# Insurance Provider Recommendations



## Young&Ambitious (Aug 11, 2010)

Hey guys,

I need recommendations on insurance providers. I've got a new job however they do not provide health/dental benefits as all work is contracted out (including mine). On that point I have no spousal benefits and no dependants (the dog doesn't quite count) and am set up as a sole proprietorship. I'm young and healthy although I do wear contacts, would like to get eye laser surgery at some future point, and regularly go to massage/physio (long term requirement). 

Any recommendations or advice, positive and negative alike, would be much appreciated!

Thanks guys


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## the-royal-mail (Dec 11, 2009)

Here's one example.

http://www.coverme.com/products/flexcare-plans.jsp

I've been in your shoes before and after selecting the benefits I wanted and seeing the cost, decided I was better off to pay cash for that stuff. Remember those providers are there to make money. This may not be as financially beneficial as you think.


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## FrugalTrader (Oct 13, 2008)

If you are a professional, Meloche Monnex has some great rates. That's who we use.


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## carverman (Nov 8, 2010)

the-royal-mail said:


> Here's one example.
> 
> http://www.coverme.com/products/flexcare-plans.jsp
> 
> I've been in your shoes before and after selecting the benefits I wanted and seeing the cost, decided I was better off to pay cash for that stuff. Remember those providers are there to make money. This may not be as financially beneficial as you think.


Yup, they are in business to make money. Being retired from a bankrupt
high tech company, I lost my pensioner health/dental/life insurance benefits
as of the first of January this year. I knew this one year ahead of time and
so far haven't (maybe because of my age) found ANY personal insurance
provider that has what I would call reasonable rates.

Most want at least $80 to $120 a month for health and dental coverage
and life insurance is separate on top of that. The health/dental has
limits on the coverage as well, so you still end up paying something
on top of what you already pay as a monthly premium,

So depending on your personal situation and whether you really need
the coverage, you could just take that $80 to $120 a month and put
it into a savings (TFSA or whatever) and save your money for a dental or
drug prescription.

If you don't use the coverage for a year, here is what you have in
your pocket vs the insurance company's pocket..
$120 x 12 months = $1440 (year one)
= $2880 (year two)

I decided that being on a declining pension and some unknown factors,
I would just save that $120 a month starting last year..now I have enough
in my drug/dental acct to cover most normal emergencies..such as
fillings or even a root canal if need be. Since my drug requirements are
very small, I can pay for my own drugs and still have some of that yearly
premium left over..

but again, it depends on your own personal situation, your age and
how healthy you are..and of course, this doesn't take into account any
accidents, such as motor vehicle, ski-ing or activities that put you into
high risk for personal injury. If you are active in those kind of activities,
then it may be a good idea to have extra coverage.


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## Four Pillars (Apr 5, 2009)

Don't forget that part of this insurance is for future unexpected costs.

At $100/month (or whatever), you might be losing money while you are healthy. But if you develop some sort of illness, disability etc that requires expensive drugs - then you will be better off if you have the insurance.

I'm not saying you should have it - just that you can't only look at current medical costs when evaluating.


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## carverman (Nov 8, 2010)

Four Pillars said:


> Don't forget that part of this insurance is for future unexpected costs.
> 
> At $100/month (or whatever), you might be losing money while you are healthy. But if you develop some sort of illness, disability etc that requires expensive drugs - then you will be better off if you have the insurance.
> 
> I'm not saying you should have it - just that you can't only look at current medical costs when evaluating.


I have the ManualLife "Followme health insurance plans sent to me for
my consideration..here is what they say for rates for a 21 to 44 yr old.

Basic Plan: $62.04 per month. Dental is NOT COVERED
Generic drugs -you pay part of the dispensing
fee + the other 20% of drug cost 

They have a $400 maximum per year
Lets say you are going for the basic plan (62.04 x 12 = $744 per year)

So for a $50 generic antibiotic prescription ($45 + $15 filling fee)= $60
you pay $9 (20%) + $7.50 (co-payment) they pay $36 + $7.50 = $43.50

If you have a bad year and have more than $400 worth of claims for drugs
they pay up to $400 and you pay the full amount after that...so they still
make $344 a year in premiums

Glasses.$150 every 2 calender years, $50 for Optometrist visit
Forget about them covering you eye laser surgery!

Registered Specialists/Therapists (I presume ones that are NOT covered
by the provincial health plan (acupuncture/chiropractor, Reg massage therapist, PHYSIOTHERAPIST, Psychologists, Podiatrists)

(life time max of $100,000)
20 visits max, per specialist, $15 per visit, you pay the rest
..now where can you get a specialist that cheap these days 

So in summary, with the basic health plan, you basically get some
generic drug coverage (up to $400 per year) for $744 a year in premiums.

