With Canadians becoming wary of increasingly longer waits for medical treatment, a relatively new type of insurance allows them to jump the queue to obtain surgical and therapeutic procedures.

Medical access insurance is designed to provide rapid access to medical treatment when a provincial health-care system fails to deliver. It is not a replacement for but rather a supplement to public health care, allowing Canadians to obtain affordable treatment more quickly, says Tim Mackie, assistant vice president and general manager of Langley, B.C.-based Envision Insurance Service, a wholly owned subsidiary of the Envision Financial credit union.

The services provided by MAI reduce the stress and time of sourcing and finding the best possible treatment, says Susan St. Amand, president of Ottawa-based Sirius Fi-nancial Services. “It is a good product because it not only provides access to treatment but also takes care of the related organizational and administrative details.”

Tim Landry, director of living benefits with MSA Financial Services in Montreal, believes MAI fills the gap for treatment alternatives, given lengthy wait times.

The features, characteristics and coverage of MAI vary among different policies and providers, making it important to understand the respective terms and conditions prior to making a purchase decision. Generally, policies fall into three broad categories: basic and enhanced, which are differentiated by the length of the waiting period before treatment is provided; and policies with no waiting time.

Companies such as Calgary-based Acure Health Corp., One World Medicare of Richmond, B.C., and Envision offer largely similar MAI policies. Products such as Toronto-based PPI Financial Group’s triAccess — which is designated as “executive health care” — are more sophisticated. MAI is available to individuals, their spouses and children; as group plans; and to members of affinity groups and associations.

THREE CATEGORIES

With basic MAI, coverage generally takes effect if a physician recommends a covered diagnostic procedure or surgery, and the policyholder is placed on a medical waiting list for more than 45 days. Enhanced coverage reduces the waiting time to 21 days or fewer. Zero-waiting policies enable treatment to be started upon diagnosis.

Once a policyholder requires treatment, the provider makes all the necessary arrangements for it based on the waiting time stipulated by the policy. The policyholder does not necessarily have to wait the full extent of the stipulated waiting time, say 45 days, for treatment to commence.

PPI’s triAccess has a zero waiting time because it facilitates treatment only in the U.S., says Scott Beckett, PPI’s vice president in Toronto.

Normally, MAI covers the full cost of pre- and post-treatment and associated tests, second opinions, diagnosis and specialist consultation, travel expenses for the policyholder and a companion, and, in most cases, out-of-town accommodation based on a per-diem allowance.

There are wide variations in the level of post-diagnostic services among providers. In most cases, treatment is available either out-of-province or in the U.S. All providers claim to offer access to either private or public health-care facilities and state-of-the-art equipment, but some are aligned with more prestigious institutions such as Best Doctors in Boston. Typically, the policyholder is allowed to choose treatment from a list of pre-approved institutions.

MAI policies generally cover about 135 conditions, which include all major illnesses. As with most health-related insurance policies, there are exclusions for treatments such as cosmetic surgery, drug addiction and experimental procedures. Some policies do not have deductibles, while those that have deductibles allow for lower premiums when a higher deductible is chosen.

Generally, no medical underwriting or evidence of insurability is required to purchase a policy. Coverage for pre-existing conditions is available, but usually the policy would only cover treatment for that condition if it had been in effect for 24 consecutive months. Some policies do not cover pre-existing conditions.

BENEFITS IN FORCE

MAI coverage is available for individuals of about two months of age to age 74. Benefits remain in force to age 75. Policies have a maximum lifetime ceiling that ranges from US$1 million to US$3 million. MAI premiums are based on age and generally guaranteed for three years, at the end of which they are annually renewable.

On average, premiums for an individual can range from $25 a month to about $300 a month. For example, a 45-year-old male non-smoker would pay $1,085 a year for a triAccess policy with a maximum US$10,000 deductible, while a female non-smoker would pay $1,456 for the same policy. Comparatively, if the same individuals were smokers, the male would pay $2,277 and the female $2,424. The triAccess policy has a $3-million lifetime ceiling.

@page_break@Coverage is provided to only Canadian residents. Some policies have a travel rider that may cover single- or multi-trip emergency medical expenses. All such expenses must be pre-approved.

Lawrence Geller, president of L.I. Geller Insurance Agencies Ltd. of Campbellville, Ont., is somewhat pessimistic about the market for MAI, saying there is “no great appetite” for such coverage. He cautions that treatment in the U.S. involves a greater number of tests that may not necessarily reduce waiting times.

Landry attributes this to greater concern about liability issues.

According to the Vancouver-based Fraser Institute’s October 2006 annual survey, Waiting Your Turn: Hospital waiting lists in Canada, waiting times for surgical and other therapeutic treatments increased slightly in 2006 over the previous year: “Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, increased from 17.7 weeks in 2005 to 17.8 weeks in 2006.”

The report adds: “Compared to 1993, waiting time in 2006 is 91% longer.” IE