Who pays for HEALTHCARE?

BRITISH COLUMBIA

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. DISABILITY HOME LONG TERM PALLIATIVE PRESCRIPTION TRAVEL EMERGENCY PROTECTION CARE CARE CARE DRUGS HEALTH

INTRODUCTION Brought to you by

Health always matters most cancers and dementia. In this context of change, we recommend you consider your own needs, Canadians strongly identify with their preferences and personal resources. Planning for system and most see it as a national icon. We have health expenses is as important as buying a house enjoyed universal, first-dollar coverage for hospitals or saving for retirement; indeed, health and wealth and physicians for decades, but other health planning are natural companions. services can be surprisingly expensive.

Our needs have changed over time, often radically. Introducing Sun Life’s While the principles of the Health Act healthcare funding guides (1984) remain sound, in the last 30 years there has These guides outline some of the coverage options, been a six-fold increase in health costs.1 Private personal costs and other key considerations for health spending by individuals and insurers was six common health events and services: disability, estimated at $63 billion in 2013. Some of those home care, long term (nursing home) care, palliative costs likely came from your pocket…or may soon. (end-of-life) care, prescription drugs and travel emergency medical. Planning and paying: A shared responsibility The guides are organized by , just as our healthcare system is operated and you’ll find many Government and employer health plans provide embedded web links to other authoritative websites complementary coverage for many health-related for more detail and the latest updates. They are expenses. But there are common, medically meant to be a quick reference that you will find necessary health services that are not fully covered. practical, informative and easily accessible. Planning Each province makes their own decisions and those ahead can provide important protection and peace entitlements may change over time, especially as of mind and help you get what you need, when governments struggle with high debts and deficits, you need it. demographic changes and higher rates of many common chronic diseases such as diabetes, certain

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). www.sunlife.ca/whopaysforhealthcare/BC 2 BRITISH COLUMBIA DISABILITY HOME LONG TERM PALLIATIVE PRESCRIPTION TRAVEL EMERGENCY PROTECTION CARE CARE CARE DRUGS HEALTH

DISABILITY PROTECTION Brought to you by

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.

have dropped at least 40% due to your condition COVERAGE Federal government and you must have at least 600 hours of insurable 4.5 million earnings during (generally) the last 52 weeks. There (14.3%) of • The Canada Pension Plan (CPP) provides a disability is a two-week waiting period once approved. Based Canadians had benefit to those under age 65 who have contributed on 55% of your insurable earnings, the maximum a disability 14.3% to the plan and who have a severe and prolonged weekly benefit was $514 in 2014, but there is a in 2006 disability that 1) prevents a claimant from being able supplement for qualifying low income families. to work at any job on a regular basis or 2) will result in death. Applications take about four months to • The Child Disability Benefit (CDB) is a tax-free Reported disabilities more benefit for families with a child under age 18 who than double after age 45 be processed, although those considering terminal conditions will be reviewed in two days. As of has a severe and prolonged impairment in mental 8% 25-44 years March 2014, the average monthly benefit is $896.87 or physical function. The CDB provides up to and the maximum benefit for 2014 is $1,236.35. The $218.83 per month for each eligible child (July 18% 45-64 years basic amount ($457.60 - 2014) is fixed for all eligible 2013 - June 2014) but is reduced according to claimants, with additional benefits based on the the number of children and family net income. claimant’s CPP contributions. If the claimant qualifies, • Veterans and active military personnel may qualify Most frequent disabilities there is also an additional benefit for dependent for a disability award or a disability pension if their are related to children payable up to age 25. The current (2014) disability is related to their military service. Current benefit is a flat monthly rate of $230.72. and former members of the RCMP and certain PAIN, agility civilians may also qualify for the disability pension. and • Employment Insurance (EI) pays a sickness benefit mobility for up to 15 weeks for those unable to work due to sickness, injury or quarantine. Your earnings must

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DISABILITY PROTECTION Brought to you by

