Q: I recently heard that you can buy insurance to cover waiting periods for health care. Is that true, and is it legal to sell or buy this type of insurance? What does it get you?
A: Everyone is concerned with the wait lists for health care. Everything from complex tests to surgery seems to involve a long wait. It’s well known that some wealthier people head to the United States if they find themselves ill and can afford the high price of foreign health care.
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As a partial answer for ordinary citizens, some companies are considering selling insurance against waiting lists. A company based in Alberta offers this service. It is anticipated that others may soon follow. Essentially, it buys a person the ability to obtain quick medical care in a non-urgent situation; that is, when the situation is diagnosed as serious but is not seen as an emergency.
As with all insurance contracts, people need to review the contract carefully to determine what they get in exchange for paying premiums. Determine how much it will cost and what is offered in return. The amount of the premiums will vary, depending on the number of people covered, where a person lives and which company is dealt with. The Alberta company is charging around $100 a month, which isn’t too bad considering the benefit a person may get.
Take a look at where the insurer will send a person for care. Also see whether this insurance provides second opinions, testing, surgery. Which procedures are covered?
Check whether this coverage is subject to a deductible that the person must pay. Sometimes there is no deductible and the insured person receives 100 percent coverage. Also check the scope of the coverage. Is just the medical procedure covered, or does it include some travel expenses?
I am not being critical of this insurance. As with any contract a person signs, read it and be aware of what you are getting.
Also determine what medical conditions the policy covers. It is not reasonable to expect that the insurer will insure against waiting for treatment for every possible medical condition that could arise. Likely the covered conditions will be listed in the policy to review.
Also check whether this insurance covers pre-existing conditions. If a person has been diagnosed with a heart problem, will this insurance cover him if the heart acts up and swift medical diagnostics or procedures are needed?
Some policies do not cover this at all. Some cover existing conditions but only if the premiums are paid for a set waiting period such as 24 months, after which coverage kicks in.
Finally, most insurance policies have an upper limit on what can be claimed, either globally or per occurrence. The policy will also have other limitations and exclusions from coverage.
I have not been able to find any cases that test whether it is legal to buy or sell this insurance. However, it does not appear to be contrary to the Canada Health Act. In 2005 the Supreme Court of Canada struck down a Quebec law that prohibited people from buying private health insurance to cover things dealt with by the public system.
This insurance is not creating two tiers of medicine available to Canadians. It simply provides that in exchange for making payments, a person will not be waiting in line but will be taken somewhere and provided health care without a wait.
There is an argument that the end result is that public waiting lists are shorter for the people who remain on them.
While the concept has not been judicially tested and will likely remain controversial for a while, it appears that wait list insurance may be able to withstand a legal challenge.
Rick Danyliuk is a practising lawyer in Saskatoon with McDougall Gauley LLP. He also has experience in teaching and writing about legal issues. His columns are intended as general advice only. Individuals are encouraged to seek other opinions and/or personal counsel when dealing with legal matters.
