|
Lifetime Maximum
|
Unlimited.
|
|
Reimbursement
|
100% of most eligible expenses subject to maximums and limits; prescription drugs are reimbursed
at the lower of the brand name or generic drug ingredient cost. If no generic drug is available,
the Plan will pay 100% of the brand name drug ingredient cost. Automatic biologic/biosimilar
switching program
|
|
Deductible:
|
Nil. Maximum dispensing fee payable of $9.50 per prescription.
|
|
Out-of-Pocket Maximum:
|
N/A
|
|
Practitioners
|
Chiropractor, Speech Therapist, Osteopath,
Naturopath, Homeopath, and Podiatrist
–
Expenses are reimbursed at 100%, up to a maximum of
$300 annually, per practitioner.
Acupuncture and Massage Therapy
–
Expenses are reimbursed at 50%, up to a maximum of
$300 annually.
Certified Athletic Therapist, Physiotherapist and
Occupational Therapist
–
Expenses are reimbursed at 100%, up to a maximum of
$75 per treatment and $5,000 annually.
Psychologist and Psychotherapist
–
Expenses are reimbursed up to a maximum of $10,000
annually per person, and up to a maximum of $200 per hour.
Please consider using the Plan's member assistance program
for free private counselling.
|
|
Prescription Drugs
|
Reimbursement (as described above) for drugs which by law
require the written prescription of a physician. Includes
oral contraceptives, fertility drugs ($2,500 per family),
diabetic supplies, smoking cessation (100% for 1st course
of treatment up to $400, 50% for 2nd course of treatment
up to $200), erectile dysfunction ($400 per calendar year),
anaesthesia, vaccinations and immunizations (subject to
individual maximums). Over the counter drugs, vitamins or
minerals are not covered. Medical cannabis including
derivates is not covered.
|
|
Ambulance
|
Reimbursement for land ambulance services when used to
transport to the nearest hospital. If ambulance services
provided by air or rail, there is a $500 maximum per
individual, per calendar year.
|
|
Accidental Dental
|
$5,000 per dental accident – work must commence
within 12 months.
|
|
Annual Medical Exam
|
$50 reimbursement to physicians for providing the Plan's "Physician's Confirmation of Annual
Medical Exam" note.
|
|
Audiometric Testing
|
Annual hearing testing or re-testing & custom fitted earplugs.
|
|
Hospital
|
The difference between ward room and semi-private hospital
room. Rehabilitation hospital room allowance is $10 per day
up to a maximum of 100 days of confinement per disability
prior to age 65.
|
|
Medical Services and Supplies
|
Medical equipment and supplies, custom foot orthotics
(maximum $400 per year) and orthopedic shoes (at 50%,
maximum $400 per year), PSA tests, oxygen and oxygen
supplies.
|
|
Hearing Aids
|
$1,500 per 48 month period.
|
|
Private Duty Nursing
|
Up to $10,000 per year.
|
|
Mobility Assistance Equipment Benefit
|
Reimbursement of 75% of the expenses associated with specific mobility equipment and its
installation, subject to a lifetime maximum benefit of $5,000. (member only).
|
|
Age 65 Provincial Plan Benefit
|
$200 annual maximum benefit to reimburse the actual cost
incurred to enroll in the individual's provincially
sponsored health care/medical plan. Covers premium,
deductibles and co-payments.
|
|
Travel Costs related to Medical Treatment
|
Reasonable expenses associated with travelling at least
100km to receive medically necessary treatment otherwise
unavailable. 80% of such expenses are reimbursed for
members or eligible dependants, subject to a lifetime
family maximum benefit of $1,000. Includes accommodation,
meal and gas/travel expenses.
|
Markham, Ontario
Edmonton, Alberta