Extended Health Care Insurance (Canada)

In Canada, many of the basics of healthcare are provided through the government health plan.  However, many important expenses are not covered, including prescription drugs, medical devices (e.g., crutches, wheelchairs and orthotics), various practitioners (e.g., chiropractors, physiotherapists and psychologists) along with many other types of medical expenses.  Extended health care insurance covers a portion of these costs, with the portion and specific costs covered varying from plan to plan. Other features of some plans include dental and vision coverage, the portion of ambulance services not covered by provincial insurance and semi-private hospital rooms.  The insurance includes many of the same coverage terms used in US health insurance. If you are considering the purchase of extended health care insurance, I suggest that you read my Health Insurance post, excluding the sections on HealthCare Flexible Savings and Health Savings Accounts.

Vision Insurance

Vision insurance is generally covers the basics – eye exams related to vision correction, glasses and contact lenses – and doesn’t usually cover more serious eye conditions.  As an aside, you should be aware that some eye conditions are considered medical in nature and are covered by health insurance. If you have an eye condition, I suggest contacting your health insurer to see if it is covered as a medical condition.

Networks of Providers

Vision insurers usually create a network of providers. My experience is that there are huge differences in coverage in and out of network, so you’ll want to see whether your providers are in or out of the network. I ran into a situation in which my eye clinic was listed as being in network, but it turned out my specific eye doctor was not. As such, it might make sense to call your eye doctor’s office before selecting vision coverage to confirm whether your specific provider is in your network.

Cost Comparison

The decision whether to by vision insurance is fairly easy. You want to answer the question, “Will I recover more than the premium?” I start by making a list of my expected annual vision expenses, including how many sets of glasses and contact lenses each person in my family is likely to need. I then apply the co-pays, deductibles and/or coinsurance to see how much I will receive from the vision insurer. See my this post on Health Insurance if you aren’t sure how co-pays, deductibles and coinsurance work.

I am also aware that some health insurance plans cover a basic vision exam. You’ll want to research whether your health plan includes that benefit. If your health insurance plan has that coverage (and your provider is in your health insurer’s network which will likely be different from the vision insurer’s network), you’ll want to exclude any recoveries from the health insurer or exclude those expenses from your list before estimating recoveries from your vision insurer.

How to Decide

I compare the total amount I estimate I will recover with the premium.  If the premium is less than the recoveries, I purchase the coverage; otherwise I don’t.  Many vision insurance plans do not cover anything other than preventative services, glasses and contact lenses.  As such, the decision to purchase vision insurance is often a straightforward cost-benefit comparison and is less focused on risk and reward.  Of course, if your plan covers other eye issues, you’ll want to take those into consideration in your decision-making process.