• For severe and prolonged disability in physical audiology services and transportation. assistance through the Home Adaptations for or mental functions, there are other federal tax Nursing support services are also available Independence Program to allow eligible low- benefits for which you may qualify, including for children and youth. income seniors and people with disabilities the Disability Tax Credit (DTC). For those who to stay in their own homes. For homeowners, • For those in financial need, British Columbia’s qualify for the DTC, contributions can be made up to $20,000 more may be available to allow Employment and Assistance Program for to a Registered Disability Savings Plan (RDSP). underlying repairs and improvements before Persons with Disabilities provides assistance Those with a RDSP are eligible for federal disability adaptations can be installed. A list of and income supplements for those who are grants and bonds. eligible renovations is available. There is also a designated as people with disabilities (PWD) home owner grant that reduces property taxes by the Ministry of Social Development and on your principle residence for those with a • Social Innovation. Note that PWD is not COVERAGE Provincial government disability or someone living with a spouse or a permanent designation and the ministry relative who has a disability. The reduction is can rescind it in exceptional circumstances. up to $845 or up to $1,045 if it is located in a • The British Columbia government has Monthly payments depend on income and northern and rural area. There is a minimum created a one-stop directory of the many assets and the number of people in the family. services it offers to disabled adults and property tax payment of $100. A property children. It offers many employment • There is a fuel tax refund for people with tax deferral may also be possible. Subsidized supports through WorkBC. qualifying disabilities that provides up to $500 housing may be available for low to moderate annually. Eligibility for the fuel tax refund income tenants with disabilities. • The Ministry of Children and Family also qualifies you for a 25% discount on basic • A variety of personal supports are available Development offers family support automobile insurance from the Insurance for residents with disabilities. services for children and youth who Corporation of British Columbia. have a developmental disability, a • British Columbia offers a supplemental • For modifications to vehicles (to install diagnosis of autism spectrum disorder bursary for students with permanent auxiliary driving controls or to accommodate or who are severely disabled and eligible disabilities. A Canada student grant may wheelchairs) used by disabled people for for the At Home Program. The At Home also be available. Program includes respite benefits (typically private (not commercial) use, there is a refund between $2,400 and $2,800 per year) and of the 12% tax on designated property. • WorkSafeBC provides income replacement benefits and healthcare coverage for qualified medical services, which includes equipment, • For tenants and homeowners, British Columbia workers through no-fault liability insurance supplies, drugs, dental care, vision and Housing provides up to $20,000 of financial mandated for employers in certain industries. www.sunlife.ca/whopaysforhealthcare/BC 4 BRITISH COLUMBIA DISABILITY HOME LONG TERM PALLIATIVE PRESCRIPTION TRAVEL EMERGENCY PROTECTION CARE CARE CARE DRUGS HEALTH

DISABILITY PROTECTION Brought to you by

Several types of benefits are payable, including There will be a waiting period before benefits wage-loss benefits, healthcare benefits and are payable, which is usually between three and COVERAGE Personal insurance permanent disability and death benefits. Wage six months following the first day of disability. loss benefits are based on 90% of net earnings If your employer has a flexible benefits plan, • Individual disability insurance plans are up to $77,900 (2014). Expect monthly benefits you may be able to choose the amount of available directly through insurers, or through to be coordinated with other sources such disability coverage you want, but only once membership in various associations including as employer-sponsored short and long term a year during an open enrolment period. post-secondary alumni associations. The risk of disability insurance benefits, CPP disability disability depends on factors such as your age, • Employers in certain industries and over a benefits and EI sickness benefits. health risks, family medical history and your certain size are required to contribute to job. Applications require proof of good health WorkSafeBC to provide income replacement to allow insurers to assess risk. Even if your for occupational injuries and illnesses – COVERAGE ProvincialEmployer plansgovernment health status is compromised, insurers may still those caused in the workplace. provide coverage at a higher-than-standard • Many larger employers and some smaller ones, rate, or they may provide coverage for all risks provide compensation when you cannot work other than a condition already diagnosed. If due to disability. These include partial or full pay one insurer declines to cover you, another may under casual absence or sick leave programs, or still offer you insurance. The benefit duration benefits paid under short term disability and/ and amount may be selected by the applicant, or long term disability (LTD) insurance plans. but the benefit cannot be greater than a Those benefits may be provided by the employer certain percentage of average annual earnings. directly, through a health and trust, Don’t forget to ask whether your benefit via third-party administrator or by an insurer. depends on you being unable to do your own Benefits payable under an LTD insurance plan job, or any job you’re qualified for based on will be taxable if the employer paid any part criteria such as your age, education, income of the monthly premium. Benefits are typically and experience. Own job coverage is more paid at between 60% and 75% of earnings and expensive but provides greater certainty of the may be offset by benefits paid from other benefit you’ll receive. Some policies pay using sources, such as Workers’ Compensation or CPP. the own job definition for the first two or five years and any job thereafter.

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DISABILITY PROTECTION Brought to you by

The Ministry of Social Development and Social COVERAGE Out-of-pocket expenses FOR HELP Innovation offers a self-serve application and assessment web portal to check on supports, • Beyond government programs and services, you The application for the CPP disability benefit programs and eligibility and to apply for may approach other organizations for financial is available online and by calling Service Canada: income assistance. assistance, including voluntary and charitable 800-277-9914. WorkSafeBC may be contacted through its website, organizations, such as the March of Dimes, The The application for the EI sickness benefit is by email, or by phone: 604-231-8888 or toll-free Easter Seals Society, Kiwanis, Rotary or Lions available online or by calling Service Canada: across Canada: 888-967-5377. Clubs. Under the Income Tax Act, certain health 800-206-7218. insurance premiums and other eligible medical expenses may count towards a tax credit when More information on the CDB is available here total medical expenses exceed the lesser of or by calling 800-387-1193. $2,152 (2013) or 3% of your net income. Veterans Affairs may be contacted at 866-522- 2122, as well as by using the links under Federal Government in the Disability Protection section COSTS of this document.

• Private disability insurance premiums can be The list of eligible medical expenses that qualify expensive, but the benefits may be crucial if for the medical expense tax credit is here. you do not have enough savings to replace your Information on federal programs is available work income. You don’t pay tax on disability through your local Service Canada office. income benefits from your policy as long as you were the only one who paid all the premiums. The Ministry of Children and Family Development has published the At Home Program guide for children and youth in transition.

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HOME CARE Brought to you by

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).

