Guaranteed Issue Health Plans

Often times people have pre-existing conditions, which are not normally covered by standard personal health plans.

When there are pre-existing medical conditions you have two options:

1. Apply for a standard health insurance plan that will exclude the specific, pre- existing condition (everything else will be covered).
2. Get a guaranteed issue health insurance plan that will then cover the pre-existing condition.

If you want to apply for a standard health plan just indicate the nature of your condition in the application's medical questionnaire. What then happens is the insurance company's underwriters look at the application and either reject it or make a counter-offer that does not include coverage for the existing condition.

Your other option is a guaranteed issue health plan. The one thing about these plans is that the coverage is limited, with maximums set for benefits. However, many times a guaranteed issue health plan will pay out immediately for the given existing condition (e.g. test strips and syringes for diabetics, etc.). In addition there are valuable core benefits for things like medical practitioners (e.g. physiotherapists, etc.), as well as dental and prescription drug coverage ( depending on the plan).

The following lists guaranteed issue health insurance plans:

• FlexCare ComboPlus Starter Plan: Core benefits (e.g. physiotherapists, home care, nursing, etc.), dental and drug coverage.
   
• FlexCare DentalPlus Basic and Enhanced Plans: Core benefits like vision, extended health care (e.g. nursing, home care, etc.), and dental insurance (does not come with prescription drug coverage).
   
• Basic Blue Choice (Ontario residents only): Comes with extended health care, prescription drugs, dental care, out-of-country travel, and optional hospital coverage. Plan Details
   
• FollowMe: personal health insurance for those who have lost or discontinued their employee benefits (i.e. group insurance). No medical questions are asked if you apply within 60 days from your group insurance termination date. If you are interested in a guaranteed issue health insurance then please call us at 1-800-474-4474.
   

Eligible Prescription Drugs

Oftentimes our brokers get inquiries about prescription drug coverage, in particular what types of drugs are covered and what are not. 

First it needs to be understood that this will vary, depending on the type of individual health insurance plan you have. However, having said this there is prescription drug coverage that is common to most plans.

To be covered by your health plan the prescription must first be prescribed by a licensed physician, and also have what is called a "DIN" (drug identification number) number that identifies the drug. Note that one DIN # can be used for products with different sizes (as long as all other product characteristics such as the product name, manufacturer name, etc. are the same).

Some examples of commonly covered prescriptions are: lipitor, prozac, amoxil, insulin, etc. .

The following are common exclusions to covered prescriptions:

• Fertility drugs are generally excluded (an exception to this is the FlexCare ComboPlus Enhanced plan).
• Some life style drugs and experimental drugs that have not been approved by the Medical Association are excluded.
• Over the counter drugs are not eligible medications.

Also, reimbursement of drugs is based on the lowest-cost generic equivalent ( if available) for many health plans.

If you do not know if a medication is covered by your health plan then call your insurance company, and give them your policy number and the DIN # of the particular prescription drug you were prescribed.

If you do not know the DIN number of a prescription drug click on the following link, select "DIN" and then enter the name of the drug in question: - Get DIN # -.