Like any other Canadian province or territory, Manitoba’s government provides universal health insurance called Manitoba Health, Seniors, and Active Living. The program is free to Canadian citizens, permanent residents, and work permit holders who live in the region for at least six months during a calendar year. 

The insurance plan pays for essential medical services and emergency services for its members. Unfortunately, the health care plan does have restrictions on the services and treatments it covers. As a result, it is often necessary to supplement provincial insurance with employer-based group benefits.

Manitoba Health Benefits Coverage

All Manitoba residents receive a Manitoba Health, Seniors, and Active Living health card or registration certificate. The Insured Benefits Branch confirms eligibility, which relies on the applicant’s permanent resident status or citizenship. The certificate includes identifying information and a 9-digit personal health identification number.

Any time a Manitoba resident seeks health services, they must present the card to cover expenses through the provincial health insurance plan. Members must report life changes such as an address change, adoption, marriage, and divorce or legal separation to the Insured Benefits Branch to continue receiving health benefits.

Manitoba Health covers various medically necessary services, including hospital care, physician visits, and prescription drugs. 

Medical Services

Manitoba Health insurance covers the following medical services in whole or in part:

• Medically necessary doctor visits
• Physician-requested laboratory and diagnostic tests in an approved facility
• Surgery
• A single eye exam by an optometrist every two years for residents under 19 years old and over 64 years old
• Medically necessary eye exams by an optometrist regardless of age
• A maximum of seven chiropractor visits within a calendar year

The insurance will occasionally pay for dental services. To qualify, a dental professional must perform the procedure in a hospital. Manitoba Health usually doesn’t cover ambulatory services unless an air or land ambulance to travel between medical facilities is necessary.  

Transportation must be a medical requirement as determined by a physician to move a patient to a health care facility for necessary treatment, diagnostic testing, or rehabilitation via ambulance transport.

Hospital Services

For those experiencing an illness or injury that requires a hospital visit, Manitoba Health insurance will cover: 

• Essential nursing services
• Basic meals and room accommodations
• All hospital-administered medication
• Nutrition counselling
• Diagnostic tests
• All surgical supplies, including anesthetics
• Therapy services, including speech therapy, physiotherapy, and occupational therapy

Personal Home Care

In Manitoba, people who need daily assistance resulting from ageing, chronic illness, or medical recovery may receive placement in a Manitoba personal care home. An authorized panel from Manitoba Health, Seniors, and Active Living determines who is eligible for home care. If qualified, plan members will receive the following benefits:

• Basic accommodations
• Standard nursing care
• Supervision or assistance with daily activities, such as grooming and eating
• Medical supplies
• Approved prescription drugs
• Meals 
• Laundry services

Though Manitoba Health will pay for the bulk of personal home care costs, patients are responsible for a daily residential fee, which is income-based. The cost of care tends to rise during the year, so the government performs annual reviews to adjust the daily residential price.

Pharmacare

Prescription drug costs are sometimes too expensive to afford without financial assistance. Manitoba Health includes a pharmacare program to help residents pay for qualifying medications. The program consists of a deductible determined by family income. 

To qualify for Pharmacare, the applicant must:

• Be eligible for the provincial insurance
• Not participate in another federal or provincial program that pays for the prescription

Note that Manitoba Pharmacare only covers eligible medications. Plan members can check if a prescription is part of the approved list by contacting their doctor or pharmacist or via the government’s Drug Formulary Look Up online.

Manitoba Health Restrictions

As with most provincial insurance plans, Manitoba health insurance does not cover all services or expenses. The programs restrictions include:

• Third-party health service requirements, such as drug testing for employment
• Most prescription drugs, unless you qualify for Pharmacare
• Ambulatory services
• Semi-private and private rooms for hospital stays
• Paramedical services like naturopathy and acupuncture
• Private nursing
• Telehealth
• Psychiatry and dietitian services outside of a hospital
• Prescribed eyewear and contact lenses
• Chiropractic services, except for spinal adjustments
• Cosmetic procedures that are not medically necessary

Supplementing Manitoba Health Insurance Plan

Supplemental health care is a way to protect your employees against unexpected medical expenses that the provincial insurance program does not cover. They could be responsible for paying coinsurance, cops, deductibles, and billable services without supplementary insurance. 

Relatively young, healthy people might get by with government health care. However, people over 25 years old who have dependents, chronic illness, injuries, or disabilities will likely need additional help. 

Employer-based group benefits help workers save on health and dental expenses. Plans are customizable to fit the needs of the company and its employees while reducing out-of-pocket costs. Here are some of the insurance plans you can add to your business’s group benefits to supplement Manitoba Health:

• Extended Health Care: This insurance provides employees access to a broader range of health-related services, including prescriptions, ambulance transport, paramedical services, vision care, and dental care.
• Group Dental Insurance: Members and their dependents will have access to routine dental care outside of a hospital setting. Dental insurance can also include major restorative services and orthodontic services that provincial health care may deem cosmetic. 
• Group Disability Insurance: If an employee experiences a disabling illness or injury, leaving them unable to work, disability insurance provides them with financial assistance. They can apply the money to daily living expenses and medical care.
• Critical Illness Insurance: Some medical conditions generate massive expenses that provincial health care won’t cover. Critical illness insurance helps employees cover the costs of life-changing illnesses.

Reduce Medical Expenses for Employees Through Group Benefits

Having comprehensive group benefits for your workers is the best way to ensure that they have good health, dental, and vision coverage for themselves and their families. At Group Enroll, we understand the importance of having adequate coverage. That’s why we help businesses all over Canada find simple, cost-effective group benefits solutions.

A customized group benefits plan will keep your workers healthy and happy with access to the coverage they need without high out-of-pocket expenses. Contact our team today for more information. You can also use our quick quote form to compare prices from multiple insurance providers in Canada fast.