Extended Health Coverage Plans is in place for supplementing your existing health and medical insurance provided by your Provincial Government. This medicare coverage aims to provide insurance for services, treatment and procedures that are not covered by your Provincial healthcare plans. It is to supplement insurance for Medicaid as well as Medicare. This coverage is available for hospital fees, drugs, medical supplies and equipment, services of paramedics, as well as coverage out-of-province and other medical benefits.
These health-insurance plans and health-care-services often have deductibles, coinsurance factors and maximums. Different coinsurance factors are applicable for different benefits. All the benefits which are covered under this health plan are discussed as follows.
Basic hospital and surgical expenses that you may have incurred during a visit to the hospital are covered by your Provincial healthcare plans. These include accommodations at the ward of the hospital, physician services, services of surgeons, diagnostic procedures that are medically necessary, as well as drugs administered in the hospital. If you are insured and a beneficiary of this medicare supplement insurance, you can obtain accommodation of private or semi-private types if it is available.
Prescription drugs are an important part of health care costs. They account for 60-80% of total medical insurance claims. There is medicare prescription drug and supplemental prescription drug coverage. There are 3 common types of drug plans.
Prescription-only drug plans:
Under a prescription-only drug medicare plan, the drugs that are prescribed in writing by a physician or a dentist are covered. If the medications that do not require a prescription in pharmacies, such as over-the-counter medicines, are prescribed by a physician, they are not covered under this plan.
Prescribed drug plans:
A prescription drug plan covers all drugs including over-the-counter medicines. However, it is more costly than the prescription-only plan. This is because this plan has a larger scope of coverage.
Hybrid drug plans:
A hybrid drug plan provides coverage for all drugs that require a prescription as well as drugs that are not legally required to be prescribed. Different types of this plan are available that list in detail which drugs are covered under each type. Such formularies can have very wide coverage, almost for all prescription medicine. They can even include certain restrictive drugs or exclude drugs of a therapeutic nature.
The two main methods of drug claims reimbursement are:
If you are insured under this plan, you will be required to pay for your drugs and later submit the bills to your insurer to be reimbursed.
Pay direct drug plans:
You are entitled to a drug insurance card if you’re insured under this plan. You can show this card to your pharmacist who will then bill your insurer directly. This plan also included many cost containment features that are not available in a reimbursement plan.
Medical Supplies And Equipment
We have listed the medical supplies and medical equipment you can purchase or rent for which you can be reimbursed.
- Wheelchairs, hospital beds, walkers, canes, crutches, and trusses.
- Hearing aids.
- Kidney dialysis equipment.
- Support hose and compression stockings.
- Insulin syringes.
- Orthopedic shoes and orthotics.
- Ileostomy apparatus and supplies.
- Colostomy apparatus and supplies.
- Oxygen and oxygen-related supplies.
- Prostheses as well as braces for leg, arm, neck or back.
Under this plan, the charges of the practitioners which are paramedical, are covered. Those healthcare providers whose services are covered under this plan are listed below.
- Fee of service of a chiropractor.
- Osteopath, naturopath and podiatrist.
- Services of an acupuncturist, masseur and physiotherapist.
- Charges of a speech therapist and psychologist.
- For residents of Quebec, services of a psychoanalyst are also covered.
There is an annual maximum limit to reimbursements. Reimbursements are also to be given only for reasonable and customary charges based on what is insured under the Provincial program.
Out-of-province Medical Emergency.
If you are insured, this health plan will provide you coverage for your out-of-province medical emergencies. It is for 60 days of incessant travel.
- Hospital rooms and boards are usually covered under this plan.
- Out-patient services are also covered.
- Services, as well as supplies, are covered.
- Diagnostic and treatment procedures and the services of a physician are also covered.
- Ambulance Service is covered.
These are covered on a referral basis if these services are not part of the plan of your provincial healthcare plan. Reimbursement of such services will require your prior approval. It is also subjected to lower maximums than the claims in an emergency.
Travel assistance will be provided by your employer. This plan gives multi-lingual assistance 24/7 worldwide.
- It will help you to locate an eligible medical facility.
- It will assist with interpretation.
- It also gives medical referrals.
- It provides on-site hospital payments.
- It also covers the return of dependents like children or any other travelling partner.
- Transportation services are also covered.
- It will help you in replacing your lost travel documents and supporting documents such as visas, passports, travel tickets.
- It will also facilitate communication with your home doctor or family employer.
Other Health Care Benefits
Extended Health Coverage Plans includes the following other medical expenses:
Private Duty Nursing
This health-plan usually provides coverage ranging from $5,000 to $25,000 per year. Services of not only a registered nurse but also a registered nursing assistant are covered. The services of a certified nurse and licensed practical nurse are also covered who administer care in your home. These services should be deemed medically necessary by your physician.
Extended Health Coverage Plans is provided if there are dental expenses due to an accidental injury outside the mouth.
Convalescent Hospital Care
Coverage is provided for Ward expenses and user fees and care providers. This can be done for active treatment or aftercare provided in a nursing home. Its usual rate is about $20 per day for 180 continuous days of confinement.