EXTENDED HEALTH BENEFITS



This benefit is designed to provide coverage for ambulance services and hospital accommodation in your Province. The Plan also supplements the provincial Medicare coverage by reimbursing necessary and reasonable health expenses that are not covered by the Provincial Plans.

Under this Plan, members will be reimbursed for reasonable and customary expenses, subject to the deductible (where applicable), for the following services:

Extended Health Benefits Deductible

The deductible is $50 (Single or Family) and is applied as $25 to the first Eligible Extended Health Benefits and Vision Care expenses and $25 to the first Prescription Drug Charge each calendar year. Not more than $50 will be applied against the combined expenses of the member and their dependents during any one calendar year. The deductible does not apply to ambulance and hospital charges incurred in Canada.

Ambulance Benefits

The cost for emergency ambulance service is covered from the place where accident or sickness occurs to the nearest hospital where appropriate treatment can be provided.

Air ambulance allowances will be paid up to the amount equivalent had the services been provided by ground ambulance.

Non-emergency trips are covered on the prior recommendation of an attending Physician.

Charges for 'non-emergency' transport by a participating medical transfer service are covered to a lifetime maximum of $250 per person.

Athletic Therapy

Services of a certified Athletic Therapist when prescribed by a Physician to a maximum of $100 per person per calendar year.

Audiologist

Charges for the services of an Audiologist including audiological assessment, communications assessment, site of lesion assessment and audiological review to a maximum of $350 per person per calendar year. Services relating to hearing aid dispensing are not covered.

Cardiac Rehabilitation

A lifetime maximum of $300 for patients with diagnosed cardiac disease that require the services of a recognized cardiac rehabilitation program, when prescribed by the attending Physician.

Chiropractor

Services of an Authorized Chiropractor to a maximum of $350 per person per calendar year.

Clinical Psychology

Services of a Provincial registered Clinical Psychologist to a maximum of $350 per person per year.

Colostomy Supplies

Charges for the cost of colostomy and ostomy supplies.

Dental Treatment - Accidental

Charges for dental treatment rendered by a Dental Surgeon, where as a result of accidental injury (and not by an object wittingly or unwittingly placed in the mouth), natural teeth have been damaged or a fractured or dislocated jaw requires setting. Dental treatment so required must be commenced within ninety (90) days of the Accident.

Drugs (90% Reimbursement)

Drugs (including oral contraceptives), serums, injectibles and insulin purchased on the written prescription of a Medical Practitioner and dispensed by a Licensed Pharmacist. To be eligible, these drugs or medicines must be listed on a Provincial Pharmacare Formulary, or on a formulary developed by Blue Cross. Fertility, and erectile dysfunction drugs are not covered. Benefits payable will be integrated with those available from any government Provincial Drug Plan. Not more than a 100 day supply will be paid.

Smoking Cessation Products

Charges for smoking cessation products, as approved by Blue Cross, which are either prescribed by a Physician or sold over the counter and dispensed by a Pharmacist up to a lifetime maximum or $400 per Subscriber.

Foot Care

Charges for diagnosis and treatment (including diagnostic x-ray examinations) by a licensed Podiatrist; and charges for a Certified Foot Care Nurse. Payment is subject to a combined maximum of $300 per person per calendar year and is also subject to per visit maximums.

Hearing Aids

Charges for the cost of hearing aids when prescribed by a Otologist or Clinical Audiologist to maximum of $300 per person per calendar year. Charges for repair, maintenance, batteries or recharging devices, are not eligible expenses.

Hospital Benefits

If you are hospitalized due to sickness or injury on the recommendation of a Physician and receive semi-private/private accommodation, the difference between the standard ward rate and the semi-private/private rate in your Province of Residence will be paid.

Hostel Accommodation

Payment of the reasonable and customary per diem charge for hostel accommodation if, on the recommendation of a Physician, you require diagnostic testing or treatment, at a Hospital more than 60 km from your residence and are placed in a recognized medical hostel associated with the Hospital.

Licensed Massage Therapist

Charges for the services of a Licensed Massage Therapist to a maximum of $350 per person per calendar year. Receipts are to include Association and License number.

