| 80% | The Health Care Plan pays reasonable and customary charges for covered services or products, as long as:
You pay the remaining cost. |
Expenses with a maximum reimbursable amount will be paid at 100%.
Read what limitations and exclusions apply to this coverage.
| Eligible Expense | Limitation |
|---|---|
| Artificial Limbs, temporary and permanent (to replace temporary) | Including replacement of existing prosthesis, no earlier than:
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. |
| Braces that contain either metal or hard plastic | Not including dental braces or braces used primarily for athletic use. |
| Breast (mammary) 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 | |
| Doctor's services, when such services would be eligible for reimbursement under one or more provincial health plans | Claims for such services, following cessation of provincial coverage, will be held by Sun Life pending the decision of the Board of Trustees. |
| 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. |
| Glucometers | Glucometers, and their repair and replacement, for insulin-dependent diabetics and for legally blind or colour blind non-insulin-dependent diabetics. No earlier than 60 months following the date of purchase of the monitor. |
| 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 | Maximum reimbursable expense of $100 for each covered person in any one calendar year. |
| Orthopaedic brassieres | Maximum reimbursable expense of $100 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:
whichever is less. |
| Orthotic inserts for shoes | Orthotics Maximum reimbursable expense of $3001 for each covered person in any one calendar year. |
| Oxygen and its administration | |
| Private duty nurse | Maximum reimbursable expense of $15,0001 for each covered person in any one calendar year:
(A private duty nurse is a registered nurse, or nursing assistant, licensed, registered or certified through the respective provincial licensing body or professional organization as the case may be. In the absence of such a registry, this will include a nurse with comparable qualifications as determined by Sun Life.) |
| Trusses, crutches, splints, cast 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 following total hair loss as the result of an illness. | Lifetime maximum reimbursable expense of $5001. |