BRITSH CTOILT - Sun Life Financialpersonal costs and other key considerations for six common health events and services: disability, home care, long term (nursing home) care, palliative

Who pays for H E A LT H C A R E ?

We gathered the information in this guide as of April 14, 2014. We’ve made a considerable effort to confirm that the information is accurate, but it may be incomplete or incorrect.

It’s important that you consult your own legal and tax advisors to review your personal situation. We also recommend you check your employer and personal insurance plans for details on your specific coverage.

BRITISH COLUMBIA

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TRAVEL EMERGENCY HEALTH

2www.sunlife.ca/whopaysforhealthcare/BC

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DISABILITY PROTECTIONBRITISH COLUMBIA

Health always matters most

Canadians strongly identify with their medicare system and most see it as a national icon. We have enjoyed universal, first-dollar coverage for hospitals and physicians for decades, but other health services can be surprisingly expensive.

Our needs have changed over time, often radically. While the principles of the Canada Health Act (1984) remain sound, in the last 30 years there has been a six-fold increase in health costs.1 Private health spending by individuals and insurers was estimated at $63 billion in 2013. Some of those costs likely came from your pocket…or may soon.

Planning and paying : A shared responsibi l i ty

Government and employer health plans provide complementary coverage for many health-related expenses. But there are common, medically necessary health services that are not fully covered. Each province makes their own decisions and those entitlements may change over time, especially as governments struggle with high debts and deficits, demographic changes and higher rates of many common chronic diseases such as diabetes, certain

cancers and dementia. In this context of change, we recommend you consider your own needs, preferences and personal resources. Planning for health expenses is as important as buying a house or saving for retirement; indeed, health and wealth planning are natural companions.

Introducing Sun L i fe’s healthcare funding guides

These guides outline some of the coverage options, personal costs and other key considerations for six common health events and services: disability, home care, long term (nursing home) care, palliative (end-of-life) care, prescription drugs and travel emergency medical.

The guides are organized by province, just as our healthcare system is operated and you’ll find many embedded web links to other authoritative websites for more detail and the latest updates. They are meant to be a quick reference that you will find practical, informative and easily accessible. Planning ahead can provide important protection and peace of mind and help you get what you need, when you need it.

Research provided by H3 Consulting. 1 Canadian Institute for Health Information, 2013. National Health Expenditure Trends 1975 to 2013 (Link: https://secure.cihi.ca/free_products/NHEXTrendsReport_EN.pdf).

INTRODUCTION

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Overview

Disability can affect your income, lifespan and quality of life and your chances of becoming disabled are greater than you may think. Statistics Canada has reported that nearly 4.5 million Canadians (14.3%) had a disability in 2006. That percentage has increased since 2001 and also increases steadily with age. Among younger people of working age (25-44), 8% reported a disability. For those ages 45-64, 18% reported a disability. For all adults, the most frequent disabilities are related to pain, mobility and agility and of those reporting a disability, 82% reported more than one and 40% reported their disability was severe or very severe.

COVERAGE Federal government

• The Canada Pension Plan (CPP) provides a disability benefit to those under age 65 who have contributed to the plan and who have a severe and prolonged disability that 1) prevents a claimant from being able to work at any job on a regular basis or 2) will result in death. Applications take about four months to be processed, although those considering terminal conditions will be reviewed in two days. As of March 2014, the average monthly benefit is $896.87 and the maximum benefit for 2014 is $1,236.35. The basic amount ($457.60 - 2014) is fixed for all eligible claimants, with additional benefits based on the claimant’s CPP contributions. If the claimant qualifies, there is also an additional benefit for dependent children payable up to age 25. The current (2014) benefit is a flat monthly rate of $230.72.

• Employment Insurance (EI) pays a sickness benefit for up to 15 weeks for those unable to work due to sickness, injury or quarantine. Your earnings must

have dropped at least 40% due to your condition and you must have at least 600 hours of insurable earnings during (generally) the last 52 weeks. There is a two-week waiting period once approved. Based on 55% of your insurable earnings, the maximum weekly benefit was $514 in 2014, but there is a supplement for qualifying low income families.

• The Child Disability Benefit (CDB) is a tax-free benefit for families with a child under age 18 who has a severe and prolonged impairment in mental or physical function. The CDB provides up to $218.83 per month for each eligible child (July 2013 - June 2014) but is reduced according to the number of children and family net income.

• Veterans and active military personnel may qualify for a disability award or a disability pension if their disability is related to their military service. Current and former members of the RCMP and certain civilians may also qualify for the disability pension.

4.5 million(14.3%) of Canadians had a disability in 2006

14.3%

25-44 years8%

45-64 years

Reported disabilities more than double after age 45

18%

DISABILITY PROTECTION

Most frequent disabilities are related to

PAIN,mobility

agilityand

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• For severe and prolonged disability in physical or mental functions, there are other federal tax benefits for which you may qualify, including the Disability Tax Credit (DTC). For those who qualify for the DTC, contributions can be made to a Registered Disability Savings Plan (RDSP). Those with a RDSP are eligible for federal grants and bonds.

• COVERAGE Provincial government

• The British Columbia government has created a one-stop directory of the many services it offers to disabled adults and children. It offers many employment supports through WorkBC.

• The Ministry of Children and Family Development offers family support services for children and youth who have a developmental disability, a diagnosis of autism spectrum disorder or who are severely disabled and eligible for the At Home Program. The At Home Program includes respite benefits (typically between $2,400 and $2,800 per year) and medical services, which includes equipment, supplies, drugs, dental care, vision and

audiology services and transportation. Nursing support services are also available for children and youth.