If you don't use any medication or specialist services, they get to keep
the $744.

*Enhanced plan *(DENTAL NOT COVERED, $85.31 per month ($1023 per year)
$800 drug coverage maximum

*Enhanced Plus*: $110.87 per month ($1330 per year)
covers 80% of basic dental (fillings/cleaning/exams) up to maximum of $700 in first year
Generic drugs up to $800 per year. Other coverage as well for specialists

*Premiere: *$143.83 per month ($1725 per year)80% for generic drugs, shared dispensing fee

80% on basic dental, crowns/bridges/dentures up to 60% only in 3rd year of coverage
year maximums on dental: $800 in year one, $1000 in year 2, $1500 in year 3

So even with the most expensive plan, you still pay out of your own pocket, anything over $800 in dental
and up to $800 for generic drugs.
Assume you had a bad health year and your costs are over the $800 + $800 drug/dental limits,
they only pay out $1600, but collect $1725, so they still keep $175 of your premiums and you end up
paying the rest!


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## Sustainable PF (Nov 5, 2010)

FrugalTrader said:


> If you are a professional, Meloche Monnex has some great rates. That's who we use.


We use them as well, however, we got to use them for being university alumni. I guess I didn't get to the probing questions about our professions.


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## Four Pillars (Apr 5, 2009)

carverman said:


> I have the ManualLife "Followme health insurance plans sent to me for
> my consideration..here is what they say for rates for a 21 to 44 yr old.
> 
> Basic Plan: $62.04 per month. Dental is NOT COVERED
> ...


Thanks for posting that info. That's the first time I've ever seen details of an actual health plan.

Well - it looks like crap to me. 

I guess you either shop around for something more reasonable or just don't get health insurance.


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## carverman (Nov 8, 2010)

Four Pillars said:


> Thanks for posting that info. That's the first time I've ever seen details of an actual health plan.
> 
> Well - it looks like crap to me.
> 
> I guess you either shop around for something more reasonable or just don't get health insurance.


To put it another way..they sort of pay your drug/dental costs out of the money you pay to them in the form of monthly premiums. 

While there are some additional benefits (like they pay $175 for a semi-private room, that doesn't always work out "1 to 1" as far as hospital costs these days.
I remember being hospitalized for 3 days many years ago, and there
were no sem-private rooms available, but the hospital admitting asked
if I had semi-private coverage, noted it before being admitted to the room.
The insurance company got the bill for semi-private room,
but I only got WARD accomodation (4 beds to a room). 

I suppose that when you are really sick, like I was, it really doesn't matter that much whether you are in a 4 bed ward or 2 bed semi-private, but these are the games that they play, fair or unfair, like charging you $13 a day
for parking, if you are over 1.5 hrs in their parking lots even as a patient. (Dont leave your
vehicle in their lots for several days at $13 a day.)

As far as better coverage, you have to go with their "premium plans"
which for me at my age (65) will be around $2000 a year. 
These also covers ambulance and air ambulance up to $4000 for air ambulance and upto $3000
per year for ACCIDENTAL dental services as well as medical appliances 
up to again $2500 per year.

All plans cover accidental death/dismemberment from $10,000 for adults
up to $50,000 for adults for the premium plan, so if you die accidently,
it appears that most of a basic funeral costs will be covered even with the
basic plan,

Also in case of a vehicle accident, which I believe your vehicle insurance covers Medical/Rehabilitation benefits (standard policy) up to $100,000 or
$1,000,000 for catastrophic impairment (loss of use of limbs etc), you
can also upgrade these benefits on an optional clause and some of the
funeral costs as well, in case of death. 

So that only leaves, accidental injury (ie: ski-ing) or some such 
bizarre accident like falling off a roof etc, where you might need drug and dental insurance that OHIP doesn't cover.

If you are frugal and can save into a TSFA account to be used as a "medical/dental insurance" acct such as I have and don't engage
in high risk activities, you MAY be able to just save the premiums that
you would have paid out and use those when you have drug or dental
expenses.

Again, you have to assess what is best for you in your own situation.

BTW..the premiums (age 21 to 44) $62 to $143 per month is for 1 person. 
Add a dependent,(couple) that rises to 56.24 to $137 PER PERSON, if you have a child (1 or 2)
depending on the age of the child, it can add another $60 per child. 

