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Lifetime Maximum
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$50,000 per covered person.
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Calendar Year Maximum
|
After the lifetime maximum is reached, there is a maximum
calendar year benefit of $5,000.
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Reimbursement
|
100% of most eligible expenses subject to maximums and
limits below. 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.
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Practitioners
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Massage Therapist
-
Expenses are reimbursed at 50%, up to a maximum of $500
per person per year.
Podiatrist
-
Expenses are reimbursed at 100%, up to a maximum of $400
per person per year.
Certified Athletic Therapist / Physiotherapist
-
Expenses are reimbursed at 100%, up to a maximum of $250
per person per year. Maximum per treatment is $100.
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.
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Prescription Drugs
|
Reimbursement (as described above) for drugs which by law
require the written prescription of a physician. Includes
oral contraceptives, diabetic supplies, smoking
cessation(1st treatment maximum of $400 at 100%, 2nd
treatment maximum of $400 at 50%; lifetime maximum of $600),
erectile dysfunction ($400 per calendar year maximum),
anesthetics, vaccinations and immunizations (subject to
individual maximums). Over the counter drugs, vitamins or
minerals are not covered. Medical cannabis including
derivates is not covered.
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Deductible
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No deductible but there is a maximum dispensing fee payable
of $9.50 per prescription.
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Hospital
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$5,000 semi-private hospital room per year.
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Ambulance
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Land/air/rail up to $200 per calendar year.
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Medical Services and Supplies
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Oxygen and supplies, PSA tests.
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Private Duty Nursing
|
$10,000 per calendar year.
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Hearing Aids
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$1,500 for each 48 month period.
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Mobility Assistance Equipment Benefit
|
Member only reimbursement of expenses associated with
mobility equipment and installation. Wheelchair lift, stair
lift, ramp, ceiling hoist, elevator. Subject to a lifetime
maximum of $5,000.
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|
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.
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|
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.
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Markham, Ontario
Edmonton, Alberta