Medical Supplies and Services

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What's Covered 


​80%

The Health Care Plan pays reasonable and customary charges for covered services or products, as long as:

  • any provincial plan has paid its maximum for the service or product, and
  • the service or product is prescribed by a physician and medically necessary.
 You pay the remaining cost.
Expenses with a maximum reimbursable amount will be paid at 100%.

Eligible Expenses 

Read what limitations and exclusions apply to this coverage:

​Eligible Expenses Limitation​s
Artificial Limbs, temporary and permanent (to replace temporary)
Including replacement of existing prosthesis, no earlier than:
  • 60 months after the last purchase for patients over age 21, or
  • 12 months after the last purchase for spouse, or child age 21 or less
Earlier replacement may be approved if medically proven that growth or shrinkage of surrounding tissue requires replacement at an earlier date.
Bandages and Surgical Dressings ​Required for the treatment of an open wound or ulcer.
Blood-glucose Monitors
Blood-glucose monitors for insulin-dependent diabetics and for legally blind or colour blind non-insulin-dependent diabetics.
 
Including repair or replacement, no earlier than 60 months following the date of purchase of the monitor.
Braces that contain either metal or hard plastic Not including dental braces or braces used primarily for athletic use.
Breast Prosthesis following mastectomy One replacement for each prosthesis in any 24 month period.
Colostomy, ileostomy and tracheostomy supplies, catheters and drainage bags for incontinent, paraplegic or quadriplegic patients
Dentist/Dental Surgeon

The Health Care Plan covers 80% of reasonable and customary charges for the services of a dentist/dental surgeon (as well as charges for braces and splints) required to treat a fractured jaw or accidental injuries to natural teeth caused by an external, violent injury or blow. Accidents associated with cleaning, chewing, and eating are not covered.

 

Treatment must take place no more than 12 months after the accident (for children under the age of 17 treatment must take place before the child reaches age 18).

Durable equipment manufactured specifically for medical use, required for temporary and therapeutic use in the patient's private residence - rental, or purchase at Sun Life's option - including walkers, hospital beds, apnea monitors and alarm systems for eneuretic patients Reimbursement limited to the cost of non-motorized equipment, unless medically proven that motorized is required.
Elasticised support stockings and elasticised apparel for burn victims Manufactured to individual patient specifications, or with a minimum compression of 30 millimetres.
Insulin jet-injector device for insulin-dependent diabetics Maximum reimbursable expense of $7601 for each covered person every 36 months.
Insulin pumps and associated equipment for insulin-dependent diabetics, including repair or replacement at least 60 months following the date of purchase Reimbursed only if prescribed by a physician associated with a recognized centre for the treatment of diabetes at university teaching centre.
Orthopaedic brassieres Maximum reimbursable expense of $1001 for each covered person in any one calendar year.
Orthopaedic shoes that are an integral part of a brace or are specifically constructed for the patient, including modifications to such shoes, prescribed by a physician, chiropodist or podiatrist
Maximum reimbursable expense for each covered person in any one calendar year of:
  • total charges, less the average cost of regular footwear, as determined by Sun Life, or
  • $1501,
whichever is less.
Orthotics Maximum reimbursable expense of $3001 for each covered person in any one calendar year.
Oxygen and its administration
​Private nursing care at home
Maximum reimbursable expense of $15,0001 for each covered person in any one calendar year, as long as the care is prescribed by a physician and medically necessary.
 
The person providing the nursing care or prescribing it:
  • does not live with the patient, and,
  • is not related to the patient by blood or marriage.
Contact Sun Life ahead of time to make sure that the plan will cover the expenses.
Physician's services, when such services would be eligible for reimbursement under one or more provincial health plans
Trusses, crutches, splints, casts and cervical collars in metal or hard plastic
Wheelchair required for therapeutic use in the patient's private residence - rental, or purchase at Sun Life's option - including repairs and replacement Reimbursement limited to the cost of non-motorized equipment, unless medically proven that motorized is required (no earlier than 60 months after the last purchase).
Wigs, when the patient is suffering from total hair loss as the result of a disease or illness Lifetime maximum reimbursable expense of $5001.
1All expenses with a maximum reimbursable amount will be paid at 100% coinsurance.

 

 

Published on February 01, 2016