Mashimesa Emoto

Does Medicare Cover Gym Memberships?

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Gym Memberships

Many seniors prioritize staying active and healthy, but gym memberships can be a financial hurdle. This guide explores cost-effective ways for seniors to maintain an active lifestyle, unpacking what Original Medicare offers and the exciting fitness benefits available with some Medicare Advantage Plans.

Budget-Friendly Fitness for Seniors

While Original Medicare doesn’t cover gym memberships, there are numerous free and low-cost options to stay active:

  • Walking: A simple yet effective way to get exercise and fresh air.
  • Swimming: Low-impact exercise that’s easy on joints.
  • Senior Center Activities: Many centers offer affordable dance or yoga classes.
  • Gardening: Combines physical activity with the benefits of being outdoors.
  • Household Chores: Daily tasks like mowing the lawn or cleaning can contribute to your activity goals.

Remember, consistency is key! Aim for at least 150 minutes of moderate-intensity exercise per week, or 30 minutes most days.

Original Medicare and Fitness Coverage

Original Medicare prioritizes medically necessary services. While gym memberships aren’t covered, it offers benefits that can improve your mobility and overall well-being:

  • Physical Therapy: Helps recover from injuries and regain strength.
  • Occupational Therapy: Assists with daily tasks like dressing or bathing.
  • Cardiac Rehabilitation: Provides exercise and education to manage heart conditions.

Medicare Advantage: Your Gateway to Fitness Benefits

Medicare Advantage Plans are an alternative to Original Medicare offered by private insurers. These plans provide all the benefits of Original Medicare, plus exciting extras like fitness coverage.

Impressively, 98% of Medicare Advantage Plans in 2024 offered some form of fitness coverage, including:

  • Gym Memberships: Access to fitness centers for regular workouts.
  • Specific Fitness Programs: Participation in tailored programs like SilverSneakers.

Explore these popular Medicare Advantage fitness program options:

  • SilverSneakers: A renowned program offering access to over 15,000 gyms and online fitness classes specifically designed for seniors.
  • Renew Active: Provides gym memberships, online workout videos through Fitbit Premium, and brain health activities through AARP Staying Sharp.
  • Silver&Fit: Offers gym memberships, personalized training consultations, on-demand exercise videos, and even home fitness kits with some plans.

Finding the Right Plan for Your Needs

Medicare Advantage Plans vary in their benefits. Working with a licensed agent or broker helps you find a plan that aligns with your fitness goals and budget. They can also explain additional benefits like:

  • Grocery Allowances: Helps you purchase healthy foods to fuel your workouts.
  • Fitness Expense Reimbursements: Provides partial or full coverage for eligible fitness-related costs.

Conclusion

Staying active and healthy doesn’t necessitate a gym membership. However, some Medicare Advantage Plans offer fantastic fitness benefits to keep you moving and engaged. Explore your options with a trusted agent and find a plan that fits your needs and budget, allowing you to stay active and on top of your health!tunesharemore_vert

Keeping Smiles Bright and Costs Low with Medicare Options

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Understanding Medicare Coverage for Dentures 768x512 1

Introduction

This guide explores how Medicare and other options can help keep denture costs manageable. Missing teeth are a common concern for many seniors, impacting not just their smile but also their ability to eat and speak clearly. Dentures offer a great solution, restoring function and confidence. However, the cost of dentures can be a major hurdle.

Dentures for Seniors: Benefits Beyond Appearance

  • Improved Chewing: Dentures let you enjoy healthy foods, promoting good nutrition.
  • Clearer Speech: Gaps from missing teeth can make talking difficult. Dentures restore clear communication.
  • Confidence Boost: A bright smile can significantly impact your well-being. Dentures help you feel good about yourself.

Understanding Medicare Coverage for Dentures

  • Original Medicare (Parts A & B): Typically doesn’t cover dentures unless medically necessary.
  • Medicare Advantage Plans (Part C): Offered by private insurers, these plans often include additional benefits like dental coverage, potentially including dentures.