• For those in financial need, British Columbia’s Employment and Assistance Program for Persons with Disabilities provides assistance and income supplements for those who are designated as people with disabilities (PWD) by the Ministry of Social Development and Social Innovation. Note that PWD is not a permanent designation and the ministry can rescind it in exceptional circumstances. Monthly payments depend on income and assets and the number of people in the family.

• There is a fuel tax refund for people with qualifying disabilities that provides up to $500 annually. Eligibility for the fuel tax refund also qualifies you for a 25% discount on basic automobile insurance from the Insurance Corporation of British Columbia.

• For modifications to vehicles (to install auxiliary driving controls or to accommodate wheelchairs) used by disabled people for private (not commercial) use, there is a refund of the 12% tax on designated property.

• For tenants and homeowners, British Columbia Housing provides up to $20,000 of financial

assistance through the Home Adaptations for Independence Program to allow eligible low-income seniors and people with disabilities to stay in their own homes. For homeowners, up to $20,000 more may be available to allow underlying repairs and improvements before disability adaptations can be installed. A list of eligible renovations is available. There is also a home owner grant that reduces property taxes on your principle residence for those with a disability or someone living with a spouse or relative who has a disability. The reduction is up to $845 or up to $1,045 if it is located in a northern and rural area. There is a minimum property tax payment of $100. A property tax deferral may also be possible. Subsidized housing may be available for low to moderate income tenants with disabilities.

• A variety of personal supports are available for residents with disabilities.

• British Columbia offers a supplemental bursary for students with permanent disabilities. A Canada student grant may also be available.

• WorkSafeBC provides income replacement benefits and healthcare coverage for qualified workers through no-fault liability insurance mandated for employers in certain industries.


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DISABILITY PROTECTIONSeveral types of benefits are payable, including wage-loss benefits, healthcare benefits and permanent disability and death benefits. Wage loss benefits are based on 90% of net earnings up to $77,900 (2014). Expect monthly benefits to be coordinated with other sources such as employer-sponsored short and long term disability insurance benefits, CPP disability benefits and EI sickness benefits.

COVERAGE Provincial governmentCOVERAGE Employer plans

• Many larger employers and some smaller ones, provide compensation when you cannot work due to disability. These include partial or full pay under casual absence or sick leave programs, or benefits paid under short term disability and/or long term disability (LTD) insurance plans. Those benefits may be provided by the employer directly, through a health and welfare trust, via third-party administrator or by an insurer. Benefits payable under an LTD insurance plan will be taxable if the employer paid any part of the monthly premium. Benefits are typically paid at between 60% and 75% of earnings and may be offset by benefits paid from other sources, such as Workers’ Compensation or CPP.

There will be a waiting period before benefits are payable, which is usually between three and six months following the first day of disability. If your employer has a flexible benefits plan, you may be able to choose the amount of disability coverage you want, but only once a year during an open enrolment period.

• Employers in certain industries and over a certain size are required to contribute to WorkSafeBC to provide income replacement for occupational injuries and illnesses – those caused in the workplace.

COVERAGE Personal insurance

• Individual disability insurance plans are available directly through insurers, or through membership in various associations including post-secondary alumni associations. The risk of disability depends on factors such as your age, health risks, family medical history and your job. Applications require proof of good health to allow insurers to assess risk. Even if your health status is compromised, insurers may still provide coverage at a higher-than-standard rate, or they may provide coverage for all risks other than a condition already diagnosed. If one insurer declines to cover you, another may still offer you insurance. The benefit duration and amount may be selected by the applicant, but the benefit cannot be greater than a certain percentage of average annual earnings. Don’t forget to ask whether your benefit depends on you being unable to do your own job, or any job you’re qualified for based on criteria such as your age, education, income and experience. Own job coverage is more expensive but provides greater certainty of the benefit you’ll receive. Some policies pay using the own job definition for the first two or five years and any job thereafter.

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COVERAGE Out-of-pocket expenses

• Beyond government programs and services, you may approach other organizations for financial assistance, including voluntary and charitable organizations, such as the March of Dimes, The Easter Seals Society, Kiwanis, Rotary or Lions Clubs. Under the Income Tax Act, certain health insurance premiums and other eligible medical expenses may count towards a tax credit when total medical expenses exceed the lesser of $2,152 (2013) or 3% of your net income.

COSTS

• Private disability insurance premiums can be expensive, but the benefits may be crucial if you do not have enough savings to replace your work income. You don’t pay tax on disability income benefits from your policy as long as you were the only one who paid all the premiums.

FOR HELP

The application for the CPP disability benefit is available online and by calling Service Canada: 800-277-9914.

The application for the EI sickness benefit is available online or by calling Service Canada: 800-206-7218.

More information on the CDB is available here or by calling 800-387-1193.

Veterans Affairs may be contacted at 866-522-2122, as well as by using the links under Federal Government in the Disability Protection section of this document.

The list of eligible medical expenses that qualify for the medical expense tax credit is here.

Information on federal programs is available through your local Service Canada office.

The Ministry of Children and Family Development has published the At Home Program guide for children and youth in transition.

The Ministry of Social Development and Social Innovation offers a self-serve application and assessment web portal to check on supports, programs and eligibility and to apply for income assistance.

WorkSafeBC may be contacted through its website, by email, or by phone: 604-231-8888 or toll-free across Canada: 888-967-5377.

