Regulation of Health Insurance (Benefits)

What is included in my health insurance premium?

Each month, every insured person pays a health insurance premium to their health insurance provider. That premium is comprised of two parts: (1) the SPR and (2) the premium for supplemental (non-SHB/MRF) benefits. More information about these two sets of coverage can be found here. […]

How are services under SHB selected and who determines the SPR?

The types of services, reimbursement rates for the SHB and MRF benefits, and the SPR are set by the Minister of Health following an annual review to ensure healthcare market sustainability, inclusion of feedback from stakeholders, affordability of services, and diversity of benefits that can support the health of individuals. Actuarial Reports provide a summary […]

Is there a copay or out-of-pocket charge for SHB and MRF services?

Approved providers of SHB and MRF services are prohibited from charging beyond the regulated reimbursement rate levels for these services. Regulated rates can be found here. […]

How long must you be on an insurance policy for maternity coverage?

Maternity coverage for services included under Standard Health Benefit (SHB) is effective from the first start date of employment which should also be the same as the first date of insurance coverage in general. Maternity benefits under SHB is typically 2nd and 3rd trimester ultrasounds at the hospital or an approved facility outside of the […]