Health Insurance for All Individuals in Canada -- Personal Medical Insurance Regulations
Health insurance for individuals must be provided to all people living in Canada.
Affordable coverage for health insurance is mandated by the universality clause in the Canada Health Act and
even if you cannot afford to buy health insurance, you can apply for assistance from
the government to have the insurance premiums paid for you.
If you can afford to buy health insurance
but remain uninsured, you must pay for all missed insurance premiums in order to reinstate your health insurance coverage.
In Canada, health care will not likely be denied. Since there are mechanisms in place for universal health care
coverage it is assumed that all individuals in Canada have health care insurance.
Personal medical insurance is available
to everyone under each territorial or provincial health insurance plan. There is only one insurance
carrier in each province for health insurance and this provider must be administered by a public authority on a
non-profit basis.
The only eligibility requirements for health insurance coverage are residency and immigration requirements.
Ability to pay and previously existing medical conditions cannot be used as a reason to withhold
insurance from an individual. In fact health care insurance cannot be with held and it is required to be provided under
law (the Canada Health Act).
If the 13 provinces and territories in Canada do not provide health insurance for all individuals living in their jurisdiction,
under the conditions set forth in the
Canada Health Act,
they run the risk that the federal government will not transfer money to them to run the health care system. (See Canada and Health Care Funding)
Medically insured services include doctors visits and procedures ordered by physicians for diagnosis and/or treatment.
Some screening or other health promotion procedures are also covered such as screening mammography and vaccinations to certain populations but there will be
variation in this coverage across the nation.
Generally drugs are not considered to be part of the basic personal medical insurance coverage. Provinces have drug or
pharmacare plans in place to provide assistance for
low income individuals who require drug therapy.
Eligibility is often determined through a financial means test.
Health Insurance for Individuals, Families, and Groups
Every province or territory must have a health insurance plan in place and they are allowed to
charge an insurance premium but the plan must be "non-profit". Not all provinces charge insurance premiums but some do.
The Canada Health Act
requires that all medically necessary services must be insured, so variation between provinces will arise in how "medically necessary" is defined by each province's
health insurance plan.
All people living in the province receive a "care card" which is an identification card for the provincial
health insurance plan. This card must be presented when accessing insured services.
Each individual carries personal medical insurance. A parent can provide medical insurance for each
family member by enrolling them as a dependent and paying an additional premium for each person enrolled.
Many unions negotiate with employers to buy health insurance for any individual who is a member of the union.
This is usually negotiated as part of the
labor union agreement.
The coverage provided to the union members is the same health care coverage provided to any other person in the
province, but it is the employer who pays the insurance premium. In most provinces this is regarded as a "taxable benefit"
to the employee so even though you do not buy the health insurance directly, you are required to
pay tax on the premium amount as if you did.
If health insurance premiums are paid by your employer, when you leave that employer your personal medical insurance cannot
be cancelled because you have left your employment. However, after a certain period of time, you must then continue to
pay the insurance premiums on your own if it is not provided as a benefit of employment with your next job.
It is a requirement that every resident of the province carries health insurance.
You cannot "opt-out" of health insurance and pay privately
for insured services. If medical insurance premiums are required to be paid and you do not pay them,
when you need care you will most likely receive the necessary services, however, you will
also receive a bill for all the missed insurance payments.
If this bill is not paid and your insurance is not
brought up to date, the insurance plan will collect the debt through debt collection services and
garnishee of wages if necessary.
The provincial policies for health insurance for all individuals in Canada even provide coverage for when you are out of the province.
This includes travel between provinces in Canada and international travel as well. This is the portability requirement of the
Canada Health Act
Provincial Health Insurance for Individuals Who Cannot Afford the Premiums
- Low Income Health Insurance Assistance -
Low income health insurance assistance is provided to make sure that everyone has personal medical insurance coverage.
If you live in a province that charges medical insurance premiums and you
cannot afford to buy health insurance, you can apply to the government and with proof
of your inability to pay (usually provided through income tax records), the medical insurance premium will be fully or partially
paid for you (and your family) by the government.
Your income will then be monitored through your annual income tax reports and when your income is
sufficient to support payment of the health insurance premiums, the government will notify you that the financial assistance has been withdrawn and you must continue to pay the premiums on your own.
Health Insurance for Individuals and Groups Provide the Same Basic Coverage
It does not matter who pays the premiums for health insurance, all individuals in the province are covered under the
same basic health insurance coverage. When employers pay the premium on behalf of employees they are paying for the
basic medical insurance coverage provided to all individuals in the province.
Groups such as those represented by labor
unions cannot shop for a specific health insurance plan since all medically necessary care is
insured under the basic provincial plan.
The only way to improve the scope of your health insurance coverage is to purchase
supplemental medical
insurance which can provide coverage for services not insured under
each provincial individual health insurance plan.
Often these types of private health insurance plans are provided by the employer and may be
part of a benefits package negotiated by a
labor union.
People who live in the province and who have not yet met residency requirements for the basic
provincial health
insurance coverage are also encouraged to purchase personal medical insurance from a private insurance carrier.
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