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Overview

Home care includes a wide range of services provided in the home and community that can address prevention, healthcare, palliative care, rehabilitation and social support for both clients and caregivers. Most (70%) of home care clients in British Columbia are seniors but services are also available for adults (29%) and children (<1%).1

In British Columbia, home care services are assessed, ordered, coordinated and managed through the five regional health authorities according to the province’s Home and Community Care Program (HCCP).

COVERAGE Provincial government

• After a personal assessment by a health professional employed by the local HCCP office, a care plan will be developed for those who qualify that identifies the funded services available. An income-based financial assessment is completed and may need to pay for some services to a maximum of $300 per month.2 There may also be a waiting list for certain services, but others will be arranged to assist you in the meantime. Urgency criteria have been developed that consider medical need, risk of neglect and the capacity of your personal support network. British Columbia offers five types of services that can be provided in-home:

• Community nursing: Nurses provide acute, chronic, palliative or rehabilitative support, generally on a short term basis. These services can include assessment, education, wound care, medication management, chronic disease management, care management, post-surgical and palliative care.

◊ Community rehabilitation: The services of a physiotherapist or occupational therapist can be arranged, generally for short term periods.

◊ Home support: Personal hygiene, transfer assistance (getting in and out of bed or a chair), dressing, eating, toileting and escort to appointments are provided by community health workers. There may be a charge for certain services.

HOME CARE

Home care includes• Prevention• Healthcare• Palliative care• Rehabilitation• Social support

1 Canadian Home Care Association, 2013. Portraits of Home Care in Canada 2013. See p.16.2 Ibid, p. 11.

Diversity of home care patients in British Columbia

70%seniors

29%adults <1%

children

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HOME CARE◊ Choice in Supports for Independent

Living (CSIL): This is a unique self-directed option for certain home support clients who receive funds from their local health authority to buy their own home support services. CSIL clients become employers who hire, schedule and supervise staff and are responsible for how CSIL funds are spent.

◊ Respite services: Directed to caregivers, such services provide a break from the physical and emotional demands of caring for someone at home. These services may be provided at home, in the community at adult day services or temporarily in a residential care facility, hospice or other community setting. There may be a charge for certain services.

◊ Social worker services are available but may be limited in some communities and dieticians are also available. Meal services in home and in groups are funded. The regional health authorities provide home oxygen, supplies for the first two weeks after acute care in a hospital and may assist with – but not provide financial support for – the purchase or rental of medical equipment such as wheelchairs and walkers.3

• British Columbia has a Seniors’ Home Renovation Tax Credit which provides up to $1,000 annually for specified, permanent home renovations that improve accessibility or help those age 65 or older to become more functional or mobile at home.

Research done for the Institute for Research on Public Policy indicated unpaid services by caregivers to the elderly had an estimated market value of between $24 billion and $31 billion in 2007. There are some tax advantages provided to informal caregivers, including the federal caregiver amount tax credit. The Public Health Agency has produced a brochure to help caregivers look after themselves in stressful times.

THE CRUCIAL ROLE OF CAREGIVERS

3 Canadian Home Care Association, 2013. Portraits of Home Care in Canada 2013. See p.16.

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HOME CARE

COVERAGE Employer plans

• Home care services are typically excluded from extended health benefit plans available through your workplace. Most health plans provide limited supplemental coverage for private nursing care for employees and eligible dependents which can be accessed if more home care services are needed. Dependents are limited to the spouse and children. Some flexible benefit plans include a health spending account (HSA) which may be used to claim home care services. However, HSAs typically offer limited funds to cover a wide variety of healthcare expenses based on provisions in the Income Tax Act.


• Some individually purchased health insurance plans reimburse the cost of in-home nursing and/or home care services according to an approved plan of care. The benefits supplement the cost of services not covered by the HCCP.

• Most long term care insurance policies (which may also include home care) provide coverage following a waiting period if you are functionally dependent, meaning that you need substantial assistance with two of six activities of daily living or substantial supervision because of cognitive impairment. There are two types of plans: those that reimburse defined expenses such as in-home care or equipment rental and those that pay a monthly income-style benefit that can be used as needed. For more detail, see: Long term care> Personal insurance> Typical coverage.


• You may be charged for home support services according to your family’s adjusted income. The maximum monthly charge is $300. However, provincially funded home care services may be inadequate in breadth, frequency or intensity. Private funding will then be required, either on a pay-as-billed basis or through an individual insurance policy. Many community services supplement those provided by the government and will also require personal funds.

• Under the Income Tax Act, certain health insurance premiums and other eligible medical expenses may count towards a tax credit when total medical expenses exceed the lesser of $2,152 (2013) or 3% of the client’s net income.

Some individually purchased health insurance plans reimburse the cost of in-home nursing and/or home

care services according to an approved plan of care.

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HOME CARE

COSTS

• For reference, one home health company provided their rates for: 1) services of a Registered Nurse: $65 per hour in Vancouver (one hour minimum) and $60 per hour in Victoria (two hour minimum) and 2) homemaking and personal care through a personal support worker (PSW): $27 per hour plus tax in Vancouver (two hour minimum) and $30.75 per hour plus tax in Victoria (two hour minimum). Rates in other British Columbia locations will vary.

• Care aides/PSWs: Care aides provide most non-medical home services and can be hired to help clients perform activities of daily living, as well as shopping, food preparation, laundry and transportation. PSWs are not a regulated profession and cannot initiate or perform care without supervision. Agencies will charge a significant premium over what they pay a PSW to allow for their overhead costs and any health benefits and travel allowances they may provide.

