Private Health Services Plans

KNOWLEDGE EXPECTED OF: QAFP® Professionals

Highest Knowledge Level: Awareness

Knowledge Levels and Associated Verbs


Awareness
The state of being aware that something exists / to have familiarity with a particular activity or subject
Understanding
To comprehend the general relationship of particulars / to have an expertise with how something works
Application
Ability to put information to use / to use knowledge for relevant, practical purposes
Evaluation
To judge or conclude by utilizing data / a systematic determination of something’s worth or significance
Define
To state exactly the meaning of
Identify
To be aware of / to recognize and correctly name / to locate an appropriate resource
Explain
To make clear the meaning of / to describe something in more detail or reveal relevant facts or ideas related to it
Determine
To ascertain / to come to a decision, such as by investigation or reasoning
Compare
To note the similarities and differences between two or more things
Estimate
To determine an approximate value for
Calculate
To find the value using mathematics
Convert
To change from one form or purpose to another
Evaluate
To reach a conclusion or make a through careful study
Interpret
To give the meaning of / to construe or understand / to translate orally

Hold cursor over or click on each term to read its definition.

  • Identify types of private health services plans.
    • Individual plans
    • Group plans
  • Identify how private health services plans in Canada are funded. 
  • Identify that insurance companies provide individual private health services plans.
  • Identify sources of group private health services plans, such as:
    • Insurance companies
    • Employer-sponsored
    • Association-sponsored
  • Identify parties who may be eligible for coverage under a private health service plan, such as: 
    • Plan member
    • Plan member’s spouse or common-law partner
    • Plan member’s dependents
  • Identify types of coverage generally provided by private health services plans, such as: 
    • Extended health coverage (above and beyond government-provided benefits)
      • Prescription drug coverage
      • Ambulance service coverage
      • Increased level of hospital accommodation
      • Out-of-country medically required care coverage
      • Vision coverage
      • Auditory coverage
      • Paramedical services coverage
      • Special medical supplies (e.g., artificial limbs, prosthetics, medical equipment)
    • Dental coverage
    • Employee Assistance Programs, where services are provided by an authorized medical practitioner, as defined by the CRA
  • Identify circumstances when an individual health services plan may be suitable, such as:
    • No group insurance in place through employer
    • Self-employed
    • Unemployed
    • Retired
    • Individual or dependent requires special or additional coverage not covered under current group plan
  • Define factors that impact the value of benefits that may be received under a private health services plan, such as: 
    • Deductible
    • Coinsurance
    • Maximum
    • Waiting periods
    • Limitations 
    • Pre-existing condition clauses
  • Identify how benefits are coordinated between private health service plans.
    • When an individual is eligible to receive benefits under multiple plans (e.g., their own plan and their spouse’s plan, or their own multiple plans)
    • When dependents are eligible to receive benefits under multiple plans (e.g., their own plan, and their parents’/guardians’ plan)
  • Identify factors that may impact the premium of a private health service plan, such as:
    • Value of coverage (i.e., deductibles, coinsurance, benefit maximums)
    • Age
    • Geographic location

KNOWLEDGE EXPECTED OF: CFP® Professionals

Highest Knowledge Level: Awareness

Knowledge Levels and Associated Verbs


Awareness
The state of being aware that something exists / to have familiarity with a particular activity or subject
Understanding
To comprehend the general relationship of particulars / to have an expertise with how something works
Application
Ability to put information to use / to use knowledge for relevant, practical purposes
Evaluation
To judge or conclude by utilizing data / a systematic determination of something’s worth or significance
Define
To state exactly the meaning of
Identify
To be aware of / to recognize and correctly name / to locate an appropriate resource
Explain
To make clear the meaning of / to describe something in more detail or reveal relevant facts or ideas related to it
Determine
To ascertain / to come to a decision, such as by investigation or reasoning
Compare
To note the similarities and differences between two or more things
Estimate
To determine an approximate value for
Calculate
To find the value using mathematics
Convert
To change from one form or purpose to another
Evaluate
To reach a conclusion or make a through careful study
Interpret
To give the meaning of / to construe or understand / to translate orally

Hold cursor over or click on each term to read its definition.

  • Identify types of private health services plans.
    • Individual plans
    • Group plans
  • Identify how private health services plans in Canada are funded. 
  • Identify that insurance companies provide individual private health services plans.
  • Identify sources of group private health services plans, such as:
    • Insurance companies
    • Employer-sponsored
    • Association-sponsored
  • Identify parties who may be eligible for coverage under a private health service plan, such as: 
    • Plan member
    • Plan member’s spouse or common-law partner
    • Plan member’s dependents
  • Identify types of coverage generally provided by private health services plans, such as: 
    • Extended health coverage (above and beyond government-provided benefits)
      • Prescription drug coverage
      • Ambulance service coverage
      • Increased level of hospital accommodation
      • Out-of-country medically required care coverage
      • Vision coverage
      • Auditory coverage
      • Paramedical services coverage
      • Special medical supplies (e.g., artificial limbs, prosthetics, medical equipment)
    • Dental coverage
    • Employee Assistance Programs, where services are provided by an authorized medical practitioner, as defined by the CRA
  • Identify circumstances when an individual health services plan may be suitable, such as:
    • No group insurance in place through employer
    • Self-employed
    • Unemployed
    • Retired
    • Individual or dependent requires special or additional coverage not covered under current group plan
  • Define factors that impact the value of benefits that may be received under a private health services plan, such as: 
    • Deductible
    • Coinsurance
    • Maximum
    • Waiting periods
    • Limitations 
    • Pre-existing condition clauses
  • Identify how benefits are coordinated between private health service plans.
    • When an individual is eligible to receive benefits under multiple plans (e.g., their own plan and their spouse’s plan, or their own multiple plans)
    • When dependents are eligible to receive benefits under multiple plans (e.g., their own plan, and their parents’/guardians’ plan)
  • Identify factors that may impact the premium of a private health service plan, such as:
    • Value of coverage (i.e., deductibles, coinsurance, benefit maximums)
    • Age
    • Geographic location

Additional Knowledge Expected of CFP Professionals
  • Identify the concept of a health and welfare trust.1

REFERENCES

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