Finding the Right Medicare Advantage Plan for Dentures

  • Dental Coverage: Plans vary in dental coverage details, so compare options to find one that covers dentures.
  • Out-of-Pocket Costs: Consider premiums, deductibles, copays, and coinsurance to find a plan that fits your budget.
  • Annual Out-of-Pocket Maximum: This limits your yearly healthcare spending under the plan.

Working with a Licensed Insurance Agent

A licensed insurance agent can:

  • Explain your Medicare options
  • Compare plans with dental benefits for dentures
  • Help you find a plan that meets your needs and budget

Alternative Coverage Options for Dentures

If a Medicare Advantage plan with dental coverage isn’t ideal, explore these alternatives:

  • Stand-alone Dental Insurance: Provides specific dental coverage, including dentures, but may have out-of-pocket costs.
  • Medicaid: May offer dental benefits for dentures to qualified low-income individuals and families (varies by state).

Keeping Your Smile Bright and Affordable

Dentures can significantly improve your quality of life. By exploring Medicare Advantage plans, stand-alone dental insurance, or other options, you can find ways to manage denture costs. Don’t hesitate to consult a licensed insurance agent for guidance towards a brighter, healthier smile.tunesharemore_vert

Unnamed Insured in Insurance Policies: Who Gets the Payout?

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Who Gets the Payout

Ever wonder who gets the insurance money when you’re not named on the policy? The answer might surprise you. In some cases, even if your name isn’t explicitly listed, you can still benefit from insurance coverage as an “unnamed insured.” This article dives into the world of unnamed insureds, helping you understand your rights and potential benefits.

Who are Unnamed Insureds?

Unlike “named insureds” who are clearly identified in the policy, unnamed insureds are not directly named but can still receive insurance proceeds under certain conditions. They typically fall within a pre-defined category of people covered by the policy.

Common Scenarios for Unnamed Insureds:

  • Construction Projects: In builders’ risk policies, subcontractors might be considered unnamed insureds even if their names aren’t listed. This is because the policy often intends to cover everyone working on the project (e.g., Sylvan Industries v. Fairview Sheet Metal Ltd.).
  • Fire Damage: If an insurance policy covers “relatives living in the house,” those relatives qualify as unnamed insureds with separate benefits that creditors cannot garnish (e.g., Austin Powder Ltd. v. Howard).

Key Points to Remember:

  • Insurable Interest Isn’t Enough: Simply having a stake in the insured property doesn’t automatically make you an unnamed insured. There must be a clear intention on the part of the named insured to include you in the coverage (e.g., Sylvan CA).
  • Burden of Proof Lies with Unnamed Insured: If you believe you’re an unnamed insured, the onus falls on you to prove the named insured intended to provide coverage (e.g., Sooter Studios Ltd. v. 74963 Manitoba Ltd.).

The Takeaway:

Determining your status as an unnamed insured depends on the specifics of your situation and may vary by jurisdiction. However, the principles outlined above provide a solid foundation for understanding this concept.

Here are some additional tips to protect yourself to Gets the Payout:

  • Always review the insurance policy wording carefully. Pay close attention to sections that mention unnamed insureds or additional insureds.
  • If unsure about your coverage, consult a lawyer or insurance professional. They can help you interpret the policy and determine your rights.
  • Consider requesting to be added as an additional insured on relevant policies. This can provide greater peace of mind knowing you’re explicitly covered.

By understanding unnamed insureds, you can ensure you receive the rightful benefits in case of an insured event, even if your name isn’t on the dotted line.

Alberta Court Upholds Clear Wording in Auto Insurance: Public Policy Arguments Fail

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Public Policy Arguments Fail

Surprising Court Decision: Swerving to Avoid Crash May Not Be Covered by Insurance

A recent Alberta court case, Funk v. Wawanesa Mutual Insurance Company (2018 ABCA 200), highlights the importance of clear and concise language in auto insurance policies. This case has implications for drivers across Canada.

