HealthSure™ Frequently Asked Questions

What is not covered?

What is not covered under the Healthsure™ plan?


  • You are not covered for pre-existing health conditions during the first two years of coverage. However, pre-existing health conditions are covered conditions after you have been continuously insured in the plan for 2 years.
  • You are not covered for any chronic medical conditions. Examples of some chronic medical conditions include: Diabetes, Multiplesclerosis, and HIV/AIDS.
  • You are not covered for any specialist consultations during your first 90 days of Healthsure™. Coverage for specialist consultations begins 90 days after the effective date of your coverage.
  • You are not covered for back, knee or hip surgical procedures during the first 2 years of coverage under your Healthsure™ plan. Coverage for bakc, knee or hip surgical procedures begins 2 years after the effective date of your coverage.
  • Although the Healthsure™ plan does provide for approved travel expenses for surgical procedures (up to $500 each for transportation for you and an approved companion, plus up to $150 a day to a total of $1,500 for your companion's accomodation and meal expenses), you are not covered for any travel costs relating to any diagnostic testing or specialist consultations.
  • If your doctor were to chare you to provide a letter or other documentation regarding your referral for a diagnostic test, sppecialist consulation, or surgical procedure to be provided under the Healthsure™ plan, such a charge would not be covered under Healthsure™.
It is important for you to review the 'Definitions' (page 10) and 'Policy Limitations and General Exclusions' (pages 15 and 16) sections of the Healthsure™ policy prior to enrolling so that you know and understand what is not covered under the plan. Click here to view a sample policy.




What is considered a pre-existing condition?


Under the Healthsure™ policy (see page 16 of the 'Sample Policy' on our website here) 'Pre-existing Condition' means: a) A condition for which an insured person is given medical care, treatment, services, medication, diagnosis, diagnostic test or consultation prior to the insured person's effective date of coverage or prior to the effective date of any benefits that is added to existing coverage; or b) A condition which produced symptoms prior to the insured person's effective date of coverage or prior to the effective date of any benefit that is added to existing coverage. These symptoms must be distinct and significant enough to establish onset or manifestation by one of the following tests: i) The symptoms would allow one learned in medicine to make a diagnosis of the disorder; ii) The symptoms would cause an ordinarily prudent person to seek medical diagnosis or treatment. This includes, but is not limited to any condition for which the insured person is already on a surgical/procedural waiting list in Canada.




What if I have not yet consulted a doctor or been diagnosed with a health condition that I have a family history of, is that considered a pre-existing condition?


As "[any] symptoms [that] would cause an ordinarily prudent person to seek medical diagnosis or treatment" are not covered, it is quite possible that this condition is not covered - these would be determined on a case-by-case basis.





Healthsure™ Plan Details

Do I have to complete a medical questionnaire or complete a health exam to qualify for the Healthsure™ Private Health Care Insurance Plan?


No, you do not have to complete a medical questionnaire or health exam; your acceptance for Healthsure™ is guaranteed regardless of any prior health conditions you may have. Healthsure™ will begin on the first day of the month following receipt of your enrollment and approval by our plan administrator MSH International (Canada). Note: Healthsure™ coverage for all covered conditions begins on the first day of the month following your enrollment and approval by our plan administrator MSH International (with the exception of any pre-existing health conditions which are not covered during the first two years of coverage but are covered thereafter if you have been continuously insured).




Once I have completed my enrollment, when does coverage begin?


You Healthsure™ plan begins on the first day of the month following receipt of your enrollment by our plan administrator.




Is there a dollar limit to the amount of health care treatment that the Healthsure™ plan will provide?


The Healthsure™ plan provides you with a limit of $1,000,000 of health care insurance coverage for each family member.




Are there any waiting periods before I can use Healthsure™?


