Group Health Insurance

Canopy’s Group Health plans are on an indemnity or administrative service only (ASO) basis. While we customize specific benefit levels to suit clients’ budgets, the overall plan structure is consistent.

Benefit Types

Each plan has three categories of benefits.

Basic Benefits

  • These benefits can be written with or without annual limits, either by dollar value or frequency and are replenished on an annual basis
  • Benefits in this category commonly include:
    • Prescription drugs
    • Doctor’s visits
    • Dental and Optical
    • Maternity
    • Preventative Care

Major Medical Benefits

  • These benefits can have annual limits, but are most often written without annual limits
  • In all respects, utilization of these benefits reduce a member’s lifetime plan maximum
  • Benefits in this category commonly include:
    • Diagnostic Procedures
    • Hospitalization
    • Surgery
    • Other miscellaneous major benefits

Benefits with Corridor Deductibles

Plans will carry varying levels of “Corridor Deductibles” as requested by Clients. For specific basic benefits (eg. Prescription Drugs), members may access major medical lifetime balances, once annual limits are reached for the benefit in question and the member satisfies the deductible stated in the policy’s schedule of benefits.

 


 

Coverage Types

Within each benefit type, Canopy plans cover medical expenses in 2 main ways:

  1. Flat coverage per occasion (eg.  $2,000 per office visit)
  2. % of Cost (eg. 80% of Prescription drug cost)

The amount not covered by Canopy is the “member’s responsibility” to be paid directly to the medical provider. Providers on the Canopy network can confirm this amount during each visit by using Canopy’s health swipe card or contacting our call center.

Eligibility Requirements

Canopy health plans are available to all full-time employees who join their companies prior to the age of 75. Employees may elect to add their dependents (spouse or children) under the age of 27.

 

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