What is Paramedical coverage?

Paramedical coverage, often referred to as simply Parameds is a subcomponent of the Extended Health Benefit (EHB). Parameds are an important part of the EHB benefit and typically account for 25-30% of EHB claims in an average group plan (second only to drugs). While most group plans cover some aspect of parameds, the types of practitioners covered and the amount provided varies significantly from group to group. Here are some of the components to consider when setting up paramed coverage:

Paramed components:

There are many components of Paramed coverage. The following is not intended to be an exhaustive list, rather these are the most common components:

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Paramed practitioners:

A choice is offered as to which paramed practitioners will be covered by the plan. There are a wide variety of paramed practitioners to choose from, although it is not as simple as just selecting the desired practitioners. Often there are additional requirements, for example practitioners may be required to be licensed, certified or registered.

Typical practitioners to choose from include:

• Acupuncturist
• Audiologist
• Chiropractor
• Chiropodist
• Dietician
• Naturopath
• Occupational Therapist
• Osteopath
• Physiotherapist
• Podiatrist
• Psychologist
• Registered Massage Therapist
• Social Worker
• Speech Therapist

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Coinsurance:

How much of the cost of the practitioner is covered by the employer. Lower coinsurances (for example 50%) create more out of pocket expenses for employees, but may also help to reduce utilization and/or fraudulent claims.

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Maximum:

There are several different ways the paramed maximum can be calculated. The calculation you choose will depend on the level of cost containment desired. Here are some of the available options:

• Per Certificate, per practitioner: This option combines the claims experience of everyone under one certificate (employee + spouse + dependants) on a per practitioner basis. For example, if there was a $300 maximum in this scenario, if one family member claimed $300 of physio then no other members of that certificate could claim physio until the next benefit period. They could however claim for a different practitioner, for example a speech therapist.
• Per Insured, per practitioner: This option provides a separate maximum for each member under one certificate (employee + spouse + dependants) on a per practitioner basis. For example, if there was a $300 maximum in this scenario, each member of the family could claim up to $300 of physio per benefit period. This option creates the greatest opportunity for risk.
• Per Certificate, All practitioners combined: This option combines the claims experience of everyone under one certificate (employee + spouse + dependants) and across all practitioners. It therefore is the option with the lowest risk (although this may not be true if a higher overall maximum is used). For example, if there was a $500 maximum in this scenario, once the combined claims of all family members reaches $500, no additional parameds can be claimed until the next benefit period.
• Per Insured, All practitioners combined: This option combines the claims experience of all practitioners for each individual member of the certificate. For example, if there was a $500 maximum in this scenario, one family member reaching the $500 maximum across all practitioners has no bearing on the other family members ability to make paramed claims.
• Maximum per visit, per insured: This option can often be used in conjunction with one of the maximums selected above. It further restricts paramed coverage by capping the amount that can be claimed per visit. For example, if this maximum was set to $100, then an insured is only reimbursed up to $100 per visit, even if the amount of the claim is higher. There is often an option to differ the maximum amount by practitioner.

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Referral required:

If this option is selected then insureds need to get a referral from their physician before they can make a paramed claim. This option is most often applied to massages. There is some debate as to how effective a deterrent this is.