PHSP vs Group Benefits

Private Health Services Plan

Traditional Group Benefits Plans

No monthly premiums, No annual fees Monthly premiums regardless of activity
No deductibles Deductibles can apply to many categories
One time set up fee Typical 80% coverage
No dispensing fee caps Limits – ie. Dispensing fee caps
No RX required for Paramedical expenses RX required for all paramedical expenses
Prescription Drugs –regardless of the Generic cost, the plan pays the out of pocket amount Prescription Drugs are only covered at the cost of the Generic brand, not the true out of pocket amount
Pre-existing health conditions make no difference in regards to coverage Pre-existing Health condition are typically not covered
Dental work expenses are paid as they are submitted, NO Estimates are required Dental work expenses require an Estimate
Employee limit or category limit is up to Employer Payments are based on “Reasonable and Customary” fee guides, employee is left paying the balance out of pocket

See the full list of allowable medical expenses with a PHSP here.

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