A COMPARISON OF MEDICAL PLANS FOR RETIRED TEACHERS
TEACHERS’ PENSION PLAN – GREEN SHIELD CANADA AND JOHNSON MEDOC VS JOHNSON’S PRESTIGE PLAN – (MEDICAL PLUS TRAVEL INSURANCE)
by Gerald Soon
When the administration of the Teachers’ Pension Plan extended health plan changed from Pacific Blue Cross to Green Shield Canada, members wondered whether or not this was the time to compare and contrast these two options for extended health benefit coverage and travel insurance.
Remember that individuals have other choices for insurance too. I am just comparing the coverage and costs for my wife and myself. We had decided upon retirement that our costs for coverage for medical and dental were well worth the money we were charged. Now that there was another option, it was time for us to decide whether or not to stay with what we had, or to shift. Note that what I write is what I have found, there may be other subtle changes that I have not included.
The Johnston Prestige plan sounded interesting. Most noteworthy was that there was no deductible yearly, and that any pre-existing medical conditions (which pushed me into a higher level of cost for coverage with Green Shield) were not considered. For the two of us, $200 yearly deductibles seemed costly. (Though this deductible does not apply to insulin injector, hearing aids, and vision). It offers multiple trips of up to 62 days duration. A lifetime maximum of $2,000,000 per person for unforeseen eligible emergency medical travel expenses is included. As is Trip cancellation/interruption of $6,000 per trip. Drugs, diagnostic services, aids and appliances as well as emergency ground and air transportation is included, and there is a 24 hour Emergency Help Line (Sigma Assistel toll free at 1-877-775-3695)
Our Emergency Medical and Non-Medical Insurance with Medoc offered two plans – a 17 day plan and a 35 day base plan. As we often are away for more than 17 days, the 35 day option works best for us so that is what we have for our coverage. There is a maximum aggregate of $5,000,000 per insured person, and $8,000 of trip cancellation, interruption and delay insurance is covered per trip. There is a supplemental plan available. It includes the base of 35 days out of the country unlimited times out of province or territory plus a SINGLE trip coverage for the number of days beyond the 35 you plan on being away. Note that this is limited up to the maximum number of days allowed under your provincial Health insurance plan.
Both Green Shield Canada and Johnston Prestige have 80% co-insurance, meaning YOU pay the first 20% until $1000 of paid claims has been reached per person per calendar year. Then, 100% co-insurance will apply. For both companies, 100% co-insurance for insulin injector, hearing aids, vision and out of province coverage is included.
While Green Shield has a $200,000 lifetime maximum coverage per person, Johnson Prestige has $250,000, and upon enrolment, the amount it counts begins at zero no matter what Green Shield has paid out for you previously.
Both plans cover dispensing fees to a maximum of $10 per prescription and for BC residents, a mark up limit of 8% over the manufacturer’s cost.
Vision care is the same for both options ($300 for eye glasses or contact lenses every 2 calendar years) However, note that with Green Shield, optometric eye exams are included as part of the $300 allowance, where Johnson Prestige adds $100 towards an eye examination every 2 years.)
Coverage for Green Shield is for BC and out-of–province within Canada, while Johnson Prestige includes out-of-country too.
Johnson Prestige has different rates, depending upon whether or not you were born in 1939 or earlier (Plan 1) , or 1939 or later (Plan 2). As well, there are two Drug options for my age group (born after 1940,) I could choose to have Drug Option A , a maximum of $1,500 per household, or Drug Option B, a maximum of $3500 per household.
Green Shield co-insurance coverage is 70% up to $1000 per person per calendar year on eligible basic dental services, while Johnson Prestige’s Basic co-insurance coverage is 80%
Green Shield’s essential Dental Plan
- diagnostic and preventative services, including recall examinations and bitewing xrays, cleaning of teeth, and topical application of fluoride once every 12 months.
- Basic restorative services, including tooth colored filling restorations (paid to full metal on molars)
- Basic oral surgery, including simple extractions
- Standard Denture services, including denture relining/rebasing, repair or adjustments
- Comprehensive oral surgery
- Endodontic treatment and Periodontal treatment including root canal therapy, and periodontal scaling/root planning.
People enrolled in the essential Dental Plan must participate for 24 months before upgrading to the Enhanced Dental Plan.
GREEN SHIELD ENHANCED DENTAL PLAN
Green Shield’s Enhanced Dental plan co-insurance coverage is 70% up to $2000 per person per calendar year on eligible Basic and Major dental expenses combined. Basic services are as above. However Major dental services include standard crowns, dentures and/or bridgework. (Replacements of each is limited to once every 5 years). Once a member upgrades to Enhanced dental they cannot downgrade to the Essential Dental Plan under any circumstance.
JOHNSON PRESTIGE DENTAL CARE PLAN
Johnson Prestige’s Dental Care plan co-insurance coverage is 80% with no annyal maximum. It includes one oral exam per calendar year, 8 units of scaling and/or root planning per year and 4 units of dental facility fees for surgical removal of teeth.
80% of Minor Restorative dental care includes endodontics / periodontics combined to a calendar year maximum of $750. 50% of Major Restorative Dental procedures is included. However these must be pre-authorized by mail, and includes $700 combined per calendar year for crowns, posts, inlays, and onlays. $700 combined per calendar year for bridges, dentures, and implants.
One thing to consider with all of the above, is that with Green Shield coverage, if we want to have health and dental coverage out-of-country, we need to supplement. Currently we have Johnson Medoc, which renews each September. The medical questionnaire that is required annually was just received in our mailbox this week, and needs to be filled out and sent in by the end of August so that if one of us is eligible for lower premiums due to having no medical issues, the company can adjust the rates. If we do nothing, we will both be charged at the higher coverage rates.
I currently pay for Green Shield plus Medoc (and our provincial MSP premiums of $150 a month). We had chosen to purchase enhanced dental, and I have pre-existing medical conditions where my wife is eligible for the Optimum rate as she is healthier than me. The total of our medical deductions, plus travel insurance for the base 35 days add up to $286.45 a month. If we choose to switch to Johnson Prestige, with the greater allowance for medical costs at $3,500 rather than the standard $1500, I would compare the Green Shield/Medoc combo of that $286.45 a month with the Johnston Prestige‘s $271 medical plus $112 dental for $383 a month. Whether or not we continue to have the $150 Medical Services Premium for people of my income level will depend upon the new Provincial government.
For now, I think I am staying with what we have. This may change as our needs change. Weigh your own options well. Compare coverage and costs. Look into other options available to you, and consider what best meets your needs. It is your decision! By doing your homework it will help to clarify what is best for your own situation. Good luck!