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Group health insurance plans cover most of the basic hospital and surgical expenses in Canada that any resident incurs during a period of hospital confinement, including accommodation at the ward level, the services of a doctor/surgeon, diagnostic procedures and drugs.
Employer-sponsored hospital benefits plans cover only the additional cost of preferred accommodation such as semi-private or private, during hospital treatment in Canada. Hospital expenses covered under a health care plan may be subject to the same deductible as well as coinsurance feature. The norm in employee benefits plans is that hospital expenses are exempted from deductibles or coinsurance.
Definitions of hospital vary from insurance carrier to insurance carrier however hospitals are typically defined as:
  • A licensed hospital
  • Operates with a staff of physicians at all times
  • Is always open
  • Offers in-patient accommodation
  • Provides continuous 24 hour nursing services
The term hospital does not include facilities such as convalescent nursing homes or institutions that provide for personal rather than medical care. Most benefit plans cover the cost of a semi-private room in a hospital with some (declining) covering the full cost of a private room. Some plans do not differentiate between private or semi-private coverage, however they limit the maximum dollar amount covered per day (.i.e $200/max/day). Charges for telephone or private television are not typically covered under the benefits plan. Most plans offer unlimited coverage for any illness or disability.