Medical and Prescription Plan

The medical plan provides coverage for a healthier you. You’ll find more detail on what’s covered in the plan booklet.

Payment

You pay an annual deductible of $50 per person, up to $100 per family. Then the plan covers most prescription and medical expenses at 80%.

At the pharmacy, you’ll present your Pay Direct Drug card, and you'll pay your portion of the covered cost of the medication out of pocket.

For other medical expenses, you’ll pay upfront and submit a health claim form (English version, French version) directly to Sun Life for reimbursement.

After you satisfy the annual deductible, the plan covers most prescriptions at 80%.

The prescription must be written by a physician or dentist and be dispensed by a licensed pharmacist or physician legally authorized to dispense medications. 

Smoking cessation aids that require a physician's prescription are covered, subject to a lifetime maximum benefit of $500 per individual.

The plan covers the following care and services.

Hospital Care

Hospital Care (Other than Chronic Care) – A semi-private room is covered 100%.

Convalescent Care

Convalescent Care Facility – A semi-private room is covered with a $20 copay per day, maximum of 180 days per disability. Confinement must begin following a minimum of three consecutive days of hospital confinement.  

  • Eye Exams are covered 100% up to $50 every two benefit years.
  • Prescription Glasses are covered 100% up to $250 every 24 months.
  • Contact Lenses (medically necessary or to improve vision to at least 20/40 in the better eye if not correctable by eyeglasses) are covered 100% up to $200 every 24 months.

Charges for the services of a licensed psychologist or social worker, licensed massage, for which a doctor’s order is required each year, licensed speech therapist, licensed physiotherapist, licensed naturopath licensed acupuncturist, licensed Christian Science Practitioners, licensed osteopath or osteopathic practitioners*, licensed chiropractor*, licensed podiatrist or chiropodist physiotherapist*.

Paramedical services are reimbursed after deductible at 80% up to a combined maximum of $500 per person per benefit year

*x-ray examinations are limited to a combined maximum of $20 per benefit year.

For a detailed list of covered medical services and supplies, please see the plan booklet.

Out-of-Province or Out-of-Canada:

  • Charges incurred for necessary medical treatment given outside the covered person’s province of residence.
  • Treatment required as a result of a Medical Emergency arising during the first 60 days while temporarily outside the province of residence, provided that the covered person who receives the treatment is also covered by the Provincial Plan during the absence from the province of residence.

A Medical Emergency is a sudden, unexpected injury that occurs or an unforeseen illness that begins while a covered person is traveling outside their province of residence and requires immediate medical attention. Such emergency no longer exists when, in the opinion of the attending physician and supporting medical evidence, the covered person is stable enough to return to the province of residence.

The plan will cover out-of-province or out-of-Canada eligible expenses after deductible at 80%. The member is responsible for paying an out of pocket maximum of $3,000 per person or $6,000 per family. The paid maximum benefit is $3,000,000 per lifetime.

Emergency Travel Assistance:

Details on the program can be found here: English Version and French Version

  • Ileostomy, Colostomy, and Incontinence Supplies
  • Oxygen
  • Medicated Dressings and Burn Garments

Ambulance transport the patient to the nearest hospital. If you are outside of your province, the Emergency Travel Assistance will cover the transport; details and limits can be found in the plan booklet.

Resources

Staff

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