• The minimum wage for a live-in home support worker is $102.50 per day (2014).

• The Ministry of Health Services manages the BC Care Aide and Community Health Worker Registry to track all home support and PSWs to protect patients, residents and clients, provide standards of care and promote professional development.

• Residents of private facilities pay the full cost of their care and accommodation. Taking Care Inc. has prepared a summary of typical costs for residents of British Columbia. Rates in private facilities ranged from $2,275 to $9,500 per month (2013).

FOR HELP

HealthLink BC is available to help residents find appropriate healthcare services. Its 8-1-1 telephone service also connects residents to health information and services and can connect them directly with a registered nurse, a registered dietitian or a pharmacist.

To arrange for care, contact your regional health authority:

◊ Fraser Health◊ Interior Health◊ Island Health◊ Northern Health◊ Vancouver Coastal Health

The Seniors Health Care Support Line is specifically geared to serve seniors. Call toll-free, 877-952-3181, or in Victoria, call 250-952-3181.

The BC Care Providers Association represents over 230 provider organizations and can help connect you to services.

The province has established patient care quality review boards, one for each health authority, to manage complaints among home care clients and other patients. The boards can be reached by telephone, toll-free at 866-952-2448 and by email at [email protected].

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Overview

There are about 281 long term care (LTC) facilities (nursing homes) in British Columbia providing health services and accommodation.5 About 30% of those are provincially owned, with the cost of care and accommodation subsidized by the province. The rest are private. All LTC homes are regulated by the province whether they are public or private, for profit or not-for-profit. Residents must have complex health issues that cannot be addressed in other settings. Most are seniors but younger adults also live there. After an assessment by a case manager from the regional health authority’s Home and Community Care Program (HCCP), eligible residents may apply to one or more facilities of their choice; however, they may have to accept a bed in a facility not on their list.


• In provincial facilities, the cost is shared between residents, who pay an income-based monthly accommodation fee and the government that pays for everything else. In private facilities, the resident must pay the full cost.

• The province sets minimum and maximum fees which are increased annually. Depending on availability, ward, semi-private or private rooms may be available. Residents rely on personal resources, government pension or disability benefits or individual health insurance policies to pay their share. Patients must take the first available bed even if the facility is not their first choice and be prepared to move in within 48 hours.

• Permanent residents of LTC facilities are eligible for drugs at no cost under the British Columbia Pharmacare Plan.

• British Columbia provides a compassionate care leave under the Employment Standards Act. Up to eight weeks of unpaid leave can be taken within a 26 week period. The employee must obtain a medical certificate which states that the family member is gravely ill with a significant risk of death within 26 weeks. An unpaid family responsibility leave is also available to employees for up to five

days each employment year to meet responsibilities related to the care, health or education of any member of the employee’s immediate family.


• LTC services are excluded from extended health benefit plans available through your workplace. Some flexible benefit plans include a health spending account (HSA) which may be used to claim LTC services for eligible dependents. However, HSAs typically offer limited funds to cover a wide variety of healthcare expenses based on provisions in the Income Tax Act.

LONG TERM CARE

5 Statistics Canada, 2011. Residential Care Facilities 2009/2010. Number reflects “Homes for the aged”, see Table 1-11. Available at: http://www.statcan.gc.ca/pub/83-237-x/83-237-x2012001-eng.pdf.

Permanent residents of long term care facilities are eligible for drugs at no cost under the British Columbia

Pharmacare Plan.

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LONG TERM CARE


• Private LTC insurance may be a good option depending on your age, health and financial means. A helpful model outlining the five stages of care was developed by Dr. Mark Frankel and his team at Taking Care Inc., an organization dedicated to helping caregivers navigate the elder-care system. The stages are: 1) independence, 2) interdependence, 3) supportive living, 4) crisis management and 5) dependence.

• Typical coverage: Terms and conditions of coverage vary in the market. Generally benefits are payable upon dependency, which may or may not include living in a long term care home. Definitions of dependency vary within the insurance industry. Dependency includes criteria for mental ability and when the insured person is unable to perform at least two of six specified activities of daily living: dressing, eating, toileting, bathing, continence and transferring. Some sample provisions follow:

◊ Benefit: An applicant selects a benefit that can range from $70 to $2,500 per week. Benefits may be paid weekly or monthly. Policies often include one-time or annual access to a person who can help plan care. In Canada, the maximum insurance available is $10,000 per person per month from all LTC insurance policies.

◊ Benefit period: The applicant typically chooses a plan that will pay for one, two, three, four or five years, or an unlimited payment period that ends with the insured person’s death.

◊ Benefit maximum: The applicant may be able to choose a maximum amount of coverage, such as $100,000, which is then reduced by each monthly benefit paid to the insured person.

◊ Waiting period: Benefits become payable typically between 30 and 90 days (but you can choose up to two years) after the policy’s definition of dependency is met.

◊ Premiums are paid monthly usually until death, or for a period such as two, 10, 20 or 25 years. Premiums are not paid while benefits are being received. LTC premiums are typically guaranteed only for the first five years and may be adjusted over the life of the policy.

◊ Optional benefits may include inflation protection, return of premiums upon death after the policy has been in force for a certain period of time and shared coverage where one spouse may draw additional coverage from the other spouse’s plan.

◊ All policies are somewhat different and all have exclusions and limitations of coverage. They should be read carefully. Questions may be directed to your insurance agent.