• Community nursing: Nurses provide acute, chronic, Diversity of home care patients COVERAGE Provincial government in British Columbia palliative or rehabilitative support, generally on a short term basis. These services can include 29% assessment, education, wound care, medication adults <1% • After a personal assessment by a health professional children employed by the local HCCP office, a care plan will management, chronic disease management, care management, post-surgical and palliative care. 70% be developed for those who qualify that identifies seniors the funded services available. An income-based ◊ Community rehabilitation: The services of a financial assessment is completed and may need physiotherapist or occupational therapist can to pay for some services to a maximum of $300 per be arranged, generally for short term periods. Home care includes month.2 There may also be a waiting list for certain • Prevention services, but others will be arranged to assist you in ◊ Home support: Personal hygiene, transfer • Healthcare the meantime. Urgency criteria have been developed assistance (getting in and out of bed or a • Palliative care that consider medical need, risk of neglect and chair), dressing, eating, toileting and escort • Rehabilitation the capacity of your personal support network. to appointments are provided by community • Social support British Columbia offers five types of services health workers. There may be a charge for that can be provided in-home: certain services.

1  Canadian Home Care Association, 2013. Portraits of Home Care in Canada 2013. See p.16. 2 Ibid, p. 11. www.sunlife.ca/whopaysforhealthcare/BC 7 BRITISH COLUMBIA DISABILITY HOME LONG TERM PALLIATIVE PRESCRIPTION TRAVEL EMERGENCY PROTECTION CARE CARE CARE DRUGS HEALTH

HOME CARE Brought to you by

◊ Choice in Supports for Independent • British Columbia has a Seniors’ Home Living (CSIL): This is a unique self-directed Renovation Tax Credit which provides up THE CRUCIAL ROLE option for certain home support clients to $1,000 annually for specified, permanent who receive funds from their local health home renovations that improve accessibility OF CAREGIVERS authority to buy their own home support or help those age 65 or older to become Research done for the Institute for Research services. CSIL clients become employers who more functional or mobile at home. on Public Policy indicated unpaid services by hire, schedule and supervise staff and are caregivers to the elderly had an estimated responsible for how CSIL funds are spent. market value of between $24 billion and $31 ◊ Respite services: Directed to caregivers, billion in 2007. There are some tax advantages such services provide a break from the provided to informal caregivers, including physical and emotional demands of caring the federal caregiver amount tax credit. for someone at home. These services may The Public Health Agency has produced be provided at home, in the community a brochure to help caregivers look after at adult day services or temporarily in a themselves in stressful times. 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

3 Canadian Home Care Association, 2013. Portraits of Home Care in Canada 2013. See p.16. www.sunlife.ca/whopaysforhealthcare/BC 8 BRITISH COLUMBIA DISABILITY HOME LONG TERM PALLIATIVE PRESCRIPTION TRAVEL EMERGENCY PROTECTION CARE CARE CARE DRUGS HEALTH

HOME CARE Brought to you by

COVERAGE Employer plans COVERAGE Personal insurance COVERAGE Out-of-pocket expenses

• Home care services are typically excluded • Some individually purchased • You may be charged for home support services from extended health benefit plans available plans reimburse the cost of in-home nursing according to your family’s adjusted income. The through your workplace. Most health plans and/or home care services according to an maximum monthly charge is $300. However, provide limited supplemental coverage for approved plan of care. The benefits supplement provincially funded home care services may be private nursing care for employees and eligible the cost of services not covered by the HCCP. inadequate in breadth, frequency or intensity. dependents which can be accessed if more Private funding will then be required, either on • Most long term care insurance policies home care services are needed. Dependents a pay-as-billed basis or through an individual (which may also include home care) provide are limited to the spouse and children. Some insurance policy. Many community services coverage following a waiting period if you are flexible benefit plans include a health spending supplement those provided by the government functionally dependent, meaning that you need account (HSA) which may be used to claim and will also require personal funds. substantial assistance with two of six activities home care services. However, HSAs typically of daily living or substantial supervision because • Under the Income Tax Act, certain health offer limited funds to cover a wide variety of of cognitive impairment. There are two types insurance premiums and other eligible medical healthcare expenses based on provisions in of plans: those that reimburse defined expenses expenses may count towards a tax credit when the Income Tax Act. such as in-home care or equipment rental and total medical expenses exceed the lesser of those that pay a monthly income-style benefit $2,152 (2013) or 3% of the client’s net income. Some individually purchased health that can be used as needed. For more detail, insurance plans reimburse the cost see: Long term care> Personal insurance> of in-home nursing and/or home Typical coverage. care services according to an approved plan of care.

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HOME CARE Brought to you by

• The minimum wage for a live-in home To arrange for care, contact your regional COSTS support worker is $102.50 per day (2014). health authority:

