Extended Health Care
The Benefit year is from January 1st to December 31st.
Ambulance Services
The plan will cover the cost of a licensed ambulance or other emergency services, (including air ambulance), that transports the insured person to and from the nearest hospital that is able to give the necessary treatment. This covers travel between hospitals.
The plan will cover up to $200 per person per calendar year towards local ambulance services, and up to $1,000 per calendar year for an air ambulance.
Paramedical Practitioner
100% up to a combined annual maximum of $1,000 per person for all paramedical specialists listed below:
- Acupuncturists
- Chiropodists / Podiatrists
- Chiropractors, including X-ray
- Correactologists
- Massage Therapists
- Limited to $90 per visit, and a referral is required
- Naturopaths
- Osteopaths
- Physiotherapists
- Speech Therapists
Mental Health Practitioner
100% up to a combined annual maximum of $1,500 per person for all practitioners listed below:
- Psychologist / Social Worker Counselling
- Psychoanalyst / Psychotherapist
These practitioners must be registered in the province where the service is given, be performing a service for which their registration applies, and cannot be a person who normally lives with you nor be a person related to nor a member of your immediate family.
Vision Care
Coverage includes eye examinations, prescription eyeglasses, contact lenses, laser eye surgery, prescription sunglasses, and prescription safety glasses when prescribed by an ophthalmologist or optometrist: to a combined maximum of $600 per person every 24 months.
Note: Eye examination is limited to a maximum of $125 every 24 months.
Registered Nurses
The plan will cover these services to a maximum of $10,000 per calendar year.
Services provided by a Registered Nurse, Registered Nursing Assistant, or Registered Practical Nurse must be approved by NexgenRx in advance. These services must be provided in the insured person’s home by a Registered Nurse, Registered Nursing Assistant, or Registered Practical Nurse who does not normally live with, is not related to, nor is a member of the insured person’s immediate family.
The plan will not cover the cost of a Registered Nurse, Registered Nursing Assistant, or Registered Practical Nurse if the care they provide is not the skilled duties that only they can provide. We will also not cover the cost of care from a Registered Nurse, Registered Nursing Assistant, or Registered Practical Nurse that is provided in a nursing home, rest home, home for the aged, hospital, or any facility that provides similar care.
Medical Equipment and Appliances
The plan has an annual combined maximum of $3,000 for medically necessary services and equipment.
The plan covers the cost of out-patient supplies obtained from a hospital or surgical supply company in your home province. It will also cover the cost to rent or purchase therapeutic equipment. If NexgenRx determines that purchasing is more economical than renting, NexgenRx must approve the purchase before it is made.
The plan will pay a reasonable and customary fee for the least expensive device that is medically adequate.
Note: Medical Supplies and Appliances require a doctor’s referral.
The following durable equipment is covered and is subject to any applicable deductible, coinsurance, and maximum as outlined in the Summary of Benefits;
- Artificial limbs and eyes and other approved prosthetic devices
- Bathroom Aids (including grab bars)
- Blood Glucose monitors
- Braces (rigid or semi-rigid)
- Breast prosthesis post-mastectomy, including replacement(s), one every 2 calendar years, and one surgical bra every 3 months
- Burn Garments
- Casts
- Custom supplies for cystic fibrosis, parkinsonism, diabetes, and heart disease
- Custom-made orthopedic shoes and custom-made orthotics prescribed by a physician, podiatrist, or chiropodist, providing the diagnosis and deem necessary for everyday living and not just for sports and recreation, and dispensed by a Podiatrist/Chiropodist, Orthotist, or Pedorthist. A combined maximum of $300 for every calendar from the last date of purchase. Proof of a biomechanical assessment/ gait analysis performed by a licensed practitioner is required.
The cost of adjustments/modifications is also covered, and such costs are included in the combined annual maximum stated.
Note: Please contact your Benefits Coordinator or NexgenRx. to find out how to submit orthotic claims.
- Extremity pumps for Lymphedema
- Femtens
- Hearing aids and repairs (excluding batteries) up to a maximum of $500 every 5 consecutive years (60 months) per ear. A combined maximum of $1,000 every 5 consecutive years (60 months)
- Hospital beds, wheelchairs, and other temporary therapeutic equipment
- Jobst Sleeves
- Jobst Extremity Pump
- Mobile Aids (including walkers, crutches, and canes)
- Mobile Aid Supplies
- Ostomy/Ileostomy/Colostomy supplies
- Phototherapy equipment and maintenance. Proof that equipment is deemed medically necessary.
- Prosthetic supplies and repairs
- PSA tests
- Respiratory equipment and supplies, such as:
- Aero Chambers, Apnea Monitors
- CPAP machine and supplies, masks limited to 2 per calendar year up to a maximum of $350 for each mask.
- Compressors, Nebulizers to administer asthma medication and.
- Oxygen and Oxygen equipment
- Transcutaneous electrical nerve stimulation (TENS machine)
- Seating devices are limited to children with cerebral palsy
- Surgical or support stockings or compression hose up to 4 pairs every calendar year
- Speech Aids
- Splints
- Synvisc or Neovisc
- Wigs following chemotherapy or radiation up to $200 per person lifetime