All policies are somewhat different and all have exclusions

and limitations of coverage. They should be read carefully.

Questions may be directed to your insurance agent.

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LONG TERM CARE


• Given the cost of accommodation and the expense of LTC insurance policy premiums, your personal financial assets and income may be used to purchase home care, supportive living and eventually a nursing home. Alternatively, you may need to rely on family and friends for caregiving services. But of course those financial and personal resources may not be enough if you lose your ability to live independently.

• Under the Income Tax Act, certain health insurance premiums and other eligible medical expenses may count towards a tax credit when total medical expenses exceed the lesser of $2,152 (2013) or 3% of your net income.

COSTS

• If eligible for a provincial subsidy, residents in provincial facilities pay a percentage of their income toward the cost of care, accommodation and other supports. Accommodation may be in ward, semi-private or private rooms. You will pay up to 80% of your after tax income towards the cost of housing and hospitality services, subject to a minimum of $970.50 per month single and $719.20 per month per person for couples (2014). The maximum monthly rate for 2014 is $3,092.60.6 Your monthly rate is calculated based on after tax income, leaving a minimum of $325 per month available for other expenses. Temporary rate reductions for up to one year are available when the minimum rate would cause severe financial hardship for you or your spouse.

• Residents of private facilities pay the full cost of their care and accommodation. Taking Care Inc. has prepared a summary of typical costs for residents of British Columbia. Rates in private facilities ranged from $2,275 to $9,500 per month (2013).

QUALITY

• Before selecting a LTC home, you’ll want to be sure it is well-equipped to look after its residents. Quality is difficult to objectively assess since it includes the facility and its professional and non-regulated staff, as well as its rooms, food, safety and health, social and recreational services. Quality should be verified: consider a site visit, discussions with staff and seek references from current or former residents and family members. Check whether the home has been independently reviewed and compared against national standards by Accreditation Canada. Look for a current Accreditation Canada certificate in the facility, or search Accreditation Canada’s website. Once on the website, click on the link titled “Find an Accredited Health Care Provider Now” located on the left side of the page to find an accredited provider.

• The assisted living registrar provides regular inspection reports of all facilities and reports of substantiated complaints.

6 Source: British Columbia Ministry of Health, available at: http://www2.gov.bc.ca/gov/topic.page?id=4FEC0F570BC04692810548267D09577E.

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LONG TERM CARE

FOR HELP

The Ministry of Health provides a directory of community care facilities by community and by health authority.

The Ministry of Health has published a guide to selecting residential care facilities which includes tips on how to arrange tours of facilities before the need for them arises and what questions to ask before making your choices. Expect the regional health authority case worker to provide you with approximate wait times for your choices.

General information may be available online through HealthLink BC, or by telephone at 8-1-1, or 7-1-1 for the hearing impaired.

Professional colleges govern the conduct of many regulated health professionals to protect the public interest, such as physicians, registered nurses and nurse practitioners, licensed practical nurses and others.

British Columbia’s ombudsman’s office is empowered to investigate complaints about healthcare facilities, including LTC complaints.

The office of the seniors advocate will be operational in Spring 2014. Its mandate is to monitor seniors’ services, promote awareness and work collaboratively with seniors, families, policymakers, service providers and others to identify solutions to systemic issues. It also makes reccomedations to government on ways to improve care for our aging population.

The BC Care Providers Association represents over 230 provider organizations and can help connect you to LTC services.

Accreditation Canada’s website provides information for the public about its standards and provides a list of accredited facilities in British Columbia.

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Overview

Palliative care refers to a variety of healthcare and support services provided as people near the end of their lives. It is intended to improve both the quality of life and the quality of death for patients and their families by addressing physical, psychosocial and spiritual needs. Advance care planning is needed. There is often a particular emphasis on pain relief. A recent national survey reported that while one quarter of respondents thought government paid for palliative services, 70% worried they didn’t have enough money to pay for their own care.

In May 2006, British Columbia published the Provincial Framework for End-of-Life Care and has been implementing its strategy since then. As of September 2012, British Columbia has a total of 266 publicly subsidized hospice palliative care beds.7

SERVICE OPTIONS

Palliative care can be provided in different settings, such as in a hospital, long term care facility, at home or in a community hospice.


• British Columbia has a palliative care benefits program, which includes no-cost access to the Pharmacare Plan and access through each regional health authority to medical supplies and equipment.

• The medical supplies and equipment component provides terminal patients who are cared for at home with some of the same medical supplies and equipment they would get if they were in hospital. This includes needles, syringes and drug delivery pumps, supplies for intravenous therapy, incontinence, wound care and equipment such as walkers, wheelchairs, mechanical lifts, bathing aids and hospital beds.

PALLIATIVE CARE

Palliative care can be provided in different settings, such as in a hospital,

long term care facility, at home or in a community hospice.

7 Source: Ministry of Health news release, March 25, 2013. Available at: http://www.newsroom.gov.bc.ca/2013/03/ action-plan-centre-for-excellence-hospice-funding-to-support-end-of-life-care.html.

70% of national survey respondents

worried they didn’t have enough money to pay for their own palliative care

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PALLIATIVE CARE• The Ministry of Health provides certain

prescription and over-the-counter medicines under its Palliative Care Drug Plan.

• British Columbia has developed the Joint Protocol for Expected/Planned Home Deaths to support individuals to die at home with their families or caregivers. The goal is to provide clarity to roles, responsibilities and activities involved in a planned home death.


