Insurance plans offer alternative to long wait times for medical care

By Susan Yellin | December 02 2014 11:12AM

A recent Report Card on Wait Times in Canada has called timely access to medical care and treatment in this country as still a work in progress. “It is not right to force Canadians to wait two or three times longer for necessary medical care than citizens of other countries that also have universal publicly funded health systems,” said the report.But the financial services industry say there is an alternative – insurance products that help ailing Canadians get not only a second opinion on health problems, but also pay for transportation and surgery to other provinces, the U.S. and elsewhere in the world, where the wait times are shorter.

A number of second-opinion type products have been available for some time in Canada, many of them added on to critical illness or disability policies. And while these products give policyholders quick access to a second opinion and even which facilities can give them the fastest resolution, many do not actually pay for the transportation to these facilities or for the cost of the treatment.

However, there are some products that do just that – provide an additional level of health insurance without the extended delay times that may take place in Canada.

PPI Advisory, which caters to the high net worth market, provides a stand-alone product called triAccess, which gives a second opinion performed by WorldCare and a full “concierge arrangement” of everything from making arrangements to get to the U.S. or another part of the world, paying for that transportation as well as treatments, up to $3 million lifetime, says Ed Hofstede, vice president, PPI Benefits.

triAccess, which PPI introduced about 10 years ago, is underwritten with exclusions for some pre-existing conditions and ends at age 74.

Hofstede says it has been sold only as an individual product, but PPI often uses it in group situations as part of an executive benefits program.

Sales have been steady so far but the MGA hopes to increase that by introducing triAccess to a larger market.

Broader market

“Up to this point, triAccess has been sold through the PPI Advisory channel which is a relatively specialized group of advisors across Canada,” said Hofstede. “We are now looking at expanding our distribution through the PPI Solutions channel, which serves the broader market throughout Canada.”

The product has offered a significant value to many clients, and as result, to many advisors, he said. “Knowing where to go, how to get another opinion and having somebody arrange for all these things during a serious illness gives them the peace of mind they were looking for.”

When Gino Stirpe’s brother was diagnosed with colon cancer and had to wait almost 10 weeks for surgery, Stirpe decided there had to be a better way. So he became involved with Best Doctors and a relatively new plan that provides access to 53,000 doctors around the world, including 2,000 in Canada.

Best Doctors Global Medical Care, insured through Lloyd’s of London, provides quick access to the closest private medical clinics providing MRIs and other diagnostic tools, rather than face long wait times in Canada. In addition, it provides access to the “best doctor” who can treat a condition, anywhere in the world, says Stirpe, now director of sales for Best Doctors Canada Insurance Services Inc.

“It’s like buying your own private medical health insurance policy,” says Stirpe.

There are seven choices of deductibles, ranging from $250 to a maximum $20,000 – the most they will be out of pocket, he says. Purchased individually, the policies are underwritten and there may be exclusions or an increased deductible if there are pre-existing conditions. There is a maximum payout of up to $5 million and the policy continues for life.

Group plan

Evidence of insurability is required for groups with nine employees or less, but not for groups with 10 or more employees. Some group plans can also include spouses and dependent children.

Ian Farrer, a partner at employee benefits firm Hamilton and Partners in Calgary, says the product works well for clients who don’t have the time to wait for treatment in Canada.

“The individual products are purchased by people with means who do not want to wait two years to get their hip done or want to access special treatment in the U.S. that may not be available in Canada because we just don’t have the technology,” says Farrer.

The plan can be relatively expensive depending on the person’s age, but Farrer, in his early 50s, says his policy costs him a couple of thousand dollars a year – less than his dental plan.

Farrer is currently working on a case for Best Doctors that could involve as many as 1,000 partners in a national legal firm, an ideal corporate scenario where highly paid executives need to get back to work as quickly as possible.

In addition, he says the plan can act as a lifetime travel insurance product for many older Canadians.

“When people retire this plan covers them anywhere in the world even if their health changes,” says Farrer. “So a lot of people from Alberta retire to Phoenix or Palm Springs and as they get older their health changes and they can’t buy traditional travel insurance. This policy will cover them as long as they want to keep it… The cost of this is fairly small in comparison to what they are spending on travel and purchasing second homes.”

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