Health care insurance policies review: A checklist

(August 2006) Need some help evaluating your clients’ health care insurance? Use this checklist from the Financial Planning Practitioner’s Guide — created by the Canadian Institute of Financial Planners — to review the adequacy of existing extended health, critical illness and long-term care insurance policies, or to identify factors that should be considered when choosing a new policy.

Part 1: Extended Health Care Policies

Clause or Consideration	Comments
Is this a group or individual policy?
What is the amount of the premiums? Who pays the premiums on this policy?
Does the coverage apply to expenses incurred out-of-province or out-of-country?
Does the policy cover prescription drugs? If so, is there a limit? Is there a deductible or co-insurance factor?
Does the policy cover basic dental preventative treatments? If so, is there a limit? Is there a deductible or co-insurance factor?
Does the policy cover basic dental restorative treatments? If so, is there a limit? Is there a deductible or co-insurance factor?
Does the policy cover dental reconstructive treatments (crowns, bridges, etc.)? If so, is there a limit? Is there a deductible or co-insurance factor?
Does the policy cover orthodontic treatments (retainers, braces, etc.)? If so, is there a limit? Is there a deductible or co-insurance factor?
Does the policy cover vision care? If so, is there a limit? Is there a deductible or co-insurance factor?
Does the policy cover assistive medical devices (crutches, wheelchairs, orthodics, etc.)? If so, is there a limit? Is there a deductible or co-insurance factor?
Does the policy cover treatments provided by other health care professionals, such as physiotherapists, chiropractors, massage therapists or naturopaths? If so, is there limit? Is there a deductible or co-insurance factor?
To what age are the insured’s children covered under the policy?

Part 2: Critical Illness Policies

Clause or Consideration

Comments

Who is covered by the policy?

What is the amount of the benefit?

What are the premiums for the policy?

Which of the following illnesses are covered by the policy:

• blindness	• kidney failure	• Alzheimer’s disease
• cancer	• severe burns	• Parkinson’s disease
• coma	• deafness	• multiple sclerosis
• stroke	• paralysis	• heart attack
• major organ transplants
• other

Be sure to read the definitions of each illness carefully, because some are quite limited. Do the definitions seem overly restrictive?

Does the policy require a waiting period? If so, does the policy provide for a refund of premiums if the insured individual dies before the expiry of the waiting period?

Does the policy include a refund of premiums provision and, if so, when is the client eligible for a full or partial refund?

Is there an option to increase coverage on certain policy anniversaries?

Part 3: Long-term Care Policies

Clause or Consideration	Comments
Who is covered by the policy?
What are the premiums for the policy?
What is the maximum benefit under the policy?
Under what conditions are benefits payable?
What is the elimination period under the policy?
Are benefits indexed for inflation?
Does the policy include a waiver of premium provision? A refund of premiums provision?
Does the policy include a refund of premiums provision and, if so, when is the client eligible for a full or partial refund?
Is there an option to increase coverage on certain policy anniversaries?
Is the client required to provide receipts for expenses that are covered by the policy?

This template is part of the Financial Planning Practitioner’s Guide created by the CIFPs which is available exclusively to its members. The CIFPs is an association of Canadian CFP™ licensees. The association is an independent, effective and powerful CFP-focused advocate for the CFP™ certification marks and the financial planning profession in Canada.

The Financial Planning Practitioner’s Guide won the “Award of Excellence” in a competition for technical publications sponsored by the Society of Technical Communication

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