Hey there, so I recently moved to Canada from the US and got my first run down of the healthcare system up here. Take a read and please let me know if I am missing anything. Also, I am still not quite clear if RXs includes insulin pump supplies and other durable medical goods? Do you just refill then at same pharmacies? THANKS for any insight :)
Yes, you just pick your supplies up from a pharmacy. It depends how your extended medical is set up - typically you pay upfront and then submit the receipts to your extended care plan. If you haven't already, you'll have to check with your extended medical provider what exactly they will cover in terms of durable medical goods. Some only cover a certain amount per year. I believe you also need a letter or doctor's note on file stating that you have diabetes.
Yes, I still need to connect with my extended health care provider. The last couple weeks have been pretty busy at work. Thanks for the info!
In BC you can go to any pharmacy (ive been able too) and get insulin (novorapid and Lantus) without a script the pharmacist will write one out and send it to insurance or MSP also most syringes, pen cap needles are covered by MSP pump reservoirs and infusion sets are included but sadly sensors are not, if you want to know what is covered give Pharmacare a call and they will tell you what is covered and what is not, or go the the pharmacy and ask them to put it through to see if it is
Kind of an open ended question. Your blog has several points that need to be corrected.
- Extended health care - Premiums are dependent on company and plan. Your company negotiates with the EHC provider and based on an average and the requirements of the health plan the fee is adjusted. For a real rough example, my company has 100 people. If we expense $100 per month total our cost will be approximately $1 per person per month. If 1 person gets real sick and expenses $901 and the rest do $99 our cost per person will go up to at least $100 per person when the contract is reviewed the next year.
My mother left the union medical and is on private EHC and is now paying about $200 per month.
Your company may also kick in for part of the EHC premium, but as of this year it is now a taxable benefit.
- MSP does not cover 100% of everything. There is a deductible, in my case it is around $2K. For hospital visits items such as a private rooms are not covered.
- To be clear on RX's - You need to get an RX for everything. Go see a doctor and say you need a prescription for diabetic supplies for 1 year (max coverage of a script) and give this to a pharmacy of your choice. Pharmacists are allowed to renew some scripts but are not allowed to write them and some EHC's will not reimburse with pharmacist ID.
Some items you can get without an RX (i.e.; test strips) and the pharmacist will provide a prescription receipt, but if it is not written as a prescription MSP may not cover it and if it doesn't have a doctors RX number associated with it your EHC may not cover it. I have talked to too many pharmacies where there pharmacist has taken care of them and then six months down the road the customer gets a letter saying they owe thousands of dollars because their claim has been rejected upon review.
- MSP will cover some standard supplies for a pumper. Some exceptions (and I will probably be wrong on some of this) are pump itself (over 18), sensors and some insulins (ie; natural). It is highly recommended to contact both MSP and your EHC and get a detailed list.
Loke - thanks so much for the clarifications.
-My EHC contribution is set for each person per month because the company covers a portion (which sounds like it can be a variable and not a fixed cost).
I will certainly check up on what is and isnt covered. And keep in mind the RX discrepancies.