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Canada (158,173)
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BU353 (31)
Chapter 14

Chapter 14.docx

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Wilfrid Laurier University
Heather Graham

Chapter 14Managing Health Related RisksThe Canada Health Act sets out the criteria and conditions to be met by provincial programs in order to be eligible for the full federal contributionsThe criteria are as follows a Pubic administration administered on a nonprofit basis by a public authorityb Comprehensive cover all necessary hospital and medical services and surgicaldental services rendered in hospitals c Universal 100 of the provinces residents must be entitled to insured health services d Portable coverage must be portable from one province to another e Accessible insured services must be provided on uniform terms and conditions for all residentsExcessive Utilizationoccurring when a patient receives care for which the cost of providing the care exceeds the expected benefit to the patientMany medical plans cap the maximum outofpocket cost for eligible expenses during the year using a stop loss clause which specifies that the medical plan will pay 100 of eligible expenses once the insured has paid a specified amount under the coinsurance clauseFor example the stop loss clause might limit the insureds maximum outofpocket cost from the application of coinsurance to 1500 in a yearDisability Insura
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