Catastrophic Coverage

seCUREme Catastrophic Coverage has been designed to be a comprehensive insurance security wrapper for either a Cost Plus Plan or an Employee Health Spending Account for plans with 5 and less employees. Until seCUREme, there has been NO true catastrophic coverage plan that could be attached to either the Cost Plus Plan or a Health Spending Account!!

As a small business owner, you may have already, or are considering implementing a Cost Plus Plan for yourself or a Health Spending Account Plan for your employees. There are many advantages to both yourself and your employees to provide these types of programs as opposed to the Traditional Insured plans offered through Insurance Companies.

  • However, could you afford the additional costs of unforeseen health issues that go beyond the coverage of your Cost Plus Plan?
  • Or, how would an employee be able to financially face the daunting health costs for themselves or their family beyond the coverage provided by their Health Spending Account?

To avoid the risks associated with serious illnesses that result in costly long term prescription medications, many Business Owners, Employers and Employees have acquired very costly stand alone Health and Dental plans through traditional Insurance Companies. Until now that was really the only way to address this critical need while enjoying the benefits of a Cost Plus Plan or Health Spending Account.

seCUREme Catastrophic, from Health Risk Services, provides this much needed Health Insurance coverage in conjunction with your Cost Plus Plan or Health Spending Account. It covers a wide range of health related services from emergency ambulance rides and hospital stays to paramedicals, hearing, dental and various other health needs. It even includes Emergency Medical Travel Insurance for travel outside of the Province or Country whether it be for business or pleasure!

Most importantly, seCUREme Catastrophic will cover the cost of expensive or long term prescription drugs – often the most devastating financial concern to a family! You can choose either 80% or 100% coverage and all medications including Generic, Brand or Biologic Drugs are covered.

seCUREme Catastrophic attaches to your Cost Plus Plan or Health Spending Account by your selection of one of these Deductibles:

$2,500, $5,000 OR $10,000

Similar to the deductible on Auto Insurance where the Insured is responsible for paying the deductible amount prior to the Insurance commencing, the seCUREme deductible amount purchased is first paid through the Cost Plus Plan or Health Spending Account and then the seCUREme benefits are payable. The deductible chosen will determine the Annual Cost of your seCUREme Catastrophic Plan. Along with the Deductible, your status such as Single, Couple or Family will also be a determining factor of your rate.

Many of the seCUREme Catastrophic benefits will reimburse at 100% and up to the specified plan maximum. Some of the benefits such as the Paramedicals and Dental reimburse at the specified levels as per the Plan Description.

If you are currently insured either as an Individual with a Stand Alone Insurance Plan through an Insurance Company OR an employee insured under a Health Risk Services provided Employee Benefit Plan, you can be Grandfathered into a Catastrophic Plan without providing evidence of insurability. However, a Declaration of Continued Good Health is required. Your application must be made within 30 days of your current coverage terminating and there is a minimum term of coverage of 3 months. All other Applications will be required to provide the Declaration of Good Health.

Coverage is not guaranteed, but the seCUREme underwriters will endeavor to provide each applicant with the most comprehensive coverage possible which may require exclusions for preexisting and ongoing chronic conditions. Your plan becomes effective on the first of the month after your application has been underwritten and your coverage has been approved. Coverage terminates at age 70. Maximum claim per Insured is $1,000,000 Lifetime.

And the good news is that seCUREme Catastrophic can be paid for through yourCost Plus Plan or your Health Spending Account!

seCUREme provides Catastrophic coverage and financial security with added benefits,
convenience and lower premium costs. seCUREme Catastrophic – a great way to protect
yourself, your employees and your business!

Contact Health Risk Services today
 to see how seCUREme can work for you!

OVERVIEW OF THE seCUREme CATASTROPHIC COVERAGE:

With so many choices for Prescribed Medications in today’s marketplace, it is excellent to know that seCUREme Catastrophic will provide coverage for Generic, Brand & Biologic prescribed drugs. Prior Authorization will be required for approval of any Biologic medication. The plan will cover costs of Prescription Drugs up to $100,000 per person per policy year.

You can choose between two coverage options:

  • Option One will reimburse 80% of Prescription Medications
  • Option Two will reimburse 100% of Prescription Medications

Smoking cessation, anti-obesity, fertility and lifestyle drugs are not covered under seCUREme.

There is a maximum Dispensing Fee of $12.30 that will be covered per script.

When a CONFIDENTIAL Medical Declaration is required there may be Pre-Existing Conditions that will be excluded from Drug Coverage. If that is the case, a challenge to the exclusion if the condition has changed can be made on the Renewal Date of the policy.

The seCUREme Catastrophic Plan will reimburse 100% of the costs associated with covered professional services to a maximum of $50 per visit with a policy year maximum of $350 per practitioner. The professional services seCUREme will cover include registered or certified massage therapists, chiropractors, physiotherapists, psychologists, osteopaths, naturopaths, speech therapists, podiatrists, psychiatrists, social workers, and acupuncturists. All paramedical professionals must be on the approved list of Regulated Health Care Professionals in their Province in which the service is being performed.

seCUREme Catastrophic will cover charges up to a maximum of $5,000 for licensed ground or air ambulance transportation to the nearest hospital, or from one hospital to another or from a hospital to the Insured Person’s residence. Air ambulance is eligible under this provision only when the emergent situation indicates that a ground ambulance cannot reach the scene easily, quickly or the terrain makes air transportation the most practical and was medically necessary.

