health
benefits

Extended Health Care

• Eligibility
• What are Extended Health Care benefits?
• Is there an annual deductible?
• Covered Expenses
• Out-of-Province Benefits
• How a Claim is Made
• Is there a lifetime maximum?
• Exclusions and Limitations
   

Eligibility
Eligible Members and their registered* dependents are entitled to the Extended Health Care benefit.

*Spouse of an Insured Person, and unmarried dependent children to age 21, unless the dependent child is attending a recognized school, college or university on a full-time basis, in which case the maximum age will be 25. A child is not a dependent if he/she is eligible for or entitled to benefits under this Plan as a Member.

1. Services of a graduate nurse (Licensed vocational nurse where an R.N. is not available) when ordered by the Attending Physician in the management of an acutely ill patient. Private Duty Nursing coverage limited to $25,000 per injury or sickness.
2. Treatment by a licensed Chiropractor, Podiatrist, Speech Therapist*, Acupuncturist*, Naturopath, Clinical Psychologist, Physiotherapist, Masseur*, (operating within the scope of their license), will be reimbursed at 50% up to a maximum of $400.00 per person per calendar year for each category. Payment of X-ray examinations required up to $50.00 per calendar year.
   *Care or service must be certified as necessary by the Attending Physician.
3. Out of hospital drugs and medicine purchased on the prescription of a Physician. 
   No amount will be payable for charges for any drug or medicine which is experimental or which has not been approved by the Ministry of Health and Welfare - Canada (Food and Drugs) for the sickness or injury for which it was prescribed.
   PLEASE NOTE: It is mandatory for all Members, who are BC residents, to register for the provincial Fair PharmaCare program and provide proof of such registration to the Administrator in order to continue to receive benefits under the Plan. To register for Fair PharmaCare call 1-800-387-4977 or visit the Government of BC Website and follow the links to the BC PharmaCare site: www.gov.bc.ca
4. Professional ambulance service.
5. Initial artificial limbs or eyes required to replace natural limbs or eyes lost while insured. Crutches, splints, oxygen as well as rental of iron lung and durable equipment for therapeutic treatment.
6. Dental treatment necessary to repair or alleviate damage to natural teeth resulting from an accident occurring while insured, provided the expense is incurred within two years from the date of such accident.
7. Hearing Aids for non-occupational conditions only, when prescribed by the Attending Certified Ear, Nose and Throat Specialist. The maximum benefit during a five-year period shall not exceed $400.00 per person and does not include payment for repairs and maintenance, batteries or recharging devices, or other such accessories.
8. Orthotics are limited to two pair per calendar year to a maximum of $400.00.
9. Custom built Orthopaedic Shoes limited to two pair per calendar year, when needed as a result of a disability incurred while insured for this benefit, to a maximum of $400.00 per pair.
10. Hospital charges for the difference between ward cost and semi-private, or when medically necessary, private accommodations.
11. Hospital charges made by an approved acute general hospital in B.C. for co-insurance and short-stay charges.
12. “Routine” eye examinations that are not covered by the Medical Services Plan of BC will be reimbursed at 90% up to a maximum of $75.00 every 24 months.
13. Co-insurance charges of up to $8.50 per day for those private hospitals approved by the Ministry of Health to a maximum of 30 days confinement for any one period of illness.

1. Physicians Services: Reasonable and customary charges for Physician’s services required in the event of an emergency while traveling or on vacation outside the Province of British Columbia, over and above the amounts paid or payable by the Medical Services Plan of British Columbia.
2. Hospital Charges: In the event of an emergency while traveling or on vacation, the total amount of the hospital room charge over and above that covered by B.C. Hospital Programs. The maximum period payable for any one accident or sickness shall be 60 days. This does not include private or semi-private room.
3. In an emergency, services and/or supplies as become necessary outside the Province of British Columbia on the same basis as they would be entitled to coverage in the Province of British Columbia.

1. the failure of any person to make claim for and receive benefits within the time and in the manner prescribed under or pursuant to the Basic Medical Plan to which you are entitled.
2. the expense of a Physician and/or Surgeon except as described under “Out-of-Province Benefits” for emergency treatment while traveling outside British Columbia and is limited thereby.
3. war or act of war or participation in a riot or civil insurrection.
4. suicide or any attempt thereat.
5. orthoptic treatment and refractions.
6. Dental services except as set out in (6) of “Covered Expenses.”
7. any portion of a Specialist’s fee not allowable under the Basic Medical Plan due to non-referral, or any amount of fees charged by any practitioner in excess of the recognized fees for such service.
8. services which are eligible for payment by the Medical Services Plan of British Columbia, Workers’ Compensation Board or any tax supported agency, without cost or at nominal cost by public authorities.
9. services and supplies for cosmetic reasons.
10. expenses incurred outside the Province, on an elective basis. Service will only be allowable for an unexpected illness or injury while the Insured Person is temporarily visiting outside the Province.
11. eligible expenses must be submitted to the Administration Office during the calendar year following the year in which expenses were incurred.