• For reference, one home health company • The Ministry of Health Services manages the ◊ Fraser Health BC Care Aide and Community Health Worker provided their rates for: 1) services of a ◊ Interior Health Registry to track all home support and PSWs Registered Nurse: $65 per hour in Vancouver ◊ Island Health to protect patients, residents and clients, (one hour minimum) and $60 per hour ◊ Northern Health provide standards of care and promote in Victoria (two hour minimum) and 2) ◊ Vancouver Coastal Health professional development. homemaking and personal care through The Seniors Health Care Support Line is specifically a personal support worker (PSW): $27 per • Residents of private facilities pay the full geared to serve seniors. Call toll-free, 877-952-3181, hour plus tax in Vancouver (two hour cost of their care and accommodation. or in Victoria, call 250-952-3181. minimum) and $30.75 per hour plus tax Taking Care Inc. has prepared a summary of The BC Care Providers Association represents over in Victoria (two hour minimum). Rates in typical costs for residents of British Columbia. 230 provider organizations and can help connect other British Columbia locations will vary. Rates in private facilities ranged from $2,275 you to services. to $9,500 per month (2013). • Care aides/PSWs: Care aides provide most The province has established patient care quality non-medical home services and can be hired review boards, one for each health authority, to to help clients perform activities of daily living, FOR HELP manage complaints among home care clients and as well as shopping, food preparation, laundry other patients. The boards can be reached by and transportation. PSWs are not a regulated HealthLink BC is available to help residents telephone, toll-free at 866-952-2448 and by email profession and cannot initiate or perform care find appropriate healthcare services. Its 8-1-1 at [email protected]. without supervision. Agencies will charge a telephone service also connects residents to significant premium over what they pay a health information and services and can connect PSW to allow for their overhead costs and them directly with a registered nurse, a registered any health benefits and travel allowances dietitian or a pharmacist. they may provide.

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LONG TERM CARE Brought to you by

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.

• Permanent residents of LTC facilities are eligible days each employment year to meet COVERAGE Provincial government for drugs at no cost under the British Columbia responsibilities related to the care, Pharmacare Plan. health or education of any member • In provincial facilities, the cost is shared of the employee’s immediate family. between residents, who pay an income- Permanent residents of based monthly accommodation fee and the long term care facilities are government that pays for everything else. COVERAGE Employer plans In private facilities, the resident must pay eligible for drugs at no cost the full cost. under the British Columbia • LTC services are excluded from extended health Pharmacare Plan. benefit plans available through your workplace. • The province sets minimum and maximum fees Some flexible benefit plans include a health which are increased annually. Depending on spending account (HSA) which may be used availability, ward, semi-private or private rooms • British Columbia provides a compassionate to claim LTC services for eligible dependents. may be available. Residents rely on personal care leave under the Employment Standards However, HSAs typically offer limited funds resources, government pension or disability Act. Up to eight weeks of unpaid leave can be to cover a wide variety of healthcare expenses benefits or individual health insurance policies taken within a 26 week period. The employee based on provisions in the Income Tax Act. to pay their share. Patients must take the first must obtain a medical certificate which states available bed even if the facility is not their that the family member is gravely ill with first choice and be prepared to move in a significant risk of death within 26 weeks. within 48 hours. An unpaid family responsibility leave is also available to employees for up to five

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. www.sunlife.ca/whopaysforhealthcare/BC 11 BRITISH COLUMBIA DISABILITY HOME LONG TERM PALLIATIVE PRESCRIPTION TRAVEL EMERGENCY PROTECTION CARE CARE CARE DRUGS HEALTH

LONG TERM CARE Brought to you by

◊ Benefit: An applicant selects a benefit that ◊ Waiting period: Benefits become payable COVERAGE Personal insurance can range from $70 to $2,500 per week. typically between 30 and 90 days (but Benefits may be paid weekly or monthly. you can choose up to two years) after the • Private LTC insurance may be a good option Policies often include one-time or annual policy’s definition of dependency is met. depending on your age, health and financial access to a person who can help plan care. ◊ Premiums are paid monthly usually until means. A helpful model outlining the five In Canada, the maximum insurance available death, or for a period such as two, 10, 20 stages of care was developed by Dr. Mark is $10,000 per person per month from all or 25 years. Premiums are not paid while Frankel and his team at Taking Care Inc., an LTC insurance policies. organization dedicated to helping caregivers benefits are being received. LTC premiums navigate the elder-care system. The stages are: ◊ Benefit period: The applicant typically are typically guaranteed only for the first 1) independence, 2) interdependence, chooses a plan that will pay for one, five years and may be adjusted over the life 3) supportive living, 4) crisis management two, three, four or five years, or an of the policy. unlimited payment period that ends and 5) dependence. ◊ Optional benefits may include inflation with the insured person’s death. • Typical coverage: Terms and conditions of protection, return of premiums upon death coverage vary in the market. Generally benefits ◊ Benefit maximum: The applicant may after the policy has been in force for a are payable upon dependency, which may be able to choose a maximum amount certain period of time and shared coverage or may not include living in a long term care of coverage, such as $100,000, which is where one spouse may draw additional home. Definitions of dependency vary within then reduced by each monthly benefit coverage from the other spouse’s plan. paid to the insured person. the insurance industry. Dependency includes ◊ All policies are somewhat different and all criteria for mental ability and when the insured have exclusions and limitations of coverage. person is unable to perform at least two of All policies are somewhat They should be read carefully. Questions six specified activities of daily living: dressing, different and all have exclusions may be directed to your insurance agent. eating, toileting, bathing, continence and and limitations of coverage. transferring. Some sample provisions follow: They should be read carefully. Questions may be directed to your insurance agent.