Medical Appliances

Charges for rental, purchase or repair of:

• an iron lung, wheelchair, respirator, hospital bed or oxygen equipment or respirator when prescribed by the attending Physician, to a lifetime maximum of $1000 per item per person. Prior approval must be obtained.

• walkers when prescribed by the attending Physician

• other medical equipment including CPAP when prescribed by the attending Physician to a maximum of $300 per member per calendar year. Prior approval must be obtained.


Naturopath

Charges for the services of an authorized Naturopath to a maximum of $350 per person per calendar year.

Nutritional Counseling

Charges for the services of an authorized Registered Dietitian when prescribed by a Physician to a maximum of $350 per person per calendar year.

Orthopedic Shoes and Modifications to Orthopedic Shoes

Charges for orthopedic shoes custom made from a mould, or stock shoes which are modified (excluding orthotics or insoles, removable or permanently affixed) to accommodate, relieve or remedy a foot defect or abnormality. Payment is limited to one (1) pair per calendar year per subscriber.

Charges for orthopedic shoe modifications (excluding orthotics or insoles, removable or permanently affixed) to accommodate, relieve or remedy a foot defect or abnormality.

A copy of a prescription from the attending Physician, including a medical diagnosis along with a detailed description of the orthopedic shoe and modification(s) is required.

Boots, sandals or sport specific footwear are not eligible.

Orthotics

Charges for orthotics when prescribed by the attending Physician, Occupational Therapist, Physiotherapist or Podiatrist to a maximum of $300 per person per calendar year.

Osteopath

Charges for the services of an authorized Osteopath to a maximum of $350 per person per calendar year.

Physiotherapy/Acupuncture

Charges for the services of a physiotherapist or Acupuncturist for diagnosis and treatment, for a combined maximum of $350 per person per calendar year.

Private Duty Nursing

Charges for private duty nursing or home visits by a professional registered nurse (not a relative), either in the hospital or home when prescribed by the attending Physician, up to a maximum of $3,000 per calendar year. Visits to the home must be within 12 months following discharge from the hospital and the service must be consistent with the treatment for the condition for which the patient was hospitalized.

Prosthetic and Remedial Equipment

Upon the prescription of the attending Physician. charges for purchase or repair of:

• artificial limbs and eyes, crutches, canes, splints, casts, trusses, braces, lumbar-sacro supports, corsets, traction equipment, cervical collars and compression garments

• breast prosthesis and surgical bras to a maximum of $100 per single prosthesis or bra or $200 per double prosthesis or bra per person per calendar year

• wigs or hairpieces to a lifetime maximum of $1000 per person.

Reflexology

Charges for the services of a Reflexologist to a maximum of $50 per session to a maximum benefit payment of $350 per person per year.

Speech Therapist

Charges for the services of an authorized Speech Therapist to a maximum of $350 per person per calendar year.

Travel Health Care

You and your eligible dependents are entitled to reimbursement for charges for medical, surgical and hospital services resulting from an emergency, injury or illness while travelling out of the province to a maximum of $2,500 per person per calendar year.

In addition, if you are under age 70, you and your eligible dependents have UNLIMITED Travel Health coverage, see Here.

X-rays

X-Rays when ordered, but not taken by Physiotherapists, Chiropractors, Naturopaths and Podiatrists.

Exclusions and Limitations

If you are hospitalized prior to the effective date of your coverage, you will not be entitled to benefits until the first of the month following 30 days after your discharge from the hospital

Manitoba Blue Cross is not responsible for the availability or provision of any of the services described herein.

Manitoba Blue Cross is not responsible for any semi-private or private hospital room charges which, in the absence of this or similar coverage would not be charged.

Manitoba Blue Cross shall not pay for the following:

• Any drug or medicine not listed in the applicable Provincial Drug Plan Formulary or Blue cross Formulary regardless of whether the prescription has been issued by a Physician.

• Dental Implants

• Orthodontic Services

• Any drugs or medicines in excess of a 100-day supply.

• Services provided by a close relative of the member.