The Scenario:

Imagine you’re driving at night. Headlights appear in the oncoming lane, forcing you to swerve to avoid a collision. Unfortunately, your car rolls over. Thankfully, there’s no other car involved, but you’re injured. Here’s the twist: your insurance company might deny coverage, even though you acted safely.

Why the Denial?

Mr. Funk’s insurance company, Wawanesa, argued he wasn’t covered because his policy required physical contact with the other vehicle. The Alberta Court of Appeal agreed. The policy clearly defined an “unidentified automobile” as one that makes physical contact with the insured’s vehicle.

Public Policy vs. Clear Wording:

Mr. Funk argued the “physical contact” requirement was unreasonable and against public policy. The lower court agreed, but the Court of Appeal reversed this decision. They prioritized clear and consistent policy wording, benefiting both insurers and insured parties by ensuring everyone understands what’s covered.

Is There Hope?

One judge dissented, believing the policy wording was ambiguous. They felt Mr. Funk had a reasonable expectation of coverage for his defensive maneuver. The case is now seeking leave to appeal to the Supreme Court of Canada, so the final verdict is yet to come.

Key Takeaways for Drivers:

  • Read Your Policy Carefully: Don’t just skim your auto insurance policy. Pay close attention to sections on unidentified drivers and understand the specific requirements for coverage.
  • Clarity is Key: Don’t assume coverage based on what seems fair. It all boils down to the exact wording in your policy.
  • Seek Help if Unsure: If you’re unsure about coverage scenarios, consult an insurance professional for clarification.

Did Swerving to Avoid a Collision Cost You Insurance Coverage? Alberta Court Says Maybe.

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Avoid a Collision Cost You Insurance

Imagine this: you’re driving at night, and headlights appear in the oncoming lane. You swerve to avoid a crash, but your car ends up rolling over. No one else is involved, but you’re injured. Here’s the twist: your insurance policy might not cover this, even though you were trying to be safe.

A recent Alberta court case highlights the importance of clear language in auto insurance policies. Mr. Funk swerved to avoid a collision but had no coverage because his policy required physical contact with the other vehicle.

The Policy Wording Wins (Alberta Court)

The Court of Appeal sided with the insurance company, Wawanesa. The policy clearly defined an “unidentified automobile” as one that makes physical contact with the insured’s vehicle. The court rejected arguments that this requirement was unreasonable or against public policy. They argued clear and consistent policy wording benefits both insurers and insured parties by ensuring everyone understands what’s covered.

But There’s a Twist…

One judge dissented, arguing the policy wording was ambiguous. They believed Mr. Funk had a reasonable expectation of coverage since he reacted to avoid a collision. The judge felt the policy could be interpreted more broadly based on the “physical evidence” needed to prove the unidentified car’s involvement. This case is now seeking leave to appeal to the Supreme Court of Canada, so the final word is not yet written.

What This Means for You:

  • Read your auto insurance policy carefully, especially sections on unidentified drivers.
  • Don’t assume coverage based on what seems reasonable – it all comes down to the specific policy wording.
  • If you’re unsure about coverage, consult an insurance professional for clarification.

This case is a reminder that clear communication is key in insurance. By understanding your policy, you can avoid unexpected coverage gaps and ensure you have the protection you need when you need it most.tunesharemore_vert

Imagine a scary scenario: you’re driving at night, headlights appear oncoming, and you swerve to avoid a crash. Unfortunately, your car rolls over. Thankfully, there’s no other car involved, but you’re injured. Now, here’s a shocker: your auto insurance might not cover this, even though you acted safely.

A recent Alberta court case sheds light on the importance of clear wording in auto insurance policies. Mr. Funk swerved to avoid a collision but was denied coverage because his policy required physical contact with the other vehicle.

