Reimbursement:
Coverage is based on reasonable and customary charges.
Percentage Payable:
100%, except 50% for orthopedic shoes that do not form part of a brace or splint
Deductible:
Nil
Lifetime Maximum Benefit:
$250,000 per individual for healthcare
Drugs:
100% with a $6.50 dispensing fee maximum and a calendar year maximum of $250,000
Lifetime Maximums:
Fertility Drugs to $2,500 per lifetime
Zyban or Champix to $500 per lifetime
Private/Semi-Private Hospital:
None
Ambulance Benefit:
One trip per disability
Out of Hospital Nursing:
$5,000 maximum per calendar year (prior approval required)
Accidental Dental:
Considered as an Extended Health Care Benefit, Unlimited if treated one year from accident
Health Practitioners Benefit:
Accredited Chiropractor, Physiotherapist, Speech Therapist, Occupational Therapist, Acupuncturist, Chiropodist/Podiatrist, Dieticians, Nutritionists and Registered Massage Therapist: $70 per visit to a maximum of $700 per practitioner per calendar year. Where applicable, X-Rays are covered to a maximum of $20 per calendar year for all specialties combined.
Licensed Clinical Psychologist (effective May 1, 2016), Psychotherapist and Social Worker (effective July 1, 2020): $150 per visit per practitioner to a combined maximum of $2,000 per calendar year.
Orthopedic Shoes Or Orthotics, Combined:
One pair every 3 years to a maximum of $300
Hearing Care Benefit:
$2,000 every 2 years, excludes repairs or batteries (effective November 1, 2022)
Durable Medical Equipment & Supplies:
Rental of a Wheelchair, Hospital Bed or Breathing Machine
Rental is limited to a maximum of 3 months
Breast Prosthesis:
Every 2 calendar years
Surgical Brassieres:
2 per calendar year
Surgical Stockings:
2 pairs every 12 consecutive months
Wigs:
Once per lifetime
Glucometer:
Once per lifetime
FreeStyle Libre & Dexcom G6 and G7 Glucose Monitor and Sensors:
Combined calendar year maximum of $4,000 for all insulin-dependent insured individuals (effective March 1, 2024)
