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Provincial Coordination

Provincial coordination refers to the process of aligning private insurance benefits with the coverage provided by your provincial or territorial government health plan. It ensures that the public plan pays for all eligible expenses first, and your private insurance covers only the remaining costs that are not paid by the government. This coordination helps prevent duplicate payments while maximizing your overall coverage.

In Canada, each province and territory operates its own government health insurance plan (GHIP), which pays for medically necessary hospital and physician services. Private insurers coordinate benefits to cover additional healthcare expenses such as prescription drugs, medical equipment, vision care, and paramedical services. For certain treatments, such as prescription medications for seniors or low-income residents, your provincial drug plan may act as the first payer before your private plan reimburses the balance.

Example:

If your provincial health plan covers $100 of a $350 medical procedure, your private insurance will coordinate benefits to pay the remaining $250, up to the policy’s maximum.

What to Watch For:

Always present your provincial health card when receiving care and provide accurate information to both the provider and insurer. Some private insurers require proof that the government plan has paid its portion before reimbursing the balance. Rules and coverage levels vary by province, so check how your plan coordinates benefits with your provincial health plan, especially if you move between provinces or travel within Canada.

Related Terms

Paramedical Disciplines

Paramedical disciplines refer to regulated health professionals who provide therapy or rehabilitation services outside of hospital settings. Common examples include physiotherapists, chiropractors, massage therapists, acupuncturists, naturopaths, osteopaths, psychologists, and speech-language pathologists.

Pay-Direct card / Drug card

A pay-direct card, also known as a drug card, is a plastic or digital card issued by your health insurance provider that allows pharmacies to bill your insurer directly for eligible prescription drugs. Instead of paying the full cost upfront and submitting a claim later, you pay only your portion - such as a deductible or coinsurance - at the point of sale.

Per Incident

Per incident refers to the way certain insurance benefits are calculated or limited based on each separate event, illness, or accident rather than by year or lifetime. When a benefit is paid “per incident,” it means you are eligible for reimbursement each time a new, distinct occurrence happens, up to the maximum amount specified for that type of claim.

Per Person / Per Family

Per person and per family describe how benefit limits, deductibles, or maximums are applied within a health or dental insurance plan. A per person limit means the specified amount applies individually to each insured member, while a per family limit represents the total combined coverage for all members under one policy.

Per-Practitioner Annual Maximum (Paramedical)

The per-practitioner annual maximum is the total amount your plan will reimburse for services from one specific type of provider in a single benefit year. For example, if your plan pays up to $500 for massage therapy annually, once that amount is reached, additional treatments from that provider type are no longer covered until the next year.

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