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LONG TERM CARE Brought to you by

COVERAGE Out-of-pocket expenses COSTS QUALITY

• Given the cost of accommodation and the • If eligible for a provincial subsidy, residents • Before selecting a LTC home, you’ll want to expense of LTC insurance policy premiums, your in provincial facilities pay a percentage be sure it is well-equipped to look after its personal financial assets and income may be of their income toward the cost of care, residents. Quality is difficult to objectively used to purchase home care, supportive living accommodation and other supports. assess since it includes the facility and its and eventually a nursing home. Alternatively, Accommodation may be in ward, semi-private professional and non-regulated staff, as well you may need to rely on family and friends for or private rooms. You will pay up to 80% of as its rooms, food, safety and health, social caregiving services. But of course those financial your after tax income towards the cost of and recreational services. Quality should be and personal resources may not be enough if housing and hospitality services, subject to verified: consider a site visit, discussions with you lose your ability to live independently. a minimum of $970.50 per month single and staff and seek references from current or $719.20 per month per person for couples former residents and family members. Check • Under the Income Tax Act, certain health (2014). The maximum monthly rate for 2014 whether the home has been independently insurance premiums and other eligible medical is $3,092.60.6 Your monthly rate is calculated reviewed and compared against national expenses may count towards a tax credit when based on after tax income, leaving a minimum standards by Accreditation Canada. Look for total medical expenses exceed the lesser of of $325 per month available for other expenses. a current Accreditation Canada certificate in $2,152 (2013) or 3% of your net income. Temporary rate reductions for up to one year the facility, or search Accreditation Canada’s are available when the minimum rate would website. Once on the website, click on the link cause severe financial hardship for you or titled “Find an Accredited Health Care Provider your spouse. Now” located on the left side of the page to find an accredited provider. • Residents of private facilities pay the full cost of their care and accommodation. Taking Care • The assisted living registrar provides regular Inc. has prepared a summary of typical costs for inspection reports of all facilities and reports residents of British Columbia. Rates in private of substantiated complaints. facilities ranged from $2,275 to $9,500 per month (2013).

6 Source: British Columbia Ministry of Health, available at: http://www2.gov.bc.ca/gov/topic.page?id=4FEC0F570BC04692810548267D09577E. www.sunlife.ca/whopaysforhealthcare/BC 13 BRITISH COLUMBIA DISABILITY HOME LONG TERM PALLIATIVE PRESCRIPTION TRAVEL EMERGENCY PROTECTION CARE CARE CARE DRUGS HEALTH

LONG TERM CARE Brought to you by

The office of the seniors advocate will be FOR HELP operational in Spring 2014. Its mandate is to monitor seniors’ services, promote awareness The Ministry of Health provides a directory of and work collaboratively with seniors, families, community care facilities by community and by policymakers, service providers and others to health authority. identify solutions to systemic issues. It also The Ministry of Health has published a guide to makes reccomedations to government on selecting residential care facilities which includes ways to improve care for our aging tips on how to arrange tours of facilities before population. the need for them arises and what questions to The BC Care Providers Association represents ask before making your choices. Expect the over 230 provider organizations and can help regional health authority case worker to provide connect you to LTC services. you with approximate wait times for your choices. Accreditation Canada’s website provides General information may be available online information for the public about its standards through HealthLink BC, or by telephone at and provides a list of accredited facilities in 8-1-1, or 7-1-1 for the hearing impaired. British Columbia. 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.

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PALLIATIVE CARE Brought to you by

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

of national SERVICE OPTIONS COVERAGE Provincial government survey 70% respondents Palliative care can be provided in different settings, • British Columbia has a palliative care benefits worried they didn’t have such as in a hospital, long term care facility, at home program, which includes no-cost access to the enough money to pay for or in a community hospice. Pharmacare Plan and access through each their own palliative care regional health authority to medical supplies and equipment. Palliative care can be provided in different settings, such as in a hospital, • The medical supplies and equipment component long term care facility, at home or in provides terminal patients who are cared for at a community hospice. 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.

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. www.sunlife.ca/whopaysforhealthcare/BC 15 BRITISH COLUMBIA DISABILITY HOME LONG TERM PALLIATIVE PRESCRIPTION TRAVEL EMERGENCY PROTECTION CARE CARE CARE DRUGS HEALTH

PALLIATIVE CARE Brought to you by

• The Ministry of Health provides certain • Personal health insurance policies provide prescription and over-the-counter medicines COVERAGE Personal insurance coverage for many health-related expenses under its Palliative Care Drug Plan. not covered by provincial medicare, such as Several kinds of individual policies may be drugs, semi-private hospital rooms, medical • British Columbia has developed the Joint purchased to help pay for palliative care. Some equipment and in-home nursing. You must Protocol for Expected/Planned Home Deaths insurers permit the conversion of some or all be under a certain age to receive coverage, to support individuals to die at home with their the benefits of a critical illness insurance (CII) e.g. 60 or 70. This varies by insurer. Policy families or caregivers. The goal is to provide policy to a long term care insurance (LTCI) policy renewals are also age limited. clarity to roles, responsibilities and activities without further evidence of good health if a involved in a planned home death. CII claim has not already been approved. • Association plans for alumni, professional, trade association, union and some interest • CII policies pay a lump sum to the policy groups (e.g. an automobile association) COVERAGE Employer plans owner or to the person they name to receive typically offer a health and dental plan the benefit when the insured person is with broader coverage than personal health diagnosed with one of several life-altering • Your health benefit plan provides coverage insurance policies and may require less conditions (which can include Alzheimer’s for prescription drugs and limited benefits for stringent proof of good health. Disease, blindness, cancer, coronary artery private home nursing which may be part of a bypass surgery, heart attack, loss of limbs, • Disability insurance policies pay a monthly palliative care plan. Long term care and home stroke, etc.) and survives the waiting period. benefit, typically to age 65 or 70, which covers care services (except those by registered nurses) Insurers offer different levels of coverage a portion of the insured person’s lost earnings. are not covered. If your plan includes a health that include different health diagnoses. spending account, many medical services are • Life insurance can help settle a person’s eligible based on provisions in the Income Tax • LTCI policies pay benefits when dependency final debts, including taxes. Act. You may be able to arrange an additional occurs, as defined in the policy, although it is leave of absence with your employer to look likely to have occurred prior to a beneficiary after a dying family member or close friend. 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. www.sunlife.ca/whopaysforhealthcare/BC 16 BRITISH COLUMBIA DISABILITY HOME LONG TERM PALLIATIVE PRESCRIPTION TRAVEL EMERGENCY PROTECTION CARE CARE CARE DRUGS HEALTH

