This article discusses private health care options, how to obtain the right information, and the role of a Health Spending Account in covering private healthcare services.

Wait times for elective procedures have increased drastically in the public health care system. As things stand now you may have to wait up to 19 weeks for elective procedures. You may want to consider using private health services if you have the resources available and don’t want to wait the required time in the public system. Before going ahead and investing in private services, however, you should take a look at your options for Canadian private health care. Sometimes these private services aren’t always better.

Private versus public health care Provincial health plans don’t cover all aspects of health care and this is when private coverage can be useful. There are many different health services that the provincial governments consider to be elective and may not be medically required. Health plans in Canada are publicly funded based on an individual’s needs and not on the ability to pay. Partial or full coverage may be provided by insurance companies for a variety of private services such as dental expenses, prescription drugs, vision care etc. If you want to have access to health services that insurance companies don’t cover, you may want to look at your options for private health care.

The waiting lists for public services are only getting longer as more Canadians are added to these lists. If you require access to a family physician that’s on call or need surgery or diagnostic imaging, you may want to access the private system in order to avoid the long wait. Your options for private healthcare If you have the resources available to pay for your own care, you’ll notice immediately that your options for health services increase. For example, if you hurt your shoulder while engaging in a sport, your doctor may recommend an MRI. In the public system, you may have a long wait ahead of you if your injury isn’t too severe. Patients are triaged according to the type and severity of injury they have. This means that you could possibly wait for weeks for your MRI while having to deal with limited mobility and pain in the meantime.

There are health clinics that are exclusive to members only and these executive clinics offer preventative services for a fee.  You will now find these private clinics in most of the major Canadian cities.  Some of these facilities provide advice regarding healthier lifestyle choices, health assessments, prevention programs, treatments, assessments and a diagnosis. Some of these clinics operate on a full-day program for testing while other medical facilities offer yearly memberships or the option of multiple visits. Most clinics have family physicians that are on-call or nurses that offer their services to members. Individuals can purchase a membership to one of these executive health facilities or an employer may offer it as a part of an employee’s health plan or as an add-on to it. Get the proper information When you’re looking through the various health care clinics that are a part of the private sector, do some research ahead of time to make sure that you find a safe and reliable facility.

In order to correctly evaluate a clinic before becoming a member, learn more by asking the following questions: • What type of healthcare providers work with the clinic and is there a medical doctor available?
• What are the clinic’s credentials?
• Have there been any complaints registered?

You can find out this information by searching the name of an individual provider on his regulatory website.
• Does the clinic only practice within a certain field of expertise?
• What are the clinic’s medical guidelines and where can you see them in writing?
• Is ongoing education a part of the facility’s protocol and can you see evidence of that?

The best way to learn more about a health care clinic is to get a list of the providers that work there and conduct a search for each one on their regulatory websites. Enter the category of the physician, for example, “specialist surgeons and physicians”. This will give you the contact information for the regulatory body that is over the provider in a selected province. By law, every regulated Canadian health professional has been provided with a license to practice through a government body. These regulations set practice and education requirements for both continued and the initial practice. As a consumer, you’ll also want to take price and value for the money into account.

Your goal is to find a provider or a clinic that has a comprehensive, organized and researched approach and they should be able to meet the following criteria:
• The facility should offer flexible payment plans.
• It should be clearly stated where you can go to get your questions answered and who will be assigned to monitor and arrange your care.
• You should be offered a detailed list of services and prices and there should never be any hidden fees.
• You should be presented with an information package that includes a contact list for all of the individual care team members.
• You should know what to expect when it comes to typical procedures and a health care member should let you know what before-care and after-care is provided.

Your PreTax Health Spending Account will cover private care options

If you company setup your PreTax Health Spending Account then private care administered by any of the CRA approved medical practitioners is covered either in Canada or in another country that you go to for this treatment. The key is that the practitioner is on the CRA approved list and that they are authorized to practice in that province, or country.  You will also want to make sure that the treatment you are actually receiving in the private clinic is performed or supervised by an authorized medical practitioner.

What about for out of country?  For example, if an owner or employee of a company with a PreTax Health plan needs to visit the Mayo clinic (or any other private health clinic) in the US then not only are the treatments covered but reasonable travel costs, including travel costs for a designated care giver. This is of course provided that the company has authorized sufficient funds in their PreTax Health Spending Account to cover these treatments. For example, if an employee needs this out of country treatment and the cost is over $5000, yet they only have $3000 authorized in their health spending account then they will be out of pocket for the difference, unless the plan admin person agrees to raise the limit.

The following list of medical practitioners will serve as a good guide:

If there is any doubt feel free to contact us at PreTax Health. 

In contrast if you only have a traditional health insurance plan (e.g. Blue Cross, Manulife, etc) most of these private health care options will be out of your reach, or you will still need to ‘pay out of pocket’ for a large portion of the costs.


The PreTax Health Team