Under Healthsure™, coverage for all covered conditions begins on the first day of the month following your enrollment and approval by our plan administrator (with the exception of pre-existing health conditions during the first two years of coverage, however, they are covered thereafter if you have been continuously insured). You are not covered for any specialist consultations during your first 90 days of Healthsure™; you will be covered after the 90 days. You are not covered for back, knee or hip surgical procedures during the first 2 years of coverage under you Healthsure™ plan; you will be covered after the 2 years. Healthsure™ is an "exclusionary" health care insurance plan. What this means is that you are covered for ecerything unless it is specifically stated in the policy that something is excluded (not covered). It is important for you to review the 'Definitions' (page 10) and 'Policy Limitations and General Exclusions' (pages 15 and 16) sections of the Healthsure™ policy prior to enrolling. Click here to view the Healthsure™ policy.




Will my Healthsure™ plan end after the first time I use it?


No, you can use your Healthsure™ plan multiple times up to a limit of $1,000,000 of health care insurance coverage for each family member.




Are there any limits to how frequently I can use Healthsure™?


Yes, Healthsure™ provides you with up to 2 specialist consultations (each of the 2 specialist consultations include both an initial consultation and a follow up consultation) per coverage period (per calendar year from the start date of your coverage). For couples, single's with a child and families, Healthsure™ provides up to 3 specialist consultations (each of the 3 specialist consultations include both an initial consultation and a follow up consultation) in total, for all individuals, per coverage period (per calendar year from the start date of your coverage). For specific policy wording, see page 24 of the 'Sample Policy' on our website here.




Are there any deductibles or co-payments that I have to make?


No, there are no deductibles or co-payments that you have to make.




Are there any extra costs I should be aware of?


Possibly. If the medical facility providing the diagnostic procedure or the specialists office were to charge you to provide a letter indicating that they are unable to provide you with the health care treatment you require withing 45 days (i.e. the provincial health care system is unable to provide you with the medical care you require within 45 days), the charge to provide that letter would not be covered under Healthsure™. Additionally, Healthsure™ does provide for approved travel expenses for surgical procedures (up to $500 each for transportation for you and an approved companion, plus up to $150 a day to a total of $1,500 for your companion's accomodation and meal expenses). You are not covered for any travel costs relating to any diagnostic testing or specialist consultations.




Are travel costs covered?


The Healthsure™ plan does provide for approved travel expenses for surgical procedures. Transportation costs are covered up to $500 each for transportation for you and an approved companion (up to a total of $1,000). Additionally, your approved companion's accommodation and meal expenses are covered up to $150 a day to a total of $1,500 while you are at the surgical facility. If your travel costs relating to a surgical procedure are greater than the Healthsure™ policy limits, then you are responsible for such costs (see pages 23 and 24 of the Sample Policy page on our website for specific details). Note: You are not covered for any travel costs relating to any diagnostic testing or specialist consultations you may have under Healthsure™.




Can my premium rate be changed?


Yes. Premiums are age banded which means your premiums will go up as you reach each age band. See the Rates page of our website to view the rates schedule and age bands. Additionally, although you cannot be singled out for a premium rate change, a product-wide premium rate increase could be implemented in the future to cover increased operational expenses of Healthsure™.




Am I locked in for a period of time or can I discontinue my Healthsure™ plan if I no longer want to be covered?


You are not locked in to Healthsure™ and can discontinue your coverage at any time upon providing MSH International (Canada) Ltd.'s Calgary regional office with 30 days written notice requesting that your Healthsure™ plan be discontinued. The Calgary regional offices of MSH International (Canada) LTd. are located at Suite 300, 999-8th Street SW Calgary, Alberta T2R 1N7. MSH International's Calgary regional headquarters toll free phone number is 1-800-672-6089 and their local number in Calgary is 403-232-8545. You can also reach their Client Services Department by email at clientservices@americas.msh.intl.com. Alternatively, you can discontinue your Healthsure™ plan at any time upon providing our office with 30 days written notice via any means on our Contact Us page.




Could my Healthsure™ be discontinued or terminated by United Benefits Group or MSH International?


