The Members’ Health Plan covers a wide range of medical services and supplies beyond what your provincial health plan provides. The benefits provided by the Plan are summarized below. It is important to take the time to learn about how the Plan can protect your financial, physical and mental well-being.
Deductibles and benefit maximums apply individually to each eligible member of your family. Reimbursements will not exceed the reasonable and customary charges, as determined by the insurer.
Below is a general summary of your health benefits. For more details contact the Members’ Health Plan.
- 100% coverage for a wide range of in-Canada medications.
- 75% coverage for Special Authorization drugs.
- $5 deductible per prescription
- 80% coverage up to benefit maximum.
- Maximum $500 coverage per calendar year for each of the following: massage therapist, physiotherapist/athletic therapist, naturopath, acupuncture, chiropractor, audiologist, dietician, podiatrist/chiropodist, occupational therapist, osteopath and speech therapist.
- Maximum $700 coverage per calendar year for psychologist/social worker.
- Eye exam – Maximum $125 every 12 months for dependent children under age 21.
- Eye exam – Maximum $125 every 24 months for you, your eligible spouse and/or dependent children age 21-25.
- Vision services and supplies – Maximum $400 every 24 months.
Diabetic Supplies & Equipment
- 80% coverage, up to benefit maximum.
- Blood-glucose monitoring machine – Maximum 1 every 4 years.
- Insulin infusion pump – Maximum $6,300 every 5 years.
- FreeStyle Libre monitor – No maximum.
- Diabetic supplies, including those listed under Prescription Drugs – Maximum $2,000 in a calendar year.
Ambulance and Hospital Room
- 100% coverage for ambulance service – no benefit maximum.
- 100% coverage for semi-private hospital room – no benefit maximum.
Out-of-Country Medical Expenses and Travel Assistance Coverage
- Emergency care – 100% coverage for expenses required as a result of a medical emergency outside of Canada.
- Travel Assistance – Provides support and benefits for travellers in emergency medical situations worldwide.
Chronic Care, Respite Care, Private Duty Nurse
- 100% coverage for chronic care and respite care – $20 per day to a maximum of 90 days.
- 100% coverage for private duty nursing – Maximum $25,000 every 3 years.
Medical Travel in Canada
- $2,000 lifetime maximum.
- Round trip distance must be 1,000 kilometres or more.
Medical Supplies, Appliances and Equipment
- 80% coverage, up to benefit maximum (must be prescribed by a physician).
- Hearing aids – Maximum $1,200 every 4 years.
- Custom-made orthopedic shoes and orthotics (prescribed by a physician or podiatrist) – Maximum $500 each calendar year. (Invoice must include a detailed description of the type of orthotics, the casting technique used and the date dispensed. A copy of the detailed biomechanical exam or gait analysis is also required).
- Custom-made compression hose – Maximum $500 each calendar year.
- Hairpieces (required as a result of a medical condition) – Maximum $1,000 every 2 calendar years.
- External breast prosthesis – Maximum 1 (per side) every 12 months.
- Surgical brassieres – Maximum 2 every 12 months.
- Mechanical or hydraulic patient lifters (excluding stair lifts) – Maximum $2,000 per lifter (electric) once every 5 years.
- Outdoor wheelchair ramps – $2,000 lifetime maximum.
- Transcutaneous nerve stimulators – $700 lifetime maximum.
- Extremity pumps for lymphedema – $1,500 lifetime maximum.