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Extended Health Care Insurance Benefits

Extended Health care includes additional non drug related health related insurance benefits. This can include but is not limited to vision care, paramedicals, hospitalization and related services.

Vision Care

This benefit provides coverage for eye examinations, eyeglasses and contact lenses. Typically a plan provides coverage of $200 for a period of 24 consecutive months. Eye examinations are also usually covered up to one examination per year per dependent child and one examination every two years for adults.

Professional Services 

Refers to the costs, up to an annual amount, for various licensed paramedical specialists such as psychologists and masseurs when referred by a doctor, speech therapist, physiotherapist, osteopath, chiropractor, naturopath, acupuncturist, podiatrist and chiropodist.

Private Duty Nursing

Coverage typically ranges from $5,000 to $25,000 per calendar year for the services of a registered nurse, registered nursing assistant, certified nursing assistant or licensed practical nurse who administers care in the claimant's home. The services must be made on the recommendation of a physician.

Accidental Dental

This coverage provides for the reimbursement of dental expenses incurred as a result of an accidental injury, external to the mouth.

Convalescent Hospital Care

Provides coverage in excess of the ward rate plus user fees for active treatment or convalescent care provided by a nursing home. Typically, the maximum amount eligible for reimbursement is $20 per day for up to 180 days of continuous confinement.

Ambulance Service

This service supplements government-sponsored benefit programs by covering charges in excess of the amount payable under the provincial health insurance plan for ambulances including an air ambulance.

Medical Supplies and Equipment

Reimbursement for supplies and the rental of or purchase of durable medical equipment including:

• Hospital beds, wheel chairs, canes, crutches, walkers and trusses;
• Prostheses, braces for back, neck, arm or leg;
• Oxygen and oxygen supplies;
• Colostomy apparatus and supplies;
• Ileostomy apparatus and supplies;
• Insulin syringes;
• Orthopaedic shoes and orthotics;
• Support hose and compression stockings;
• Kidney dialysis equipment;
• Hearing aids.

There are two basic methods of reimbursing drug claims:

• Reimbursement plans, where the person insured pays the service provider for the services provided and submits the bill to the insurer for reimbursement.
• Pay direct benefit cards, where the person insured presents his/her benefit card to the service provider who, in turn, bills the insurer directly.