|
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.
|
|
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.
|
|
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