Friday, 16 January 2015

Mom's Own Health: Group Benefit Insurance

New Year's Resolution: Feel Better.

In Canada, as in many countries, most of our healthcare is paid for with taxes.  If we were to get in to an emergency situation, we never have to worry about the expense of a hospital stay or a broken bone. That said, a number of our day to day costs are not included in that government funding. Things like glasses, prescription drugs, and dental services are among the pricey things we pay for out of pocket. If you're lucky, you may have some additional coverage through work. Group benefit plans are a wonderful bonus companies offer because they account for and cover many of these items and practitioners that complement your government entitlement.

When you start a job, however, you are bombarded with a lot of paperwork all at once.  You have job training, names to remember, and a whole lot of employee documentation that you put in a drawer, often to never review again. It is also true, that companies occasionally renegotiate contracts and change carriers for improved rates or services. For this reason, I can safely say that most workers have no idea what they are entitled to. Often, they avoid the care they need, or make unnecessary payments as a result. As a mom and an administrator in the benefit insurance industry, here are the two most common benefits that parents under or improperly use and might be available to you.

Semi-Private Hospitalization

While, as I already mentioned, hospitalization is covered by your provincial healthcare plan, what you are entitled to is ward care. A ward room is a large space housing on average 4-8 (or more) beds separated by privacy curtains. This is a perfectly fine way to be treated and if you can afford no better, there is no shame at all. The same nurses, medication, and care is provided in this space as in any room of the hospital. If, however, your company covers semi-private (common) or private (less common) room availability, you might be a little more comfortable.

When dealing with some of the private activities associated with birth and delivery (breastfeeding, bleed checks, etc), it might feel like the fewer people that know about it, the better. There will already be a whole host of doctors and nurses down there so it's understandable. In addition, you might be receiving some visitors to see your new family member, so the additional space is usually appreciated. It varies by hospital, but a semi-private room charge is typically in the range of $225 nightly, with approximately an additional $50 for a private space. Check with your insurance company (not just someone at work) before you agree to the luxury so that you're not on the hook.

Practitioner Services

In the late stages of pregnancy and soon after delivery, you experience a great deal of pain. From lower back aches to pulled muscles and tension headaches, it can really hurt to bring a person in to the world, apart from labour (obviously). There are many specialists that might have the ticket to a great deal of relief for you through physiotherapy, massage therapy, or chiropractic services. Individual sessions range from $40 - 100 each, so a course of treatment can add up very, very quickly.

I would suggest that you speak to your doctor about any discomfort you are experiencing first for a number of reasons, but mainly to ensure that they recommend that you receive services of a healthcare practitioner rather than a prescription or other covered remedy. Many group plans require a doctor's note in order to consider payment for any treatment. The doctor may also refer you to some one with experience in your particular condition (ie pre-natal, postpartum, or any other pre-exisiting trouble). Registered Massage Therapist (RMT), for example, is a protected title, so you know the individual is trained and licensed. Not just any hot stone session is covered by group plans. Next, speak to your insurance company about any deductible, per visit maximum and insured year maximum your plan has so you know the amount you have to work with. 

If you're on the phone with your insurer, why not ask for a current copy of your benefit booklet so that you can see what other expenses are available to you. Not all plans cover eye glasses, not all dental procedures are eligible, and a big bill on maternity leave is the last thing you want to be stuck with.

One final thing... your company might not have junior's particulars on file yet! Make sure your insurer has your baby's full name, gender, and date of birth so that if he or she needs a prescription, you're all prepared!

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