PALLIATIVE CARE Brought to you by

COVERAGE Out-of-pocket expenses COSTS FOR HELP

• Depending on where the palliative patient lives, • There is no charge for professional services The province has published a patient information there may be personal costs, such as the cost of provided by home care nurses, case managers, sheet for its Palliative Care Benefits Program. The a semi-private hospital room, accommodation physiotherapists, occupational therapists, social program application, to be completed by the charges in long term care homes, home workers and dieticians or for services provided patient’s physician is here. renovations, medical equipment or additional under the Palliative Care Benefit Program. HealthLink BC provides helpful information on community resources (meals, personal support However, some end-of-life care services will care at the end of life, including advance care services or private nursing) that can be expensive. cost the patient, such as publicly subsidized planning and preparing yourself, family and Please refer to other sections of this guide residential hospice palliative care, which are attending physician for the last few months for more detail. Respite care – a break for the available at a fixed daily rate of $31.90 (2014). of life. More information is provided on hospice caregiver – may also cost you out of pocket. Information on costs and eligibility for short- palliative care. term residential care services, which includes • Under the Income Tax Act, certain health residential hospice palliative care, is available Each regional health authority offers information insurance premiums and other eligible here. If the cost is likely to cause serious and assistance: medical expenses may count towards a financial hardship, a temporary rate tax credit when total medical expenses ◊ Fraser Health reduction for up to one year is possible. exceed the lesser of $2,152 (2013) or 3% ◊ Interior Health of your net income. • Drugs may also be available through employer ◊ Island Health plans, personal insurance or will be purchased ◊ Northern Health out of pocket. Many communities have private ◊ Vancouver Coastal Health supportive services such as day programs and There are a number of organizations with respite care, available at extra cost. 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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PALLIATIVE CARE Brought to you by

The BC Hospice Palliative Care Association works with healthcare professionals, volunteers, members of government and others to ensure residents of British Columbia and the 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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PRESCRIPTION DRUGS Brought to you by

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 COVERAGE Provincial government Canadians spend more on prescription drugs Provincial drug plans provide extensive, subsidized British Columbia’s Pharmacare Program covers than any other coverage for a defined list of drugs, called a formulary. most of the cost of the prescription drugs on its health cost. More now offer access to universal coverage formulary, as well as insulin and diabetic supplies, for all residents, but sometimes coverage is just insulin pumps for children and adolescents, as well for certain groups, such as seniors, those on social as the following: 1) ostomy supplies, 2) permanent assistance and those with high-cost drugs. If you’re prosthetic appliances and 3) children’s orthotic employed or retired, your employer may provide a devices. There are eligibility criteria for both comprehensive drug plan for you and your family. people and drug products as defined in legislation However, plan designs, eligibility and costs vary widely and regulations. Pharmacare also covers the full and may be changed by the employer or insurer. Many cost of a pharmacist-delivered medication review workplaces do not provide coverage for part-time for those taking at least five medications and employees, contract employees or after retirement. pharmacist service fees for prescription renewal Coverage is also available through personal health or adaptation. 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.

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. www.sunlife.ca/whopaysforhealthcare/BC 19 BRITISH COLUMBIA DISABILITY HOME LONG TERM PALLIATIVE PRESCRIPTION TRAVEL EMERGENCY PROTECTION CARE CARE CARE DRUGS HEALTH