If anyone can find "cheap" medical/drug/dental insurance in Ontario,
please post it here and let us know.


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## the-royal-mail (Dec 11, 2009)

Thanks caverman for all of your informative posts. I did this research a few years ago when I was in the same boat as the OP, and the results back then were exactly the same. Additionally, your posts assume a healthy applicant with NO health issues. As soon as you add any kind of pre-existing medical condition or drug needs to the questionnaire they make you sign, they tell you you have to pay more. It must be that the only people who buy these plans, are those who don't do math.


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## carverman (Nov 8, 2010)

the-royal-mail said:


> Thanks caverman for all of your informative posts. I did this research a few years ago when I was in the same boat as the OP, and the results back then were exactly the same. Additionally, your posts assume a healthy applicant with NO health issues. As soon as you add any kind of pre-existing medical condition or drug needs to the questionnaire they make you sign, they tell you you have to pay more. It must be that the only people who buy these plans, are those who don't do math.


I wasn't aware of pre existing conditions the drug/dental/medical insurance,
but these days, anything is possible. I know that most life insurance
companies would want some kind of medical questionaire answered if
you are applying for anything more than $20K in life insurance..basically
funeral costs, and there is a limited payout for the first 2 years, I believe
on those.

So far, I haven't found a plan that will be cost effective for me at my age.
Just like life insurance, these plans are a gamble on whether you will
use them enough to justify the $100 dollar a month cost. They are in the
business to make money, so they put in all sorts of caps on benefits payable.
either maximums per year, or lifetime maximums and you pay the difference.
And..the ManuLife plans (according to the brochure) only cover GENERIC drugs. 

If you have a condition that requires proprietary drugs, you may have to pay for them out of your own pocket, unless you can find some government assistance or plan to help you. 

For those 65 or over, Ontario has a drug benefit plan (ODB) that only costs $100 per year and the co-payment is very little. 

As an Ontario taxpayer, I would use that first over joining any insurance scheme, and then just put away some money each month to take care of any emergency dental needs..like a filling or root canal.


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## Young&Ambitious (Aug 11, 2010)

Thanks guys for all the great insight and advice!

I wonder if I would be better off getting term life insurance (I believe this is the correct term for the one I'm thinking of...) to take care of accidents as this is the one I'm more concerned about but as it has been pointed out, your basic plan won't cover these unforeseen emergencies/accidents and whatnot. 

What do you guys think of this? This could almost be a whole new thread here now oops!


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## WallyK (Jan 29, 2011)

Most people have the concept of insurance all wrong.

You don't buy auto insurance and then hope you have an accident just so you can get your moneys worth.

Same with health insurance. If you plan to pay for health coverage then your upset that you didn't use enuff of the benefits then you shouldn't buy the insurance. Take a $100 or $200 per month and stick it in an envelope every month and pay your expenses out of the envelope. It's called self-insurance.

However, just be aware that if you are in your 50's, a health plan with full coverage will cost in excess of $400/mth for a married couple.

But.....like any insurance, you are insuring against extraordinary risk. You may not get "your money's worth" if all you need is a couple of prescriptions per year BUT if you get cancer and even though the chemotherapy is free, they still send you home with a mitt-ful of prescriptions, your benefits become well worth it very quickly.

Likewise life insurance. We can all debate till the cows come home about the costs of term versus whole life, etc, etc. Bottomline is that if you buy term the price will go up on renewal and it may go up to a point where you drop coverage.....and that's stupid. The Life Ins companies count on a high percentage of clients dropping their coverage before they die. That's how they make a lot of money. Since we all die eventually, the only smart insurance to get is whole life of one type or another or a long-term plan like Term100. Sure it will cost more, but so -what. If you get $250,000, eventually someone (beneficiary) is gonna collect on that policy......and that is guaranteed 100%. Of course, shop around but shop for policies for the long term otherwise it's just a huge waste of money.


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## carverman (Nov 8, 2010)

WallyK said:


> Most people have the concept of insurance all wrong.
> 
> You don't buy auto insurance and then hope you have an accident just so you can get your moneys worth.
> 
> Same with health insurance. If you plan to pay for health coverage then your upset that you didn't use enuff of the benefits then you shouldn't buy the insurance. Take a $100 or $200 per month and stick it in an envelope every month and pay your expenses out of the envelope. It's called self-insurance.


Buying any kind of insurance is managing the risks in your life.
Some insurance such as car insurance is compulsory and enforced with huge
fines in the thousands. Besides, today, if you have an accident and 
people are seriously injured or killed and it is deemed to be your fault,
you want to have a million or two of liability protection.