Clear Policy Wording Wins (For Now):

The Alberta Court of Appeal sided with the insurance company, Wawanesa. The policy clearly defined an “unidentified automobile” as one that makes physical contact with the insured’s vehicle. The court prioritized clear and consistent policy wording, arguing it benefits both insurers and insured parties by ensuring everyone understands what’s covered. This approach promotes transparency and avoids confusion.

But Wait, There’s More:

One judge disagreed, arguing the policy wording was ambiguous. They believed Mr. Funk had a reasonable expectation of coverage for his defensive maneuver. This judge felt the policy could be interpreted more broadly based on the need for “physical evidence” to prove the unidentified car’s involvement. The case is now seeking leave to appeal to the Supreme Court of Canada, so the final verdict is yet to come.

Key Takeaways for Drivers:

  • Read Your Policy Carefully: Don’t just skim your auto insurance policy. Pay close attention to sections on unidentified drivers and understand the specific requirements for coverage.
  • Clarity is Key: Don’t assume coverage based on what seems fair. It all boils down to the exact wording in your policy.
  • Seek Help if Unsure: If you’re unsure about coverage scenarios, consult an insurance professional for clarification. Don’t be afraid to ask questions!

When Insurers Must Step Up: Understanding Duty to Defend vs. Duty to Indemnify

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Understanding Duty to Defend vs. Duty to Indemnify

Many businesses rely on insurance to protect them from financial losses. However, when a claim arises, confusion can emerge regarding the insurer’s responsibilities. This article clarifies the key differences between an insurer’s duty to defend and duty to indemnify.

Duty to Defend: Taking on the Fight

  • Triggers when a lawsuit alleges acts covered by the insured’s policy.
  • Broader scope than duty to indemnify – even potentially false claims can trigger a defense.
  • Applies to both primary and excess insurance policies (depending on coverage levels).

How it Works:

  1. Policy Review: The insurer analyzes the policy wording to confirm a “duty to defend” clause exists.
  2. Claim Assessment: The insurer compares the lawsuit’s allegations to the policy’s coverage.
    • “Pleadings Rule”: Even if the allegations seem unlikely, the insurer may still have a duty to defend if they could fall under the policy’s coverage.
    • “True Nature” Test: Courts may look beyond the claim’s wording to assess its actual substance.
  3. Derivative Claims: If a claim solely mirrors another covered claim (e.g., negligence mirroring an intentional tort), it might not trigger a separate defense duty.

Duty to Indemnify: Paying Up

  • Narrower scope than duty to defend – only triggered when proven liability falls under the policy.
  • Insurer pays for settlements or judgments within the policy’s coverage limits.

A Rare Exception:

While the duty to defend usually aligns with the duty to indemnify, there are rare instances where the insurer might indemnify (pay) even without defending.

Key Takeaway:

Clear and concise policy language is crucial. Ambiguity will be interpreted in favor of the insured, potentially expanding coverage.

Action for Insurers:

  • Draft policies meticulously to define the scope of each duty.
  • Use clear exclusionary language if certain claims should be exempt.
  • Be aware of potential scenarios where one duty might exist without the other.

By understanding these distinctions, both insurers and insureds can navigate claims with greater clarity.tunesharemore_vert

Important Update for Property and Casualty Insurers in Canada: OSFI Clarifies Minimum Capital Test Calculations

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Capital Test Calculations

The Situation:

The Office of the Superintendent of Financial Institutions (OSFI) recently released adjustments and clarifications to the 2024 Minimum Capital Test (MCT) for property and casualty insurers in Canada. These changes, effective January 1, 2024, affect the way insurers calculate capital requirements related to unexpired coverage for reinsurance contracts held.

What Changed?

