Group Accident and Sickness (Group A&S)

Health insurance is available to all Canadians through provincial health plans. The services vary and have limits. Group Accident & Sickness insurance provides additional coverage, the same goal as individual plans.

Coverage

Extended Health Care

• also called "Major Medical"
• fills gaps in government health plans, e.g., by providing the same benefits as individual plans

Group Dental Plans

• like individual plans
• often probationary period for pre-existing conditions

Vision Care

• for purchase or replacement of glasses or contact lenses
• maximum benefit per period of time (e.g., $200 every 24 months)

Employee Assistance Program (EAP)

• an employee benefit, not an insurance product
• employer paid
• generally only in large companies
• provide consultation to employees and their families for immediate support, education, access to resources for many employee needs, e.g.,
  • counseling for stress or drug addictions
  • financial counseling
  • legal advice (e.g., family law, bankruptcy, divorce)

Cost-Sharing

• group plans have deductibles and coinsurance, as with individual coverage

Coordination of Benefits (COB)

• the CLHIA developing guidelines to coordinate health and dental benefits from all group plans which cover a person and their family
  • prevents the insured from profiting by submitting multiple claims for the same expenses
• some group plans may not have Coordination of Benefits
• the primary carrier pays first
  • a plan without Coordination of Benefits is the primary carrier
• the secondary carrier pays a balance to the lesser of
  1. the amount it would have paid as the primary carrier
  2. 100% of the eligible expenses less the benefits payable for those expenses by the primary carrier