Options
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Basic plan
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Standard plan
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Enhanced plan
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Prescription drugs3 |
Reimbursement
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60%
100% of dispensing fee up to $5
|
70% of the first $7,000 of expenses
100% on the next $93,000
|
80% of the first $5,000 of expenses
100% on the next $95,000
|
Annual maximum
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$750
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$100,000
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$100,000
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Deductible (the amount you pay)
|
None
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None
|
None
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Fertility drugs/contraceptives
|
No
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No
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Yes
(oral contraceptives only)
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Smoking cessation medication
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Up to $250 lifetime maximum
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Up to $250 lifetime maximum
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Up to $250 lifetime maximum
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Pay-Direct drug card
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Yes
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Yes
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Yes
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Exclusions
(exclusions apply to Basic, Standard and Enhanced plans)
|
Drugs used to treat infertility, erectile dysfunction, or obesity
Dietary supplements, vitamins and infant foods
Cost of giving injections, serums, vaccines
Contraceptives (other than oral in the Enhanced plan)
Over-the-counter products to help with quitting smoking.
|
Extended health care
These services must be medically necessary and within reasonable and customary charges. A provincially authorized medical professional must prescribe them. |
Reimbursement
|
60%
$25 per visit and calendar year maximum of $250 for each practitioner
|
100%
Up to $300 each calendar year for each practitioner
|
100%
Up to $400 each calendar year for each practitioner
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Deductible
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None
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None
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None
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Accidental dental
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$2,000 for each fracture or injury
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$2,000 for each fracture or injury
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$2,000 for each fracture or injury
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Air ambulance services
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Yes
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Yes
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Yes
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Hearing aids
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$400 every five years
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$400 every five years
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$400 every five years
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In home nursing (by RNs, RPNs, RNAs, CNAs or LPAs)
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No
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$5,000 each calendar year
$25,000 lifetime maximum
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$10,000 each calendar year
$30,000 lifetime maximum
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Medical services and equipment
|
$2,500 each calendar year
$20,000 lifetime maximum
|
$5,000 each calendar year
|
$5,000 each calendar year
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Wigs and/or hair pieces
|
$100 each calendar year
|
$500 lifetime maximum
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$500 lifetime maximum
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Orthopedic shoes and orthotics
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$150 each calendar year
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$200 each calendar year
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$200 each calendar year
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Blood glucose monitor
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$150 every 5 years
|
$300 every 5 years
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$300 every 5 years
|
Splints and crutches, braces and/or casts
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Yes
|
Yes
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Yes
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Wheelchairs, walkers, traction kits
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$1,000 lifetime maximum only applicable for wheelchair
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$4,000 lifetime maximum only applicable for wheelchair
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$4,000 lifetime maximum only applicable for wheelchair
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Hospital bed
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Yes
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$1,500 lifetime maximum
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$1,500 lifetime maximum
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Prosthetic appliances
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Yes
|
Yes
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Yes
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Breast prosthesis
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No
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$200 each calendar year
|
$200 each calendar year
|
Exclusions
(exclusions apply to Basic, Standard and Enhanced plans)
|
Services of a homemaker or home service worker
Items solely for athletic use
Dental expenses that aren’t accidental or aren’t to natural teeth
User fees
|
Semi-private hospital room (in Canada) |
Reimbursement
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n/a
|
85%
$200 each day
$5,000 annual maximum
Convalescent hospital:
- $20 daily maximum; 180 days for each incident
- If you are pregnant when you apply, we will pay up to two days of hospitalization due to pregnancy
|
85%
$200 each day
$5,000 annual maximum
Convalescent hospital:
- $20 daily maximum; 180 days for each incident
- If you are pregnant when you apply, we will pay up to two days of hospitalization due to pregnancy
|
Major exclusions
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n/a
|
Expenses that aren’t medically necessary
|
Expenses that aren’t medically necessary
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Emergency travel medical |
Eligibility
|
n/a
|
Up to age 80
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Up to age 80
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Reimbursement
|
n/a
|
100%
$1 million lifetime maximum
Pre-existing conditions not included
|
100%
$1 million lifetime maximum
Pre-existing conditions not included
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Trip length
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n/a
|
60 days each trip
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60 days each trip
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Travel assistance
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n/a
|
Toll-free number for emergency assistance services
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Toll-free number for emergency assistance services
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Emergency payment assistance
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n/a
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Yes
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Yes
|
Repatriation
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n/a
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Yes
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Yes
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Vehicle return
|
n/a
|
Yes
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Yes
|
Major exclusions
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n/a
|
Services that are not immediately required or which could wait until return home
Related illness or injury after the emergency has ended
Services rendered after you could have returned home (based on medical evidence)
Injury, illness or complications if you refused recommended medical services
Injury or illness related to or resulting from travel for medical treatment
Emergencies more than 60 days after leaving your home province
Regular treatment of a chronic injury or illness
Pre-existing medical condition. This means that you had symptoms or needed treatment in the nine months before you left your home province. This includes changes in medication or doses
Due to pregnancy and incurred within four weeks of the expected delivery date
For a child born outside of Canada, until their coverage is in effect or they return to Canada (whichever is later)
Incurred on an non-emergency referral basis
|
Vision care
(Prescription eyeglasses, contact lenses, prescription sunglasses, laser eye surgery) |
Reimbursement
|
No
|
100%
|
100%
|
Maximum
|
No
|
$150 every 2 years; every year for dependants under 18
|
$200 every 2 years; every year for dependants under 18
|
Eye exams
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No
|
$50 every 2 years; every year for dependants under 18
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$50 every 2 years; every year for dependants under 18
|
Waiting period
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No
|
1 year
|
1 year
|
Dental – preventive |
Reimbursement
|
60%
|
70%
|
80%
|
Annual maximum
|
$750 each calendar year
|
$750 each calendar year
|
$750 each calendar year
|
Waiting period
|
3 months |
3 months |
3 months |
Exclusions
(exclusions apply to Basic, Standard and Enhanced plans)
|
Lost, stolen, misplaced appliances, dentures and space maintainers
Full mouth reconstructions for vertical dimension correction or for correction of temporomandibular joint dysfunction
Expenses incurred for the treatment of malocclusion or for orthodontic treatment
Services rendered in conjunction with surgical services payable under a government plan
Services needed due to congenital malformation
Charges for missed appointments
Charges for completing claims forms
|
Dental – restorative |
Reimbursement
|
n/a
|
n/a
|
50%
|
Annual maximum
|
n/a
|
n/a
|
$500 annual maximum
|
Waiting period
|
n/a
|
n/a
|
1 year
|
Dental – orthodontics |
Reimbursement
|
n/a
|
n/a
|
60%
|
Lifetime maximum
|
n/a
|
n/a
|
$1,500
|
Waiting period
|
n/a
|
n/a
|
2 years
|