The focus of the adjustments is on how unexpired coverage for reinsurance contracts is factored into the MCT calculations. There are two main updates:

  1. General Measurement Method (GMM): The calculation now excludes premium and reinsurance commission cash flows that are already due when estimating future cash flows for reinsurance contracts held. Essentially, OSFI clarifies that only future cash flows are considered.
  2. Premium Allocation Approach (PAA): Similar to the GMM, the PAA calculation clarifies that “expected premiums payable” and “associated reinsurance commissions receivable” refer only to those amounts not yet due. Payments already due are not factored in.

The Impact:

These changes may lead to either increases or decreases in the capital requirements for some insurers, depending on their specific reinsurance arrangements and calculation methods.

What You Should Do:

Federally regulated property and casualty insurers in Canada are strongly advised to:

  • Review the Amendments: Carefully analyze the details of the OSFI adjustments to understand the potential impact on your company’s capital requirements.
  • Consult with an Actuary: Discuss the changes with your appointed actuary to determine how they affect your specific calculations and ensure compliance with the updated MCT.

Dentons Canada Can Help:

Dentons Canada’s Corporate and Regulatory Insurance Group is here to assist you. We can answer your questions about the revised MCT and provide guidance on applying these changes to your company’s capital requirements.

Don’t wait! Get in touch with Dentons Canada today to ensure a smooth transition under the updated Minimum Capital Test.

New Brunswick Streamlines Pet Insurance Claims Process

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Pet Insurance Claims

Good News for Pet Parents in New Brunswick: Faster Claims for Fido and Fluffy!

Calling all animal lovers in New Brunswick! Great news for your furry (or feathery, or scaly) family members: getting reimbursed for vet bills just got easier. Here’s the scoop:

No More Licensing Headaches!

Previously, anyone handling pet insurance claims needed a full adjuster license, just like car or home insurance adjusters. But let’s face it, Fido’s ear infection is a lot different than a fender bender.

The good folks at the New Brunswick Superintendent of Insurance listened and made a change! Now, adjusters dealing specifically with pet health claims are exempt from needing that license. This means faster claim processing for you and less paperwork for insurance companies.

Faster Help for Your Furry Friend

Think about it: your precious pup needs surgery, and you need to get reimbursed quickly. This new exemption means the claim can move through the system smoother, getting that money back in your pocket faster so you can focus on what matters most – your pet’s health!

Peace of Mind for Pet Parents

While the licensing requirement is gone, there are still safeguards in place. Insurance companies will still make sure the adjusters they work with are qualified and experienced in handling pet insurance claims. You can rest assured your precious companion’s care is in good hands.

Is this the future of pet insurance?

This change in New Brunswick could be a big deal for pet owners across Canada. It shows that regulators are recognizing the growing importance of pet insurance and making things easier for everyone involved. Here’s hoping other provinces follow suit!

So, New Brunswick pet parents, rejoice! This new exemption is a win-win for you and your furry companions. Now you can focus on spoiling your loved ones (with healthy treats, of course!) knowing getting reimbursed for unexpected vet bills won’t be a hassle.tunesharemore_vert

OSFI Strengthens Security and Integrity Requirements for Financial Institutions

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money and security

Recent Updates from Canada’s OSFI

The Office of the Superintendent of Financial Institutions (OSFI) has recently implemented new regulations to ensure stronger security and integrity practices among federally regulated financial institutions (FRFIs) in Canada. These updates include:

  • Final Release of the Integrity and Security Guideline (IS Guideline): Published in January 2024, the IS Guideline outlines OSFI’s expectations for FRFIs to manage risks related to integrity and security, including foreign interference. This final version incorporates feedback received during a public consultation period.
  • Amendments to Guideline B-10 (Third-Party Risk Management) and Guideline B-13 (Technology and Cyber Risk Management): Released in February 2024, these amendments clarify that both guidelines now apply to foreign bank and insurance company branches operating in Canada, aligning them with the new IS Guideline.