When an accidental blow to the mouth or face results in Injury to an Insured Person, seCUREme Catastrophic will pay up to a maximum of $2,500 per Insured Person per Policy Term for the emergency dental treatment necessary to restore or replace permanently attached artificial teeth or sound natural teeth lost or damaged in an accident, and for which dental treatment is initiated within thirty (30) days following an accident and completed within the Policy Term. Detailed medical documentation from a Physician or Dentist must be provided to support an Insured Person’s claim.

When, by reason of Injury or Sickness, an Insured Person is confined to a hospital, seCUREme Catastrophic will pay the Reasonable and Customary Costs for room and board charges (semiprivate or private room accommodation up to $150 per day and a maximum of $5,000 per Insured Person per Policy Term) over and above the applicable Provincial Government Health Care Plan, including the costs relating to Physicians, Surgeons, nursing, operating room, prescription drugs, dressings, diagnostic services, medical appliances, and any other medically necessary cost incurred by the hospital for inpatient hospital services, day patient hospital services, as well as costs incurred in an intensive care unit.

 

seCUREme Catastrophic will cover the Reasonable and Customary Costs up to a maximum of $3,000 per Insured Person per Policy Term for the medical services of a licensed nurse practitioner in the Insured Person’s home when prescribed by a Physician and related directly to a medical condition for which the Insured Person has received or is receiving treatment covered under this Policy. The nurse cannot be an immediate family member or currently residing with the Insured Person.

 

 

seCUREme Catastrophic will cover prosthetics when required as a result of a surgical procedure up to a maximum of $500 per Insured Person per Policy Term

 

seCUREme Catastrophic Coverage will cover non-durable medical supplies such as cast, splints, canes, slings, trusses, and braces for temporary therapeutic relief when prescribed by a Physician, Surgeon, Physician’s Assistant, or Nurse Practitioner up to a maximum of $1,000 per Insured Person per Policy Term.

 

seCUREme Catastrophic Coverage will cover the rental (or purchase, at the option of the Insurer) of Hospital-type bed, ventilator, respirator, hearings aids or other approved durable medical equipment for temporary therapeutic use and the temporary rental of a wheelchair when prescribed by a Physician, Surgeon, Physician’s Assistant, or Nurse Practitioner up to a maximum of $2,500 per Insured Person per Policy Term.

 

seCUREme Catastrophic Coverage will cover orthopedic footwear or orthotics up to a maximum of $300 per Insured Person per Policy Term.

If an Insured Person is temporarily outside of their province of residence or out Canada, seCUREme Catastrophic Coverage will reimburse the Reasonable and Customary Costs of medically necessary outpatient treatment provided by or under the care of a Physician or Surgeon that an Insured Person needs by reason of injury or sickness in an emergency situation.

If it is deemed medically necessary to evacuate an Insured Person who has a critical medical condition as determined by the Insurer to the nearest hospital equipped to provide appropriate care and facilities, seCUREme will reimburse the Reasonable and Customary Cost of emergency evacuation and medical care to such Hospital. seCUREme will also reimburse reasonable transportation costs for one other person accompanying the patient when this is deemed necessary, and will pay the cost of a one-way economy airfare back to Canada. If this Benefit is provided by another insurer, this Policy automatically becomes the second payor.

seCUREme Catastrophic Coverage provides 100% coverage up to a maximum $100,000 CAD for trip of up to 30 days in duration with an aggregate maximum of 90 days per Insured Person per Policy Term.

Individuals insured under the seCUREme Catastrophic Coverage plan will be happy to hear that they are covered for 80% of Basic Dental procedures and 50% of Major Dental procedures. There is a combined maximum coverage of $1250 per Policy Term for Basic and Major services. There is a 9 month waiting period for major coverage to become effective.

That means you can expect to be reimbursed 80% of the costs of examinations, x-rays, cleanings (every 9 months), fillings and extractions, periodontics, and endodontic. For Major treatments, you can expect to be reimbursed 50% of the cost of dentures, bridges, crowns, inlays/onlays, and implants.

NOTE: Dental Fee Reimbursement – Current Practitioner Pricing that is Reasonable and Customary in the area where the expense is incurred.

Basic Dental Procedures will include:

  • Complete Examinations – Every 60 months
  • Recall Examinations – Every 9 months
  • Specific Examination (including endodontic, periodontics, surgical & emergency
  • Cleaning and prophylaxis and fluoride for children under age 19 – Every 9 months
  • Periodontal scaling and root planning – 10 units every policy term
  • Gum surgery
  • Panoramic x-ray – Every 60 months
  • Bitewing x-ray – Maximum of 4 every policy year
  • Periapical Films
  • Fillings (composite and Amalgam)
  • Surgical Extractions
  • Endodontic – Root Canal Therapy

Major Dental Procedures will include:

  • Dentures, Bridges, Crowns, Inlays/Onlays & Implants
  • Optional seCUREme Vision Care provides coverage of $250 per Insured person every 24 months.
  • The Vision Care option provides coverage for Eye Examinations, Prescription Eye Wear (glasses & contacts) and Laser Eye Surgery.
 

Orthodontic Coverage:

 
  • Optional Orthodontic Coverage provides coverage at 50% of your costs up to a lifetime maximum of up to a lifetime maximum of $2000 Per person insured.
  • seCUREme Orthodontic Coverage is limited to dependent children under the age of 19.
  • There is a 9 month waiting or eligibility period for Orthodontic Coverage to become effective.

seCUREme provides Catastrophic coverage and financial security with added benefits, convenience and lower premium costs. seCUREme Catastrophic – a great way to protect yourself, your employees and your business!

Contact Health Risk Services today
and see how seCUREme can work for you!!

NOTE: Further description of ALL seCUREme Catastrophic Benefits will be identified in the Policy Contract.