Your plan will pay for the usual cost of covered services and supplies that are medically necessary to treat an illness, injury, or pregnancy and incurred in Canada by a recognized practitioner/provider.
It will cover;
- The amount that is usually charged for the service or supplies in the area in which the charge is made.
- Services and supplies that are needed to diagnose or treat an illness, injury, or pregnancy and that are recognized by the Canadian Medical Association as effective and appropriate and based on accepted standards of Canadian health care and the Canada Revenue Agency.
- Services and supplies that the private plan are legally allowed by the government. The plan will not cover services or supplies that are covered by the government plan in your home province.
- Charges for services and supplies that are incurred while the person is covered under this plan.
Supplemental Health Care
Deductible |
NIL |
| Prescription Drugs | 100% for Lowest Generic and Biosimilar equivalent- effective Jan 1, 2023
(brand name ONLY covered to lowest generic version cost-NO exceptions) |
| Dispensing Fee Cap | $8 per prescription / $1000 per year |
| Maximum | $10,000 per person per calendar |
| Extended Health Care Overall Annual Maximum |
100% – some inner limits. See Benefit Description coverage details. |
| Health Practitioners | $1,000 per person combined for all practitioners combined per calendar year. See Benefit Description coverage details. |
| Mental Health Practitioners (Psychologist, Social Worker, Psychoanalyst, Psychotherapist) | A combined maximum of $1,500 per person per calendar year for all practitioners combined in this category. |
| Vision Care Expenses | Corrective glasses or contact lenses, prescription sunglasses, prescription safety glasses, laser eye surgery, and eye examination up to a combined maximum of $600 per person every 24 months.
Note: Eye Examination is limited to $125 every 24 months. |
| Private Duty Nursing | $10,000 per person per calendar year |
| Accidental Dental | $5,000 per accident |
| Orthopedic Shoes and Custom-Made Orthotics | A combined maximum of $300 per person per calendar year (when prescribed by a physician, podiatrist, or chiropodist) |
| Ambulance Services (Air, Ground Ambulance) | $1,000 per calendar year $200 per calendar year |
| Hearing Aid | $500 per ear to an overall combined maximum of $1,000 every 5 consecutive years |
| Medical Equipment and Supplies | A combined maximum of $3,000 per calendar year. See Benefit Description for coverage details. |
Dental Care
| Fee Guide | Current year minus 1 year for General Practitioners and Specialists in the employee’s province of residence. |
Deductible |
NIL |
| Coinsurance | |
| Basic Services | 85% |
| Major Restorative | 85% |
| Orthodontics | 50% |
| Maximums |
|
| Basic & Major Restorative | A combined maximum of $2,000 per calendar year |
| Orthodontics | $2,000 per lifetime |
| Recall Exam | Once every 9 months |