Healthsure™ cannot be discontinued or terminated by United Benefits Group. MSH International cannot specifically single out your Healthsure™ plan to be discontinued, however, they could terminate the entire Healthsure™ product offering at any time upon 30 days written notice to plan holders. To keep the Healthsure™ plan of an insured person in force, each premium must be paid no later than 31 days after its premium due date. This 31 day period is known as the 'grace period'. If any premium is not paid within the grace period, the applicable Healthsure™ plan will terminate on the expiration of the grace period effective from the premium due date of the unpaid premium.





Making a Claim

Who provides the plan administration and management of medical services for Healthsure™?


United Benefits Group provides plan enrollment and service support for Healthsure™. Please see our Contact Us page if you need to contact us. Plan administration and management of medical services for Healthsure™ are provided by MSH International (Canada) Ltd which is a Lloyd's Approved Coverholder. MSH International's Calgary regional headquarters are located at Suite 300, 999-8th Street SW Calgary, Alberta T2R 1N7. You can reach them toll free at 1-800-672-6089 or locally in Calgary at 403-232-8545. MSH International's email address for Client Services in Calgary is clientservices@americas.msh.intl.com.




If the provincial health care system cannot provide me with a diagnostic test, specialist consultation or surgical procedure within 45 days, how do I arrange for health care treatment through Healthsure™?


Hopefully, you or your family members will never have a medical condition that results in being placed on a waitlist. However, if you do, we will be here to help assist you with a claim under your Healthsure™ plan. If your doctor refers you for a diagnostic test, specialist consultation or surgical procedure, as soon as you are advised by the medical facility or the specialists office that they will not be able to provide the health care treatment you require within 45 days, simply contact us (toll free at 1-888-264-8020, 403-264-8020 in Calgary, or send an email to our Client Support Administrator, Kathy Shearer at kathys@accessbenefits.ca) and we will assist you to book and receive prompt, first class medical care. All that is required for you or a family member to make a claim for a covered diagnostic test, specialist consultation or surgical procedure is a letter from the facility or specialists office that you have been referred to indicating that the scheduled or anticipated appointment date is greater than 45 days from the date that you were referred. We can help you acquired this letter - please contact us if you need assistance with your claim.




Can I choose the medical specialist or the facility where I am treated?


Possibly: every reasonable effort will be made to accommodate any specific requests you may have.




Do I have to pay for any health care treatment that I receive through Healthsure™ and then make a claim and wait to get reimbursed?


No. Under Healthsure™, fees for diagnostic testing, specialist consultations and surgical procedures, including facility fees, are paid directly by the plan administrator, MSH International (Canada) Ltd., through their Calgary regional office to health care and facility providers. You do not have to pay health care and facility providers for your health care treatment and then seek reimbursement.




Can I just arrange private medical care for myself and submit the expense?


No. If you obtain a diagnostic test, specialist consultation or surgical procedure on your own, without first obtaining approval from our plan administrator, then such services will not be paid for under Healthsure™. Arranging for medical care is easy. All you have to do is contact us and we will help you receive prompt, first class medical care.




If I think that I should have a diagnostic procedure such as an MRI or that I should have a specialist consultation or surgical procedure by my doctor disagrees and will not refer me, can I use Healthsure™ to obtain the diagnostic procedure or specialist consultation?


No. You must first have a referral from a physician for a diagnostic test, specialist consultation or surgical procedure. If you have been advised that the provincial health care system cannot provide the test, consultation or procedure within 45 days, then you are covered under Healthsure™ and every effort will be made to arrange for you to have the treatment you require within 21 days. If you feel that your personal physician is not advocating an approach to your health care that you agree with, then you may want to consider getting a second opinion on whether you should have a referral for a diagnostic test, specialist consultation or surgical procedure.




What if I am traveling out of the country and suddenly require a diagnostic test, specialist consultation or surgical procedure while I am away, will my Healthsure™ plan cover me for this?


