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Extended Health Care Benefits
All extended health benefits are subject to a $25 calendar year deductible (maximum $50 per family). An overall lifetime maximum of $50,000 applies to all benefits other than out-of-country expenses. For groups with fewer than five employees, or who have no previous group insurance coverage – to be replaced by this program – coverage is limited to $500 per person for the first calendar year of coverage. Each employee can choose single or family coverage, or can waive this coverage entirely if there is comparable coverage under a spouse’s plan.
Some available features include:
Medical Services and Supplies (100% coverage)
- Accidental dental
- Charges by a physician in excess of amounts allowed under the covered employee’s provincial health plan
- Charges by the following licensed and qualified practitioners for treatment of injury or sickness in excess of amounts allowed under the covered employee’s provincial health care benefits, to a maximum of $500 per practitioner per covered person:
- Chiropractor
- Massage Therapist
- Naturopath
- Osteopath
- Physiotherapist
- Podiatrist
- Psychologist
- Speech Therapist
- Charges for anaesthetic material, oxygen, blood, and blood products that are necessary for medical care of injury or sickness
- Charges for exe examinations by an Optometrist or Ophthalmologist, when no portion of the cost is covered by the employee’s provincial health care benefits
- Charges for professional ambulance service, including air travel when medically necessary, required because of injury or sickness
- Diabetic supplies - $1,000 per year per covered person
- Hearing Aid expenses - $300 every 5 years per covered person
- Laboratory expenses ordered by a physician
- Nursing expenses prescribed by the attending physician ( necessary for medical treatment of Injury or Sickness) - $15,000 per 3 years per covered person
- Orthopaedic Appliances - $300 per year per covered person
- Ostomy supplies
- Other medical equipment
- Out-patient care expenses
- Prosthetics
Prescription Drugs (80% coverage)
Covers charges for drugs or medicines required for medical treatment of injury or sickness, which is prescribed by a licensed physician or dentist. Coverage is limited to $1,000 maximum per person per calendar year.
Semi-private Hospital Accommodation Coverage (100% coverage)
Provides coverage for semi-private accommodation at an approved hospital. This benefit does not have a maximum for semi-private accommodation charges incurred nor a maximum number of days of hospitalization.
Out-of-Country/Province Coverage (100% coverage)
This benefit is limited to the first ninety (90) days of travel by the covered person outside his/her province of residence. These charges are not subject to any deductible or co-insurance amounts.
Note that your provincial health care plan covers emergency care while temporarily absent from your home province, but often will not pay the full cost of these services. This supplementary health plan covers these additional hospital and medical costs up to the reasonable and customary charges in the area where service is actually provided to $1,000,000 lifetime maximum.
Covered charges include those listed below for emergency medical care or emergency hospitalization incurred by a covered person while travelling outside their province of residence. The plan covers emergency medical expenses required as the result of a sudden and unexpected illness or injury which occurs while temporarily outside your home province. These include:
- Hospitalization charges made by an approved hospital for a semi-private room and in-hospital services at a licensed hospital
- Prescription drugs and injectables
- Ambulance services, including air ambulance
- Crutches, wheelchairs and other medical equipment
- Reasonable and customary charges by a physician for the emergency medical care of an injury or sickness, which are in excess of the covered person’s provincial health care plan
- Reasonable and customary charges made by an approved hospital for the emergency medical care of an injury or sickness, which are in excess of the covered person’s provincial health care plan
- Reasonable and customary charges for the services of an approved hospital and supplies furnished during emergency hospitalization.
- Reasonable and customary charges for X-ray examinations and laboratory tests related to emergency medical care rendered without hospitalization
The charges for medical care or hospitalization are subject to the same conditions as if incurred in the employee’s province of residence. The charges for medical care or hospitalization must be eligible for reimbursement by the employee’s province of residence’s provincial health care plan. Emergency medical care does not include medical attention for the monitoring of a stabilized condition.
If a covered person is, on medical evidence, able to return to their province or residence following diagnosis of, or the emergency medical care for a medical condition which requires further treatment, hospitalization or surgery, and elects to have such treatment, hospitalization or surgery outside the province, the expense for such continuing services will not be covered.
Where a covered person is referred by a physician to an approved hospital outside Canada for medical care for which there is no medically sufficient alternative in Canada and if prior approval was obtained from the covered person’s provincial health care plan, the charges for any allowable expense outlined in the covered services provision of the master policy incurred outside of Canada will be reimbursed only up to the same levels as if the allowable expense was incurred in the covered person’s province.
Note: This summary is intended to provide a brief description of the benefits available under RCC's group insurance program. This material does not create or confer any rights. The exact terms and conditions of your benefits are outlined in the applicable group benefits agreements or policies. Some restrictions and/or limitations may apply to all benefits mentioned above. Please contact Morneau Sobeco for full details.