STANDARD HEALTH BENEFIT (SHB)

The story starts with the Standard Premium Rate (SPR) which is the price calculated to cover the cost of each insured individual (1) having access to a base package of mandated health benefits, collectively referred to as SHB, and (2) contributing to select high cost health procedures (like dialysis and kidney transplants) and the cost of health system administration.  The second component is collectively referred to as Mutual Reinsurance Fund benefits.  This separation of SHB and MRF is based on the differences in funding of the two components and does not impact access for individuals with an active health insurance policy.

Each month, every insured person pays a health insurance premium to their health insurance provider.  Included in that payment is the premium for SHB, the premium for MRF (collectively referred to as SPR) and the premium for supplemental benefits.  The supplemental benefits are not mandated and thus each insurer decides what that portion of the premium is and what benefits it covers.  Supplemental benefits may include services such as vision care, dental care and allied health services.

The types of services, reimbursement rates for the SHB and MRF benefits, and the SPR are set by the Minister of Health and are reviewed annually to ensure healthcare market sustainability, inclusion of feedback from stakeholders, affordability of services, and diversity of benefits that can support the health of individuals.

Standard Premium Rates – 2016 to Present

[Notice: The log is currently under review.]

Click here for the reimbursement rates for approved providers.  See the Change Log tab monthly for updates. Approved providers are prohibited from charging beyond the regulated reimbursement rate levels for these procedures. All fees for services not included under SHB are set by the health professionals providing care.

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