses that would have been covered by the benefit program are paid from this account. We have had some unexpected medical costs over the years in addition to the usual visits to the dentist and the odd prescription. There is still enough in the account to buy a small car.

It may not work for everyone but it is something to consider.