No. Healthsure™ provides you with diagnostic testing, specialist consultations and surgical procedures if you are advised by a physician in Canada that your provincial health care system cannot provide you with a covered medical treatment within 45 days. In order to be covered for medical treatment while traveling, you would need Out of Country or Travel Insurance coverage which is a different type of coverage than Healthsure™. Please contact us for more information.





Coverage For Family Members

Can my parents be covered under my Healthsure™ plan?


Your parents can not be covered under your Healthsure™ plan, however, your parents can be covered under their own Healthsure™ plan. Your parents can enroll for Healthsure™ up until age 75 (unless they live in Quebec or the Territories where Healthsure™ is currently unavailable). Your parents do not have to complete a medical questionnaire or health exam. Their acceptance for Healthsure™ is guaranteed regardless of any prior health conditions they may have. Your parent's Healthsure™ plan will begin on the first day of the month following receipt of their enrollment by our plan administrator. Note: Under the Healthsure™ plan, coverage for all covered conditions begins on the first day of the month following your parent's enrollment and approval by our plan administrator (with the exception of pre-existing health conditions during the first two year of coverage, pre-existing health conditions are covered conditions after your children have been continuously insured in the plan for 2 years).




Can my adult cildren be covered under my Healthsure™ plan?


Yes. Your children can continue to be covered under Healthsure™ from the time they turn 18 up until the time they turn 25 provided that they are attending an accredted secondary (high school) or post-secondary educational institution on a full time basis (ex. university or college). If your children are not attending an accredited secondary or post secondary educational institution on a full time basis, once they turn 18, complete or discontinue their studies, they will no longer be covered under Healthsure™. If your children turn 18 years of age and are not attending an accredited secondary or post-secondary educational institution on a full time basis or they are but have now turned 25 years of age, they can enroll for their own Healthsure™ plan. The single rate up until age 30 is $44.69 monthly which they can pay or you can pay for them, if you so choose. Your adult children do not have to complete a medical questionnaire or health exam. Their acceptance for Healsure™ is guaranteed regardless of any prior health conditions they may have. Note: Under the Healthsure™ plan, coverage for all covered conditions begins on the first day of the month following your child's enrollment and approval by our plan administrator (with the exception of pre-existing health conditions during the first two year of coverage, pre-existing health conditions are covered conditions after your children have been continuously insured in the plan for 2 years).





General Questions About Private Health Care in Canada

When I have a claim, am I "jumping the queue"? Will other people have to wait longer for treatment because I am being treated right away?


No, in fact the opposite is true. When you receive expedited health care under Healthsure™, you are leaving the queue to be treated through private health care. As a result, everyone else in the queue waiting to receive health care services after you has now moved up and will receive their health care services sooner. Healthsure™ helps get you the care you need quickly and eases the burden on provincial health care systems as a whole - something we can all feel good about!




How long has Healthsure™ been available?


Healthsure™ has been providing Canadians with first-class expedited health care for close to 15 years (since 2005).




Is expedited health care allowed under the Canada Health Care Act?


Yes, it is permitted under the Canada Health Care Act for Canadians to purchase health care insurance coverage in the province in which they reside. In order for Healthsure™ to be compliant under the Canada Health Care Act, surgical procedures are provided to individuals covered under the plan in a province in which they do not reside or in another country such as the United States. Specialist consultations and diagnostic tests are provided in the same city which you reside, if the consultation can be arranged locally. If a specialist consultation cannot be arranged locally, you will be required to travel to a city closest to which you reside or another country. The reason diagnostic tests are provided localy is that provincial governments have set a precedence of using private facilities within their province to fast track diagnostifc testing for individuals covered under Workers Compensation Insurance programs.




Is there any court precedence relating to private medical insurance in Canada?