• Your health benefit plan provides coverage for prescription drugs and limited benefits for private home nursing which may be part of a palliative care plan. Long term care and home care services (except those by registered nurses) are not covered. If your plan includes a health spending account, many medical services are eligible based on provisions in the Income Tax Act. You may be able to arrange an additional leave of absence with your employer to look after a dying family member or close friend.


Several kinds of individual policies may be purchased to help pay for palliative care. Some insurers permit the conversion of some or all the benefits of a critical illness insurance (CII) policy to a long term care insurance (LTCI) policy without further evidence of good health if a CII claim has not already been approved.

• CII policies pay a lump sum to the policy owner or to the person they name to receive the benefit when the insured person is diagnosed with one of several life-altering conditions (which can include Alzheimer’s Disease, blindness, cancer, coronary artery bypass surgery, heart attack, loss of limbs, stroke, etc.) and survives the waiting period. Insurers offer different levels of coverage that include different health diagnoses.

• LTCI policies pay benefits when dependency occurs, as defined in the policy, although it is likely to have occurred prior to a beneficiary becoming palliative. Some LTCI policies provide benefits even when the beneficiary is not resident in a long term care home. It is important to note that while many policies refer to physical dependency, the patient may be physically fine but dependent because of deteriorated mental ability.

• Personal health insurance policies provide coverage for many health-related expenses not covered by provincial medicare, such as drugs, semi-private hospital rooms, medical equipment and in-home nursing. You must be under a certain age to receive coverage, e.g. 60 or 70. This varies by insurer. Policy renewals are also age limited.

• Association plans for alumni, professional, trade association, union and some interest groups (e.g. an automobile association) typically offer a health and dental plan with broader coverage than personal health insurance policies and may require less stringent proof of good health.

• Disability insurance policies pay a monthly benefit, typically to age 65 or 70, which covers a portion of the insured person’s lost earnings.

• Life insurance can help settle a person’s final debts, including taxes.

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PALLIATIVE CARE


• Depending on where the palliative patient lives, there may be personal costs, such as the cost of a semi-private hospital room, accommodation charges in long term care homes, home renovations, medical equipment or additional community resources (meals, personal support services or private nursing) that can be expensive. Please refer to other sections of this guide for more detail. Respite care – a break for the caregiver – may also cost you out of pocket.


COSTS

• There is no charge for professional services provided by home care nurses, case managers, physiotherapists, occupational therapists, social workers and dieticians or for services provided under the Palliative Care Benefit Program. However, some end-of-life care services will cost the patient, such as publicly subsidized residential hospice palliative care, which are available at a fixed daily rate of $31.90 (2014). Information on costs and eligibility for short-term residential care services, which includes residential hospice palliative care, is available here. If the cost is likely to cause serious financial hardship, a temporary rate reduction for up to one year is possible.

• Drugs may also be available through employer plans, personal insurance or will be purchased out of pocket. Many communities have private supportive services such as day programs and respite care, available at extra cost.

FOR HELP

The province has published a patient information sheet for its Palliative Care Benefits Program. The program application, to be completed by the patient’s physician is here.

HealthLink BC provides helpful information on care at the end of life, including advance care planning and preparing yourself, family and attending physician for the last few months of life. More information is provided on hospice palliative care.

Each regional health authority offers information and assistance:

◊ Fraser Health◊ Interior Health◊ Island Health◊ Northern Health◊ Vancouver Coastal Health

There are a number of organizations with information helpful to those planning end of life care. The Canadian Hospice Palliative Care Association has published an Advance Care Planning Workbook as part of their Speak Up campaign.

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The BC Hospice Palliative Care Association works with healthcare professionals, volunteers, members of government and others to ensure residents of British Columbia and the Yukon have access to high quality care at the end of life.

The Canadian Virtual Hospice provides many resources, including its Ask a Professional feature. It includes information for British Columbia.

The Victorian Order of Nurses supports caregiver-connect.ca which includes many helpful links by province.

The World Health Organization has created definitions of palliative care for adults and children.

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Overview

Canadians spend more on prescription drugs than any other health cost except hospitals and physicians.8 Access to prescription medicines is an important part of staying healthy, curing illness and preventing more serious harm. Coverage may be offered through different sources, but you should expect to pay at least some of the cost.

COVERAGE OPTIONS

Provincial drug plans provide extensive, subsidized coverage for a defined list of drugs, called a formulary. More provinces now offer access to universal coverage for all residents, but sometimes coverage is just for certain groups, such as seniors, those on social assistance and those with high-cost drugs. If you’re employed or retired, your employer may provide a comprehensive drug plan for you and your family. However, plan designs, eligibility and costs vary widely and may be changed by the employer or insurer. Many workplaces do not provide coverage for part-time employees, contract employees or after retirement. Coverage is also available through personal health insurance plans or through alumni, professional, trade union or business associations. Your health and any existing drug use are typically used to determine the amount of insurance available to you or any exclusions that may apply.


British Columbia’s Pharmacare Program covers most of the cost of the prescription drugs on its formulary, as well as insulin and diabetic supplies, insulin pumps for children and adolescents, as well as the following: 1) ostomy supplies, 2) permanent prosthetic appliances and 3) children’s orthotic devices. There are eligibility criteria for both people and drug products as defined in legislation and regulations. Pharmacare also covers the full cost of a pharmacist-delivered medication review for those taking at least five medications and pharmacist service fees for prescription renewal or adaptation.