PRESCRIPTION DRUGS Brought to you by

Eligibility: To be eligible for one of the nine ◊ More information on each plan Pharmacare plans, you must be enrolled in the is available here. COVERAGE Employer plans Medical Services Plan (MSP). MSP enrolment is Some drugs are not covered by Pharmacare, such mandatory for all residents. • Drug plans offered through your workplace as those for: 1) cancer (contact the BC Cancer typically have broad formularies, low co- ◊ Fair Pharmacare: Most British Columbia Agency), 2) transplants (contact the Transplant payments and cover everyone regardless of residents are covered by this income- Society), 3) kidney dialysis (contact the BC Renal health status. However, expensive drugs may based plan. Agency) and 4) vaccines funded by the BC Centre create serious financial hardship for some ◊ Plan B: Permanent residents of licensed for Disease Control. claimants because most plans do not limit residential care facilities. Fair Pharmacare your out-of-pocket expenses. Plan design, ◊ Plan C: Individuals receiving income eligibility and cost-sharing are determined You must register for this plan in order to receive assistance. by the employer and are not guaranteed. benefits. Benefits are based on your net family ◊ Plan D: Individuals registered with a income as reported to the Canada Revenue Agency, • For employer plans, enrolment is typically provincial cystic fibrosis clinic. but there is a two-year lag. Your 2014 benefits are completed on or near your first day of work. A waiting period may apply. Most plans provide ◊ Plan F: Children receiving medical or full based on your family’s 2012 income tax returns. a drug card to eliminate claim forms and reduce financial assistance through the At Home Most residents receive 70% reimbursement of your out-of-pocket costs at the time the drug is Program of the Ministry of Children and eligible costs after paying an annual, income-based Family Development. deductible. There is a maximum annual out-of- dispensed at the pharmacy. pocket cost, ranging from 2% to 4% of your net ◊ Plan G: Mental health services centre • Your plan may be coordinated with that of family income. If you or your spouse were born for clients for whom drug costs are a your spouse to increase the total amount you in or before 1939, the plan provides enhanced significant barrier to treatment. will be reimbursed. Insurers have standardized coverage, e.g. reimbursement is 75%. After the coordination of benefit rules. ◊ BC Palliative Care Benefits Program: For family maximum out-of-pocket cost is reached, those who choose to receive palliative all eligible drugs are available without charge. • If your employer plan terminates you may care at home. convert to a personal health insurance plan Changes in family status and income can within 30 days. ◊ Plan S: Smoking cessation products. change your entitlement. ◊ Plan X: Anti-retroviral treatment administered by the BC Centre for Excellence in HIV/AIDS. www.sunlife.ca/whopaysforhealthcare/BC 20 BRITISH COLUMBIA DISABILITY HOME LONG TERM PALLIATIVE PRESCRIPTION TRAVEL EMERGENCY PROTECTION CARE CARE CARE DRUGS HEALTH

PRESCRIPTION DRUGS Brought to you by

• Private insurance plans will cover the cost of • Most private drug plans require members to pay COVERAGE Personal insurance the Pharmacare coinsurance and deductible, a share of premiums, plus an annual deductible and may provide coverage for drugs not on and/or coinsurance fee for each claim. Most • Personal insurance plans provide top-up the Pharmacare formulary. do not limit out-of-pocket payments, which can coverage for prescription drug expenses not be an issue for claimants in poor health with • Under the Income Tax Act, certain health covered by the provincial plan or your group high-cost therapy. Coordination of benefits insurance premiums and other eligible medical or association coverage. Even if you are between two plans — employee and spouse — expenses may count towards a tax credit when ineligible for coverage through the government may provide 100% coverage. total medical expenses exceed the lesser of or an employer (either your plan or your $2,152 (2013) or 3% of your net income. spouse’s), you may be able to apply for an individual plan or an association health FOR HELP insurance plan. Payment of the first premium after the insurer or association accepts your COSTS You can register for the income-based Fair application automatically starts your coverage. Pharmacare Plan at any time. • Depending on which Pharmacare plan you qualify for, out-of-pocket costs can be A variety of patient information sheets are available.

significant although there is an annual limit COVERAGE Out-of-pocket expenses More information is available through the that will not exceed 4% of your net family Pharmacare website or by calling 604-683-7151 income. You can estimate your coverage • If your insurance is limited or you have none, (Vancouver) or toll-free 800-663-7100. drug costs will be paid out of pocket. For under the Fair Pharmacare Plan by using selected products, drug manufacturers may an online calculator. For private insurance, contact your employer, offer patient assistance programs to qualified insurer, financial advisor, association or union for administrative help. Your pharmacist may patients, typically where affordability is a Certain physicians may be able problem. Certain physicians may be able to also help with questions on plan design and to enrol qualified patients into formulary eligibility. enrol qualified patients into experimental trial experimental trial drug programs drug programs testing new medicines before testing new medicines before they they are approved by . are approved by Health Canada.

www.sunlife.ca/whopaysforhealthcare/BC 21 BRITISH COLUMBIA DISABILITY HOME LONG TERM PALLIATIVE PRESCRIPTION TRAVEL EMERGENCY PROTECTION CARE CARE CARE DRUGS HEALTH

TRAVEL EMERGENCY HEALTH Brought to you by

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.

• If you are travelling outside of Canada, you • MSP eligibility: COVERAGE Provincial government are strongly advised by the MSP to buy travel ◊ MSP enrolment is mandatory for all emergency health insurance. Otherwise, it is British Columbia residents. Citizens and • When you’re travelling in Canada but likely you will have to pay for health services permanent residents and selected others outside British Columbia and need hospital before care is provided and reimbursement by (e.g. holding student or work permits) are and physician services, reciprocal billing MSP is likely to take 3-4 months. Even then, the eligible for coverage as long as they have arrangements exist among the provinces and government warns that reimbursement will be a valid BC CareCard or BC services card. so presenting your BC CareCard or BC services for emergency services only and that it provides MSP coverage will lapse if you are not card may ensure there are no out-of-pocket only limited reimbursement, e.g. $75 per day physically present in British Columbia for expenses. The exceptions relate to residents for emergency inpatient services. The MSP at least six months in any 12-month period. from the rest of Canada who need physician only reimburses physician services in Canadian Eligible British Columbia residents who services in and residents of Quebec funds and at the same rate as would be paid are away on vacation may remain eligible needing health (especially physician) services in Bristish Columbia. It does not pay for drugs, as long as they are not absent for more in other provinces. When travelling in Quebec ambulance service or medical supplies. than seven months. Most new residents or outside of Canada, you will probably be and former residents returning to Bristish required to pay for your medical services Columbia must wait the balance of the When travelling in Quebec and seek reimbursement later from the MSP. month in which they arrive plus two more or outside of Canada, you will months after (re-)establishing residency to probably be required to pay for get coverage. Other conditions may apply. your medical services and seek reimbursement later from the Medical Services Plan.