Key Requirements of the IS Guideline

The IS Guideline introduces new and expanded expectations for FRFIs, including:

  • Leadership and Culture: Senior personnel must demonstrate good character, and the FRFI’s culture should promote ethical behavior. Codes of conduct and clear communication are essential.
  • Compliance Management: FRFIs should have robust systems to ensure adherence to regulations and ethical standards, considering reputational risks.
  • Whistleblowing: Effective channels for employees and stakeholders to report non-compliance are crucial.
  • Background Checks: Risk-based background checks for employees and contractors are required.
  • Data Security: Data classification and access controls must consider vulnerability to malicious activity and foreign interference.
  • Third-Party Due Diligence: Thorough due diligence is necessary for third parties accessing FRFI resources. Procurement processes should be transparent and objective.
  • Incident Reporting: FRFIs must report incidents of potential undue influence, foreign interference, or malicious activity to law enforcement.

Implementation Timeline

  • IS Guideline Compliance: OSFI will apply expectations proportionally based on FRFI characteristics. FRFIs must assess their risk exposure and implement mitigating actions if they face challenges in meeting the guidelines.
  • Questionnaires: Completed by FRFIs by April 2, 2024.
  • Compliance Plan: Submission of a comprehensive plan outlining interim deliverables to achieve compliance by July 31, 2024.
  • Full Compliance: All new or expanded expectations (except background checks) must be met by January 31, 2025. Background check compliance deadline is July 31, 2025.

Foreign Branches – Important Note

Canadian branches of foreign banks and insurers are now subject to Guidelines B-10 and B-13, with a deadline of March 31, 2025 for adherence to Guideline B-10.

Conclusion

These regulatory updates from OSFI demonstrate Canada’s commitment to a strong and secure financial sector. FRFIs must take necessary steps to comply with the new guidelines and ensure robust integrity and security practices.

Choosing Your Life Insurance Beneficiary: A Guide for Smart Planning

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Life Insurance Beneficiary

Introduction:

Selecting a beneficiary for your life insurance policy is crucial. This article offers valuable insights for navigating this critical decision, ensuring your loved ones receive the financial support intended in your absence.

Body:

  • Understanding Your Purpose:

Life insurance serves a specific purpose. Common scenarios include: * Family Protection: In this case, your spouse is often the ideal beneficiary. * Business Continuity: If you aim to sustain your business, a business partner might be a suitable choice.

  • Beneficiary Options Beyond Spouses and Children:

Life insurance allows flexibility in beneficiary selection. You can designate: * Friends or Significant Others * Godchildren * Charitable Organizations * Trusts * Multiple Beneficiaries (with specified allocation)

Important Note for Community Property States:

Married individuals residing in community property states require spousal consent before naming a non-spousal beneficiary.

  • Consult a Qualified Agent: Our experienced agent can provide personalized guidance on navigating beneficiary selection tailored to your specific situation.
  • The Importance of Secondary Beneficiaries:

Life’s uncertainties extend beyond your own well-being. Consider the possibility of your primary beneficiary predeceasing you. Naming secondary beneficiaries ensures: * Contingency Plan: In case your primary beneficiary is unable to receive the payout. * Control Over Distribution: You have a say in who ultimately receives the death benefit.

  • Why Minors Should Not Be Direct Beneficiaries:

Legally, minors cannot directly handle life insurance proceeds. Appointing a minor as beneficiary leads to: * Court Intervention: A court would appoint a legal guardian to manage the funds, potentially contradicting your wishes.

  • Trust as a Preferred Option:

Establishing a trust for your minor child and naming it as the beneficiary offers greater control: * Appointed Trustee: Choose a trusted individual to manage the funds responsibly until your child reaches adulthood.

  • Keeping Beneficiary Information Current:

Life circumstances can change. Update your beneficiaries upon: * Marriage or Divorce * Children Reaching Adulthood

By following these steps, you can ensure your life insurance policy effectively fulfills its purpose – providing vital financial support to your designated beneficiaries.

Life insurance beneficiary Call to Action:

Contact a qualified agent today to discuss your life insurance needs and receive personalized guidance on selecting the right beneficiaries.