|
Plan Item |
Coverage Level |
|
Health Care |
Plan 84500 |
| Maximum |
Unlimited life maximum |
| Deductible |
$75 per year |
| Prescription drugs |
80% |
|
Licensed
ambulance |
100% |
Osteopath, podiatrist,
chiropodist,
chiropractor, speech therapist,
naturopath, acupuncturist, VON |
100% to a combined maximum
of $1,500 per year. (Each discipline cannot
exceed $500 per calendar year).
100% to a maximum of $500 per year |
| Physiotherapist |
100% |
| Psychologist |
100% to a maximum of $1000 per
year |
| Mammary prostheses |
100% to a maximum of $200 per
year |
| Elastic support stock |
$50 per year at 100% |
| Hospital stay |
100% semi-private |
| Outside Canada |
100% to a maximum of 180 days |
| Orthopedic shoes |
100% of reasonable and customary
charges
for 1 pair per year |
| Wheelchair |
100% of reasonable and customary
charges |
| Hearing aid |
100% to a maximum of $1000
every five years |
| Dental accident (repair teeth) |
100% |
| ManuAssist -
(Out-of-country Emergency Travel Coverage) |
100%
Lifetime maximum of $1,000,000 |
| Vision Care |
$225 at 100% with a
prescription change
$250 at 100% with a
prescription change in any 18 month period
for persons under age 18, and in any 24
month period for persons age 18 and over. |
| Under 18 |
18 months |
| Age 18 & over |
24 months |
| Ophthalmologist |
$25 per 2 years at 100% |