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8 Canadian Institute for Health Information, 2013. National Health Expenditure Trends, 1975-2013. See Table A.3.1.1-Part 2. Note that total expenditures for prescribed and non-prescribed drugs are greater than for physician spending.

Canadians spend more on prescription drugs

than any other health cost.

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Eligibility: To be eligible for one of the nine Pharmacare plans, you must be enrolled in the Medical Services Plan (MSP). MSP enrolment is mandatory for all residents.

◊ Fair Pharmacare: Most British Columbia residents are covered by this income- based plan.

◊ Plan B: Permanent residents of licensed residential care facilities.

◊ Plan C: Individuals receiving income assistance.

◊ Plan D: Individuals registered with a provincial cystic fibrosis clinic.

◊ Plan F: Children receiving medical or full financial assistance through the At Home Program of the Ministry of Children and Family Development.

◊ Plan G: Mental health services centre for clients for whom drug costs are a significant barrier to treatment.

◊ BC Palliative Care Benefits Program: For those who choose to receive palliative care at home.

◊ Plan S: Smoking cessation products.

◊ Plan X: Anti-retroviral treatment administered by the BC Centre for Excellence in HIV/AIDS.

◊ More information on each plan is available here.

Some drugs are not covered by Pharmacare, such as those for: 1) cancer (contact the BC Cancer Agency), 2) transplants (contact the Transplant Society), 3) kidney dialysis (contact the BC Renal Agency) and 4) vaccines funded by the BC Centre for Disease Control.

Fair Pharmacare

You must register for this plan in order to receive benefits. Benefits are based on your net family income as reported to the Canada Revenue Agency, but there is a two-year lag. Your 2014 benefits are based on your family’s 2012 income tax returns. Most residents receive 70% reimbursement of eligible costs after paying an annual, income-based deductible. There is a maximum annual out-of- pocket cost, ranging from 2% to 4% of your net family income. If you or your spouse were born in or before 1939, the plan provides enhanced coverage, e.g. reimbursement is 75%. After the family maximum out-of-pocket cost is reached, all eligible drugs are available without charge.

Changes in family status and income can change your entitlement.


• Drug plans offered through your workplace typically have broad formularies, low co-payments and cover everyone regardless of health status. However, expensive drugs may create serious financial hardship for some claimants because most plans do not limit your out-of-pocket expenses. Plan design, eligibility and cost-sharing are determined by the employer and are not guaranteed.

• For employer plans, enrolment is typically completed on or near your first day of work. A waiting period may apply. Most plans provide a drug card to eliminate claim forms and reduce your out-of-pocket costs at the time the drug is dispensed at the pharmacy.

• Your plan may be coordinated with that of your spouse to increase the total amount you will be reimbursed. Insurers have standardized coordination of benefit rules.

• If your employer plan terminates you may convert to a personal health insurance plan within 30 days.

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• Personal insurance plans provide top-up coverage for prescription drug expenses not covered by the provincial plan or your group or association coverage. Even if you are ineligible for coverage through the government or an employer (either your plan or your spouse’s), you may be able to apply for an individual plan or an association health insurance plan. Payment of the first premium after the insurer or association accepts your application automatically starts your coverage.


• If your insurance is limited or you have none, drug costs will be paid out of pocket. For selected products, drug manufacturers may offer patient assistance programs to qualified patients, typically where affordability is a problem. Certain physicians may be able to enrol qualified patients into experimental trial drug programs testing new medicines before they are approved by Health Canada.

• Private insurance plans will cover the cost of the Pharmacare coinsurance and deductible, and may provide coverage for drugs not on the Pharmacare formulary.


COSTS

• Depending on which Pharmacare plan you qualify for, out-of-pocket costs can be significant although there is an annual limit that will not exceed 4% of your net family income. You can estimate your coverage under the Fair Pharmacare Plan by using an online calculator.

• Most private drug plans require members to pay a share of premiums, plus an annual deductible and/or coinsurance fee for each claim. Most do not limit out-of-pocket payments, which can be an issue for claimants in poor health with high-cost therapy. Coordination of benefits between two plans — employee and spouse —may provide 100% coverage.

FOR HELP

You can register for the income-based Fair Pharmacare Plan at any time.

A variety of patient information sheets are available.

More information is available through the Pharmacare website or by calling 604-683-7151 (Vancouver) or toll-free 800-663-7100.

For private insurance, contact your employer, insurer, financial advisor, association or union for administrative help. Your pharmacist may also help with questions on plan design and formulary eligibility.

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Certain physicians may be able to enrol qualified patients into

experimental trial drug programs testing new medicines before they

are approved by Health Canada.

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Overview

British Columbia’s Medical Service Plan (MSP) pays little and sometimes nothing for health services needed when outside Canada. Provincial governments recommend that you purchase travel health coverage for medically necessary emergency services when you are out of your province or outside Canada. The policy includes such things as a hospital stay, outpatient and physician services and assistance resulting from emergency treatment. Coverage will be limited to trips of a certain duration, e.g. 60, 180 or 365 days. There are limits to coverage and exclusions for pre-existing conditions including pregnancy. These limitations and exclusions may vary between individual and group plans.


• When you’re travelling in Canada but outside British Columbia and need hospital and physician services, reciprocal billing arrangements exist among the provinces and so presenting your BC CareCard or BC services card may ensure there are no out-of-pocket expenses. The exceptions relate to residents from the rest of Canada who need physician services in Quebec and residents of Quebec needing health (especially physician) services in other provinces. When travelling in Quebec or outside of Canada, you will probably be required to pay for your medical services and seek reimbursement later from the MSP.