www.sunlife.ca/whopaysforhealthcare/BC 22 BRITISH COLUMBIA DISABILITY HOME LONG TERM PALLIATIVE PRESCRIPTION TRAVEL EMERGENCY PROTECTION CARE CARE CARE DRUGS HEALTH

TRAVEL EMERGENCY HEALTH Brought to you by

before a medical emergency would be eligible. health or travel insurance plans which offer COVERAGE Employer plans It is important to check your plan for coverage broader coverage and higher limits at higher outside Canada before you travel. cost. Individual plans will be restricted to • Most group health plans cover reasonable and people of certain ages, require proof of good customary emergency hospital and medical Physician services outside health and contain exclusions or limitations for expenses while you are travelling out of Canada are covered for emergency pre-existing conditions and certain services. your home province. Many plans also offer treatment but may be limited Travel health policies can also be purchased supplemental emergency travel assistance through an automobile association, travel to the rate set by your provincial services. Group benefit plans usually exclude agent or through brokers that can offer a wider medical association. costs for non-emergency or elective medical variety of coverage through different insurers, treatment or surgery performed outside including single or multiple trip and basic or Canada. They also limit the number of days comprehensive policies. of coverage. Many plans require that the COVERAGE Personal insurance travel assistance number be called as soon as • If you don’t have travel emergency health insurance, you can expect healthcare providers possible after a medical emergency. Failure to • Coverage may be included with an individual do so may result in a reduction or decline in to demand payment before services are health insurance policy but will typically have provided, especially in the United States. coverage of expenses. When in Canada, but limits on the amount and duration of coverage outside your home province, reimbursement In worst-case scenarios, that can run tens and the age of the insured person. The insurer or hundreds of thousands of dollars and it is typically limited to the difference between will require you to call a travel assistance ward and semi-private hospital room rates and can also cost you the advantage of having number to pre-authorize and manage a professional case manager to assist you in the underlying cost of a ward room is billed to treatment before any is given. Pre-existing your provincial health plan. Physician services understanding treatment options, trouble- health conditions are usually excluded or shooting service issues, making decisions outside Canada are covered for emergency eligible only under defined conditions. treatment but may be limited to the rate set and returning safely to Canada. by your provincial medical association. This • Travel emergency health coverage may be could be less than the actual charges where available through gold or higher level credit the service is provided. Your group plan may cards, or through the institutions that offer exclude pre-existing conditions or require your them. There are important differences health to be stable for at least three months between travel assistance and travel

www.sunlife.ca/whopaysforhealthcare/BC 23 BRITISH COLUMBIA DISABILITY HOME LONG TERM PALLIATIVE PRESCRIPTION TRAVEL EMERGENCY PROTECTION CARE CARE CARE DRUGS HEALTH

TRAVEL EMERGENCY HEALTH Brought to you by

2 COVERAGE Out-of-pocket expenses FOR HELP

• Policies typically cost a few dollars a day The provincial out-of-country claim form is here. depending on your age, medical issues, features The out-of-country claims unit can be reached of the plan, the duration of your trip and the by telephone at 604-683-7151 or toll-free at insurer you choose. As with all insurance, buy 800-663-7100. Claims for medical care must be from a highly rated insurer and use a reputable submitted within 90 days of the date of service agent or broker. Inexpensive coverage may not and hospital claims must be submitted within be the most appropriate or offer the best value. six months of the date of discharge.

• Under the Income Tax Act, certain health If you already have travel emergency health insurance premiums and other eligible medical insurance, then your insurer or broker is your first expenses may count towards a tax credit when point of contact. Many brokers maintain self-serve total medical expenses exceed the lesser websites that provide comparative quotes after of $2,152 (2013) or 3% of your net income. 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.

www.sunlife.ca/whopaysforhealthcare/BC 24 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 informationWe in gatheredthis guide the was information gathered from in this various guide authoritative as of April 14, sources 2014. We’ve as of madeApril 14,a considerable 2014. effort We’ve made a considerableto confirm that effort the toinformation confirm that is accurate, this information but it may is accurate,be incomplete but in orsome incorrect. cases it may be incomplete or incorrect. The information in this guide may not be current when you read it. It’s important that you consult your own legal and tax advisors to review your personal situation. Sun Life AssuranceWe alsoCompany recommend of Canada you ischeck a member your employer of the Sun and Life personal Financial insurance group of plans companies. for details on your © Sun Life Assurancespecific Company coverage. of Canada, 2014.