Yes. The Supreme Court of Canada rendered a judgement on June 9th, 2005 concerning private medical insurance. The judgement rendered was written by Chief Justice Beverley McLachlin in the case of Jacques Chaoulli & George Zeliotis v. Attorney General of Quebec & Attorney General of Canada [Chaoulli v. Quebec (AG)]. The ruling found that the laws in question violated section 7 of the Canadian Charter of Rights and Freedoms. Specifically, it was found that Section 15 of the Health Insurance Act and Section 11 of the Hospital Insurance Act, which outlaw private medical insurance, violate the right to personal inviolability as guaranteed by the Quebec Charter of Human Rights and Freedoms. The case involved Jacques Chaoulli and George Zeliotis. Mr. Chaoulli was a doctor who provided home appointments to patients. Mr. Chaoulli had attempted to get a license to offer his services as an independent private hospital, but was rejected due to provincial legislation prohibiting private health insurance. At the time, Mr. Zeliotis was a 73 year old salesman who had previously suffered from numerous health problems including a hip replacement and had become an advocate for reducing wait times for patients at Quebec hospitals. Together, the 2 men sought a declaratory judgement to contest the prohibition with the Supreme Court of Canada ultimately ruling in their favor. Although the ruling is binding only in Quebec, the provinces of Ontario, Manitoba, British Columbia, Alberta and Prince Edward Island have each implemented legislation that is very similar to the impugned laws in Quebec. Both Mr. Chaoulli and Mr. Zeliotis are considered historical leaders in the movement to allow private health care in Canada. Read more about Chaoulli v. Quebec here.




What is the Canadian Medical Association's position on private health care in Canada?


In August 2005, delegates to the Canadian Medical Association adopted a motion supporting access to private sector health services and private medical insurance in circumstances where patients cannot obtain timely access to care through the single-payer health care system. Read more here.




The Healthsure™ plan will allow for claims in circumstances where the provincial health care system is unable to provide certain diagnostic tests, specialist consultations and surgical procedures within 45 days. What is the significance of the 45 day time frame?


The Canada Health Act states that "the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers." The time frame of 45 days is a subjective period of time determined by the designer of Healthsure™ to be a period of time within which diagnostic testing, specialist consultations and surgical procedures should be made available to Canadians through their provincial health care system in order to constitute provincial health care systems providing Canadians with "reasonable access to health services".




How is it possible for Healthsure™ to provide expedited health care treatment when there are already such long wait times?


The primary reason is that, due to the shortfall in funding for provincial health systems, many medical specialists in Canada have had their operating times cut back. In effect, they are limited to the number of individuals that they can provide their specialist services to. In order to fill their schedules beyond the number of individuals the provincial health care systems will permit them to treat, many top specialists in Canada make their specialist services available to Canadians through private health care facilities.




Are wait times for health care treatment really that bad? Don't provincial governments have plans to improve provincial health care systems?


Yes. It is now a fact of life that Canadians have suffered financial stress, physical discomfort and even death as a result of waiting for health care. We now know that of the 2 in every 5 Canadians who will experience cancer in their lifetime, 65-95% (depending on the cancer) will survive if their cancer is detected early enough. Unvortunately, due to continued delays and inefficiencies within our provincial health care system, many Canadians are not being diagnosed early enough to provide lifesaving treatement. The Fraser Institute tracks provincial health care wait times across Canada and now reports that the average wait time in Canada for treatment is approximately 6 months. Unfortunately, there does not appear to be a solution in sight for provincial health care systems in Canada to close the gap between the requirement for prompt health care services as continuing financial issues plague provincial health care systems. Due to the continued aging of the Canadian population, it appears that the demands on our provincial health care systems will continue to increase which could lead to further deterioration of prompt delivery of health care.




Can I meet with someone to go through the Healthsure™ plan or to register with them?


Yes, we would be pleased to meet with you at your home, office, or at a place of your choosing to answer any questions you may have. Just call us toll free at 1-888-264-8020 or in Calgary at 403-264-8020 or you can use the "Book an Introductory Coffe Meeting" button below.





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