Same with house/content insurance...the replacement and rebuild costs
are beyone the financial scope of most individuals.

When it comes to optional insurance such as medical/dental and life,
it depends on the individuals situation and family responsibilites.

I agree with you that buying medical/dental insurance is not just
getting your money's worth as there may be a year where you don't
have any significant claims to even amount to the premiums..and
that's what insurance companies are gambling on. After all, if they
have to pay out more than what you are paying, they will put on
yearly limits so that you don't claim more than you pay in in premiums.

But they have several tiers of insurance, the more you pay in premiums,
the more you can claim and get re-imbursed. Most basic plans cover
about 70% of the claim...so lets take a tooth filling cost of $150.
and a basic plan cost for me (age 65)...of around $84 a month.

Lets say, I have a claim in the first month of the plan...they pay
70% of the cost $105, and I have to pay the rest out of my own
pocket ($45). In this scenario, I win by $21 in re-imbursements
that they have to pay out. If I don't have any further claims in the
same year, they win.

I've looked at two or three plans including the Sears Health and Dental,
and these are tiered as well with minimum coverage and yearly limits
on claims. ( These premums are based on my age group.)

Basic plan ($84 per month)..generic drugs and simple dental 
(fillings exams etc) 70% Hospital extended care excluded 

Bronze $108 per month..similar but larger yearly maximums 
( 70% coverage on first $500 and 80% on next $2500 within the same year
Generic drugs

Silver $155 per month 80% more coverage, 80% on first $500 and 100% on the next $4650 in claims Generic drugs
Gold $224 per month, you get practically everything covered, 90% on
first $2,200 and 100% on next $8000 in claims. Name brand drugs.

So again, it depends on what your expectations are and what your individual
health concerns are..if you enroll in the Sears Gold plan..($224 per month),
you don't have to worry about anything..except saving that $2688 per year.

It's a gamble, just like life insurance, but at least you will collect some of it
sooner or later in health or dental costs.

Because my drug/dental needs are low, I am putting away $100 or $200
a month in a "health savings acct", but this takes discipline.
So lets say that (at least for now) I save $1200 a year minimum, by
not enrolling right away in a health/dental plan.

In 5 years, I will have saved $6000 in insurance premiums, and as long
as I keep this money in an acct, I can enroll in a health plan later if
I really need it. 



> But.....like any insurance, you are insuring against extraordinary risk. You may not get "your money's worth" if all you need is a couple of prescriptions per year BUT if you get cancer and even though the chemotherapy is free, they still send you home with a mitt-ful of prescriptions, your benefits become well worth it very quickly.


No argument from me on this. Cancer in most cases requires proprietary
drugs, although some are available now as generic. I have had cancer about 10 years ago and have
a ongoing health issue that requires treatment at a local hospital on a monthly basis and a generic
drug that I need to take daily. The cost of generic drug is still affordable to me, even on a reduced
pension this year ($65 for a 1000 pills), so for now, I'm just banking the premiums for future use.


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## davext (Apr 11, 2010)

I just pay cash as well although it can get expensive. However, for the dentist I get the senior's discount because I asked for it since I don't have insurance coverage.


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## Berubeland (Sep 6, 2009)

I also did this same evaluation and came to the same conclusions.Every item has limits and there is no way you can get more benefits than you pay. 

Indeed it is only good for those bad at math.


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## carverman (Nov 8, 2010)

Berubeland said:


> I also did this same evaluation and came to the same conclusions.Every item has limits and there is no way you can get more benefits than you pay.
> 
> Indeed it is only good for those bad at math.


Those plans are also designed for employers, although depending on how many employees are included, the employer gets a group discount, since the insurance company can easily manage the risks due to the high premium coming in. 

Not everyone in a group plan will need expensive drugs or submit dental claims within a given year, so that kind of insurance scheme is no doubt, lucrative for the insurers, even if they have the odd catastropic claim due to accident or cancer etc...
however, when it comes to an individual plan, it's a diffrent story..one has to be concious of what you are getting for
the premiums paid out. 

Obviously, if it's peace of mind you are interested in, then paying out a monthly premium gives you that to some degree....
until you have to collect on it.

But again, you get back as much as you pay in..so if you are willing to subscribe to their "Gold Plan", you can be assured that the insurer will chip in at least 50% or more, for things that are not covered under other plans..
(like semi-private room, air ambulance etc. )

Of course they protect themselves with " life time maximum" for each individual , and if you exceed that in treatment
or unusally high claims.well you are your own again.

It all boils down to risks and making a profit.


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