Extended Health
Extended heath care (EHC) is a form of medical insurance that covers health costs that may not be covered by provincial health plans. EHC coverage will give you and your family protection against the major expenses sickness can bring with it. The following services are available through EHC:
- Ambulance Emergency Services
- Hearing Aids
- Orthotics/Support Stockings
- Paramedical Services
- Private Duty Nursing
- Semi Private Hospital
Ambulance Emergency Services
This benefit coverage includes:
- licensed ambulance service, including air ambulance, to and from the nearest hospital where adequate treatment is available
Hearing Aids
This benefit coverage includes:
- cost, installation, repair, and maintenance of hearing aids (including charges for batteries), to a maximum of $600 every five calendar years
Note: If an assistive devices program (ADP) is available in your province, it will pay first and you must submit proof of the ADP's payment with your claim.
Orthotics and Orthopaedic Shoes
Coverage is as follows:
- stock item orthopaedic shoes recommended by a physician or foot specialist (chiropodist/podiatrist) paid at 50% up to an annual calendar year maximum of $450
- modifications to regular footwear recommended by a physician or foot specialist (chiropodist/podiatrist) paid at 100% of reasonable and customary charges
- custom made orthopaedic shoes required because of a medical foot deformity, which are constructed by a professional dealing exclusively with the manufacturing of orthopaedic footwear, such as a certified orthotist, certified pedorthist, or a certified footwear specialist, paid at 50% up to a $450 calendar year maximum
- casted custom made orthotics recommended by a physician or foot specialist (chiropodist/podiatrist) paid at 100% up to a calendar year maximum of $200
Note: Shoes, modifications, and orthotics must be obtained from a specialized establishment or laboratory, duly authorized under provincial regulations, if applicable, to provide, manufacture, and/or fit such orthopaedic shoes, modifications, and orthotics. They must also be manufactured, dispensed, and fitted in conjunction with professionals dealing exclusively with foot or ankle disorders. Orthotic inserts dispensed by any other practitioners, such as chiropractors or physiotherapists, will not be considered a payable benefit.
It is strongly recommended that you submit an estimate to the eastern CLAC Benefit Administration office before making a purchase. We can then submit the estimate to the insurance company, and they will advise you of the amount you are entitled to receive under this benefit.
For complete details, refer to the following Standard Life communiqué:
Claims Process for Orthotics & Orthopaedic Shoes (22KB)
Support Hose and Surgical Stockings
Coverage is as follows:
- 4 pairs per calendar year with a minimum compression strength of 20-30 mmhg as recommended by a physician
For complete details, refer to the following Standard Life communiqué:
Claims Process for Support Hose and Surgical Stockings (22KB)
Paramedical Services
All coverage for this benefit will be reimbursed up to the reimbursable maximum at the rate of 100%, or 80% if you wallet identification card shows 80% under Extended Health: Drug Coverage.
Eligible paramedical services must be performed by licensed (registered) practitioners. These services are paid to a maximum of $600 per person, per calendar year, for each of the following specialties:
| Podiatrist/Chiropodist | Naturopath |
|---|---|
| Osteopath | Physiotherapist |
| Speech Therapist | Massage therapist |
| Psychologist | Chiropractor |
The maximum for each paramedical specialty above includes no more than 4 x-rays per calendar year. Recommendation by a physician for professional services is not required.
Please note that acupuncture is covered only if it is performed by a registered chiropractor, physiotherapist, or massage therapist. Eligible expenses for acupuncture are included in reaching the maximum for any one of these professionals.
Limitation
Some expenses may be payable in part by provincial plans (e.g., podiatrist in Ontario). In those provinces, expenses are covered only after the provincial plan's maximum for the benefit year has been paid.
Private Duty Nursing
Services that are medically necessary, prescribed by a treating physician, and are deemed to be within the practice of nursing and provided in the patient's home by:
- a registered nurse, or
- a licensed practical nurse (or equivalent designation) who has completed an approved medications training program.
Covered expenses are subject to a maximum of $15,000 per calendar year.
Pre-determination of benefits
The benefit providers suggest that a detailed treatment plan be submitted with cost estimates before private duty nursing services begin. The benefit providers will then advise you of any benefit that will be a covered expense.
Charges for the following services are not covered:
- custodial care, homemaking duties, or supervision
- those performed by a nursing practitioner who is an immediate family member or who lives with the patient
- those performed while the patient is confined in a hospital, nursing home, or similar institution
- those that can be performed by a person of lesser qualification, a relative, friend, or a member of the patient's household
Semi Private Hospital Coverage
The semi-private hospital coverage provides a benefit equal to the difference in the cost of semi-private accommodation and the hospital's public ward charge when:
- the person is confined to hospital on an inpatient basis, and
- the accommodation is specifically chosen by the patient
Coverage for semi-private hospital, if applicable, has been determined by your group and specified in your collective agreement, or in the absence thereof, determined by the CLAC Benefit Committee. If you are entitled to this benefit, it will be shown on your wallet identification card.
Exclusions
No benefits are payable for:
- charges for any portion of the cost of ward accommodation
- utilization or co-payment fees
- room and board in a rehabilitation institution, convalescent home, or chronic-care institution or convalescent care in a regular hospital
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