Why You Should Have Hospital Coverage

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Your provincial health plan covers standard hospital ward stays. It’s important to consider whether that is enough before you face out-of-pocket expenses.

You never know when you might need to go to the hospital. From accidents and illnesses to chronic conditions, people find themselves in the hospital without warning all the time. If you are hospitalized for a while, you could face unexpected costs that your provincial health insurance plan does not cover.

Many Canadians are under the impression that they have access to free health care. In reality, we are funding our provincial health insurance plans through our tax dollars, and this doesn’t mean that you will always be able to get the hospital-related services you need at no additional cost to you. There are some services that are billed to patients if they opt for higher cost options or do not have health insurance – things like ambulance service, medication, delisted procedures, private duty nurses and post-hospital care.

Did you know that your provincial healthcare plan will only cover a standard hospital ward stay? Some provincial plans will also cover semi-private or private rooms up to a certain dollar amount, but only if it is medically necessary (e.g., in the case of infectious disease). That means that all too often, hospital rooms are another expense that must be paid out of pocket – and that can be expensive.

Understanding Your Hospitalization Choices

During admission or pre-admission, the hospital staff will ask you to make a request for accommodation.

Your choices include:

  • Private (one bed per room, private bathroom), often costing up $400 per day
  • Semi-private (two beds per room, shared bathroom for two patients), costing about $300 per day
  • Standard ward (four beds per room, shared bathrooms for four patients) covered for individuals with provincial health insurance

If you prefer to stay in a private or semi-private room during your hospital stay, a premium rate will be charged to you. But is it worth it?

There are a number of reasons you should consider opting for private accommodation:

  • Hospital-acquired infections are the most common complication of hospital care, increasing cost and risk of mortality; private rooms minimize the spread of disease and aid recovery times.
  • Fewer individuals per room can reduce medical errors.
  • Your personal privacy is protected.
  • You can control the noise level and enjoy quiet when you want or speak freely when you choose.

Hospital coverage helps pay out-of-pocket costs

Hospital insurance coverage is affordable, and an ideal part of a comprehensive health insurance plan. Some health plans have semi-private or private hospital benefits included, while others do not.  You can select an add on option to make hospital stays more comfortable with coverage for a semi-private hospital room. If you don’t have a more comprehensive health plan, you can even choose standalone hospital coverage.

Keep in mind that different insurers offer different forms of hospital benefit coverage.

Here’s how a hospital plan works:

  • The plan pays up to a maximum dollar amount (typically $150-$250 every day for a semi-private or private hospital room)
  • If a semi-private or private room is not available, a reduced benefit may be payable after a short stay (e.g., $25 a day starting on day four, up to a maximum of $750).

The amount reimbursed every day is calculated based on the reasonable and customary provincial room rate. Benefits are for each person every year unless otherwise noted in the policy.

When you provide your health insurance information to your hospital on your pre-admission form, they will bill your insurer directly. If only a portion of the private or semi-private cost is covered, you will be required to pay the balance to the hospital.

Protect yourself and your family today

Are you prepared? Without coverage, you risk needing to spend thousands of dollars on hospital costs, to avoid spending what could be months in a hospital ward with strangers. Your healing will depend on the quality of the rest and privacy you can get at this difficult time.

Don’t depend on your provincial coverage to carry you through your health woes. It’s a great help, but ultimately, you’ll be glad you had supplementary health insurance to cover the rest.

Call our office today and we’ll be happy to help you find the perfect plan for you and your family. Our staff is trained to assist you and go over your options carefully. We’ll make sure you can count on the care you might need.


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