FAQ

Any company holding active UCDA membership can apply for coverage.  Should your UCDA membership be cancelled or revoked, then your coverage in the health insurance plan also terminates.

Our plan includes health care expenses not covered by OHIP such as paramedicals, semi-private hospital, vision care, prescription drugs, and dental care.  For a summary of our benefit schedule, click here.  If you use our quote request form here you can request a full proposal with more details.

Our plan is designed to be very inclusive and all coverages come bundled together.  There are optional benefits such as life insurance, disability, and critical illness coverage, but the core health and dental program is the same for all members.

Our Forms page includes applications for enrollment, which should be completed and faxed to the number on the bottom of the form.  There are separate forms for companies with 5 or more employees, vs. companies with 1-4 employees.

The coverage does not differ, only the application process.  The two page health application for companies with 1-4 employees asks a number of questions regarding your medical history.  It is imperative that you answer all questions truthfully and completely, including calling your pharmacist if necessary to confirm the full price of any pre-existing medications you may be taking.

If your company has 5 or more employees, then all pre-existing conditions are covered and we do not ask any medical questions to determine your current health status.

If your company has 1-4 employees enrolling in the program, then pre-existing conditions may be covered, but at a surcharged premium.  Also, the applicant may choose to exclude the pre-existing condition, and join at our standard monthly premium here.

The surcharged premium is calculated at approximately $1.50 for every $1.00 of pre-existing drug expense, with extra sometimes added for serious or progressive ailments.  The surcharge is higher than the pre-existing cost because we are not only insuring the medication, but also the condition.  In time, one might change to a new, more expensive drug for the condition, or may develop other secondary ailments.  Once a surcharged condition has been added, we cover all future costs associated with that condition.

If you have current health or dental benefits with another insurer, then we will need to see past health claims history with that company.  Should this claims data be within our allowable range, we will allow you to join at our standard monthly premiums, listed here.  Should this claims data be above our allowable range, then we will either offer your group coverage at surcharged monthly rates, or we will decline to quote.

Provided that your company holds active UCDA membership, you must remain in the program for a minimum of 12 months from your effective date.

Drugs are paid using a pay-direct drug card from claims payor NexgenRx.  If you do not have your drug card on you and you pay for drugs out-of-pocket, you can be reimbursed by mailing a [health claim form] and original receipt of payment to NexgenRx, who will post you a cheque to your home address.

Non-drug health claims are always paid by mailing in your original receipt to NexgenRx along with a [health claim form.]  NexgenRx’s address is included on the form.  You will receive a cheque at your home address.

Our program renews on December 1st, of every year, for all members regardless of what month they originally joined.  On that date all annual maximums for coverages reset to zero for all members.  Each year, our program experiences an approximate 3-5% increase in premiums.  This is due to regular increases in the Ontario Dental Association fee guide, which we remain current with, and inflation in health care costs, especially prescription drugs.

However, on your first December 1st renewal, we may assess a surcharge based upon your claims experience with us.  Once you have been in the program beyond that date, then all claims are pooled with the hundreds of plan members across Ontario.  This may provide greater rate stability than you will find elsewhere.