Beauty & Wellness

Recommendations on a good private health insurance plan?

  • Last Updated:
  • Nov 30th, 2017 10:00 am
[OP]
Jr. Member
Aug 12, 2016
141 posts
17 upvotes

Recommendations on a good private health insurance plan?

I unfortunately do not have any health insurance outside OHIP from my employer. I am now seriously looking into getting some private health insurance on my own. Any recommendations on a private health insurance package with a reasonable monthly premium and very generous health benefits?\

Regards
2 replies
Newbie
Sep 24, 2010
42 posts
31 upvotes
GTA
Savak2015 wrote:
Mar 27th, 2017 2:39 pm
Any recommendations on a private health insurance package with a reasonable monthly premium and very generous health benefits?\

Regards
Such a thing does not exist!

First problem: Private vs Group. Group insurance plans provide reasonable benefits for reasonable premiums, because if a larger employer is providing coverage for all employees, there is pooling of risk. A few people might use a lot, but many others will use less, so the group can get a reasonable plan. In fact, for many very large employers, the insurers are just helping the manage the plan (the insurer is not really at risk, as the employer pays the cost of claims plus an administrative services fee to the insurer). For Private insurance, insurers know that the people who buy private coverage are planning to use it, and will use it as to the max; the insurer is at risk, and must account for anti-selection in pricing.

OHIP covers all physician and in-hospital costs (which are most of the big major catastrophic costs that are unpredictable). That means private plans cover prescription drugs and "para-medical" services (physio, chiro, massage). Paramedical services are generally more predictable -- people know if they will be using these services and how many times they will use these services. SOme of these services are arguably discretionary (e.g. most people get massage because they want it, not because it is medically necessary). Since the customer knows, the insurance will have major restrictions on how much they will pay for paramedical services, otherwise they will lose money.

What some small employers do is arrange for a Health Care Expense account plan to be administered. In these plans, the employer and the insurer is not at risk. A predefined amount of money is deposited pre-tax into a spending account, and the employee can use the dollar amount in the account to pay for health care. [No insurance element, but a tax advantage]
[OP]
Jr. Member
Aug 12, 2016
141 posts
17 upvotes
I had been Diagnosed with depression and Aspergers Syndrome in the middle of 2016. Then in 2017 i developed a severe back problem which has badly incapacitated me physically and mentally for the last 7 months. The cost of prescriptions, counselling sessions, physiotherapy e.t.c. all began to add up. I never had any employment health insurance from any employer i ever worked with in the last 2 years. The only health insurance i ever had was from my University when i was a student and even then it was very meager.

So i finally decided to apply for the top most Private Health Insurance packages by Blue Cross and even made inquiries at Sun Life and West Life. I decided to first go with Blue Cross because they were the only organization that dealt with pre-existing conditions and also because they had the quickest processing time of 18-21 days compared to Sun Life and West Life who said it takes them 90 days to process an appliation.

I was extremely truthful about my problems with the Blue Cross people and unfortunately i got a rejection letter from them. According to an insurance advisor i contacted, i was told that because i got rejected by Blue Cross, my file is now screwed, it is being shared by the whole industry, on every application they will now ask "Have you ever been rejected by an Insurance company before?". Bottomline, she was like your chances of getting any form of Health insurance is completely non-existant now, you screwed up by applying individually on your own rather than going through an insurance advisor and that now even the top insurance advisors will not be able to do anything for you. She was like you will need to wait for another 4-5 years now before you can start applying for private health insurance.

I wanted to ask people i.e. Is there any other hope or means for me to get Health Insurance? Should i take the Insurance advisors feedback as gospel or should i keep applying for private health insurance. Will be grateful for any tips and advice.

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