You keep health insurance on long-term disability in Canada through the universal health care system. If you carry a supplemental policy for prescription, vision, and dental benefits, you should check with your employer or policy provider for its specific guidelines.
Long-term disability insurance provides payments to cover your living expenses as you deem necessary. Therefore, you are permitted to use benefits to cover additional medical expenses and policy premiums.
The Basics of Health Insurance While on Long-Term Disability
While you are receiving long-term disability benefits, the Canada Health Act permits you to receive basic coverage under the promise of accessibility. You will receive benefits through your specific territory or province to receive essential health services provided by physicians, hospitals, and maxillofacial surgeons.
For senior citizens and minor-aged children, territories and provinces offer supplemental coverage options. These additional services align with the specific needs of these groups for additional medical coverage and benefits.
Consider a Supplementary Plan for Coverage Gaps
While most publicly funded health plans cover your basic needs, you may need to elect and pay for additional coverage while on long-term disability if you do not already have it. A supplementary health care plan will provide coverage when a territorial or provincial plan does not offer benefits.
If you have a private plan through your employer, you should check with your manager or human resources department to determine how your plan works while receiving benefits.
You can also purchase a private policy while on long-term disability to cover things like:
- Prescription drugs
- Ambulance services
- Mental health
- Long-term care
- Other services not covered
Determining whether you need a supplemental plan is a decision that is made based on your personal situation. You can compare policy costs to your anticipated usage of certain health services to establish if it makes sense to purchase these policies.
You May Not Be Insured When Travelling in and Around Canada
When you are traveling in or around Canada, it is vital to understand that your benefits may not cover you when you are in another territory or province. Canada does not provide benefits when you are traveling outside the country.
Discovering that your policy does not offer benefits when you think you will need them is frustrating. Prior to selecting an insurance provider, it is advisable that you carefully review the terms and conditions outlined in the plan, including limitations and exclusions.
Your Employer May Stop Paying Certain Health Benefits if You Are 65 or Over
If you’re a long-term disability recipient nearing your 65th birthday, you may want to check with your employer to determine how long it will continue to provide you with private health benefits if you receive them. Since Canadian employer plans consider 65 the standard age for ending LTD contracts, you might lose supplemental coverage as well.
It Is Possible the Government May Deny Your Benefits
While it is not common, there are situations in which your health care insurance benefits could be denied by the federal or a provincial government. Health coverage denial may seem counterintuitive to the system, but it does occur and surprises Canadian citizens when it happens.
There are three reasons why your treatment may be denied in Canada:
- Not deemed “medically essential”
- Gaps for waiting periods
- Not coverable
If you believe that your treatment should be covered by the public system, then you may want to discuss this situation with your long-term disability claims lawyer. He or she can help you file for reconsideration with the Health Services Appeal and Review Board.
Call Preszler Injury Lawyers to Protect Your Rights
You should have access to the reasonable living expense benefits payments which your employer or provider promised before you became disabled. At Preszler Injury Lawyers, our clients are always our top priority. You will have the peace of mind knowing that your health and well-being come first. It is our goal to make sure you receive the benefits to which you may be entitled.
If you need legal help with your long-term disability claim or appeal, contact an Ontario long-term disability claims lawyer at Preszler Injury Lawyers to discuss your options. Contact our office for a free initial consultation today at (416) 364-2000. Preszler Injury Lawyers is available to answer your calls 24 hours a day, 7 days a week.