• If you are travelling outside of Canada, you are strongly advised by the MSP to buy travel emergency health insurance. Otherwise, it is likely you will have to pay for health services before care is provided and reimbursement by MSP is likely to take 3-4 months. Even then, the government warns that reimbursement will be for emergency services only and that it provides only limited reimbursement, e.g. $75 per day for emergency inpatient services. The MSP only reimburses physician services in Canadian funds and at the same rate as would be paid in Bristish Columbia. It does not pay for drugs, ambulance service or medical supplies.

• MSP eligibility:◊ MSP enrolment is mandatory for all

British Columbia residents. Citizens and permanent residents and selected others (e.g. holding student or work permits) are eligible for coverage as long as they have a valid BC CareCard or BC services card. MSP coverage will lapse if you are not physically present in British Columbia for at least six months in any 12-month period. Eligible British Columbia residents who are away on vacation may remain eligible as long as they are not absent for more than seven months. Most new residents and former residents returning to Bristish Columbia must wait the balance of the month in which they arrive plus two more months after (re-)establishing residency to get coverage. Other conditions may apply.


When travelling in Quebec or outside of Canada, you will

probably be required to pay for your medical services and seek reimbursement later from the

Medical Services Plan.

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• Most group health plans cover reasonable and customary emergency hospital and medical expenses while you are travelling out of your home province. Many plans also offer supplemental emergency travel assistance services. Group benefit plans usually exclude costs for non-emergency or elective medical treatment or surgery performed outside Canada. They also limit the number of days of coverage. Many plans require that the travel assistance number be called as soon as possible after a medical emergency. Failure to do so may result in a reduction or decline in coverage of expenses. When in Canada, but outside your home province, reimbursement is typically limited to the difference between ward and semi-private hospital room rates and the underlying cost of a ward room is billed to your provincial health plan. Physician services outside Canada are covered for emergency treatment but may be limited to the rate set by your provincial medical association. This could be less than the actual charges where the service is provided. Your group plan may exclude pre-existing conditions or require your health to be stable for at least three months

before a medical emergency would be eligible. It is important to check your plan for coverage outside Canada before you travel.


• Coverage may be included with an individual health insurance policy but will typically have limits on the amount and duration of coverage and the age of the insured person. The insurer will require you to call a travel assistance number to pre-authorize and manage treatment before any is given. Pre-existing health conditions are usually excluded or eligible only under defined conditions.

• Travel emergency health coverage may be available through gold or higher level credit cards, or through the institutions that offer them. There are important differences between travel assistance and travel

health or travel insurance plans which offer broader coverage and higher limits at higher cost. Individual plans will be restricted to people of certain ages, require proof of good health and contain exclusions or limitations for pre-existing conditions and certain services. Travel health policies can also be purchased through an automobile association, travel agent or through brokers that can offer a wider variety of coverage through different insurers, including single or multiple trip and basic or comprehensive policies.

• If you don’t have travel emergency health insurance, you can expect healthcare providers to demand payment before services are provided, especially in the United States. In worst-case scenarios, that can run tens or hundreds of thousands of dollars and it can also cost you the advantage of having a professional case manager to assist you in understanding treatment options, trouble-shooting service issues, making decisions and returning safely to Canada.


Physician services outside Canada are covered for emergency

treatment but may be limited to the rate set by your provincial

medical association.

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2COVERAGE Out-of-pocket expenses

• Policies typically cost a few dollars a day depending on your age, medical issues, features of the plan, the duration of your trip and the insurer you choose. As with all insurance, buy from a highly rated insurer and use a reputable agent or broker. Inexpensive coverage may not be the most appropriate or offer the best value.


FOR HELP

The provincial out-of-country claim form is here. The out-of-country claims unit can be reached by telephone at 604-683-7151 or toll-free at 800-663-7100. Claims for medical care must be submitted within 90 days of the date of service and hospital claims must be submitted within six months of the date of discharge.

If you already have travel emergency health insurance, then your insurer or broker is your first point of contact. Many brokers maintain self-serve websites that provide comparative quotes after you answer a few questions about your trip and your health.

To learn more about the industry and its partners, contact the Travel Health Insurance Association of Canada. The association maintains a consumer section on its website and recently published a short overview of travel insurance.

As well, the Canadian Life and Health Insurance Association has published a consumer booklet entitled A Guide to Travel Health Insurance.


We gathered the information in this guide as of April 14, 2014. We’ve made a considerable effort to confirm that the information is accurate, but it may be incomplete or incorrect.

It’s important that you consult your own legal and tax advisors to review your personal situation. We also recommend you check your employer and personal insurance plans for details on your specific coverage.

Life’s brighter under the sun

We created this document for your information only. It’s important that you consult your own legal and tax advisors to review your personal situation. We also recommend you check your employer and personal insurance plans for details on your specific coverage.

The information in this guide was gathered from various authoritative sources as of April 14, 2014. We’ve made a considerable effort to confirm that this information is accurate, but in some cases it may be incomplete or incorrect. The information in this guide may not be current when you read it.

Sun Life Assurance Company of Canada is a member of the Sun Life Financial group of companies.© Sun Life Assurance Company of Canada, 2014.

Documents

BRITSH CTOILT - Sun Life Financialpersonal costs and other key considerations for six common health events and services: disability, home care, long term (nursing home) care, palliative