|
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.
|
|
Practitioners
|
Chiropractor, Speech Therapist, Osteopath,
Naturopath, Homeopath, and Podiatrist
-
Expenses are reimbursed at 100%, up to a maximum of
$400 annually, per practitioner.
Acupuncture and Massage Therapy
-
Expenses are reimbursed at 50%, up to a maximum of
$500 annually.
Certified Athletic Therapist, Physiotherapist and
Occupational Therapist
-
Expenses are reimbursed at 100%, up to a maximum of
$100 per treatment and $5,000 annually.
Psychologist
-
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.
Automatic biologic/biosimilar switching program.
|
|
Deductible
|
Nil. Maximum dispensing fee of $9.50 per prescription.
|
|
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.
|
|
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 for each 48 month period.
|
|
Private Duty Nursing
|
Up to $10,000 per year.
|
|
Mobility Assistance Equipment Benefit
|
Member only reimbursement of 75% of the expenses associated
with specific mobility equipment and its installation.
Subject to a lifetime maximum benefit of $5,000.
|
|
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 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
maximum benefit per family of $1,000. Includes
accommodation, meal and gas/travel expenses.
|
Markham, Ontario
Edmonton, Alberta