EXTENDED HEALTH CARE
Extended Health Care helps employees and their dependants pay for necessary medical expenses that aren't covered by their provincial plan. Each Extended Health Care plan can be customized to meet the specific requirements of each organization with a variety of options including:
Medical Services and Supplies - may include private or semi-private rooms in hospital, nursing care (in hospital or in home), laboratory tests, diagnostic tests, x-rays, hospital beds, braces, foot orthotics, canes, crutches, walkers, prosthetics, hearing aids, ambulance services, communication aids, diabetic supplies, breathing equipment, incontinence supplies, and paramedical practitioner services (physiotherapist, chiropractor, podiatrist, clinical psychologist, social worker, osteopath, homeopath, chiropodist, naturopath, dietician, speech therapist/pathologist, acupuncturist, registered massage therapist, occupational therapist)
Drug Card Plans have two options. The Pay-Direct Drug Card allows for on the spot processing of prescription drugs at most pharmacies across Canada. The plan member presents his/her Drug Card to the pharmacist who submits the claim electronically leaving the plan member to pay only the portion not covered by the plan. The Deferred Payment Drug Card also allows for on the spot processing, but the plan member pays for his/her prescription and is reimbursed by the plan once a pre-specified dollar amount or time period is reached.
Two Tier Drug Plans offer plan members choice in how they manage their drug benefit. Tier 1 Drugs are Formulary Drugs which are used to treat serious medical conditions and are recognized as first-line therapy for the treatment of disease. They are also less expensive drugs. Tier 2 Drugs are not Formulary Drugs. They may be used to treat non-life threatening conditions and are not always considered first-line therapy for the treatment of disease. They are more expensive drugs.
Managed Formulary Drug Plans provide coverage for a selective list of drugs through managed care formularies. The covered drugs are selected on the basis of cost and therapeutic value therefore encouraging the use of drugs that are more cost effective.
Generic Drug Tiered Plans offer product selection that can include generic or brand name drug products with different levels of restriction. However when a prescribed drug has a generic substitute, a greater benefit will be applied to the generic drug.
Vision Coverage may help pay for prescription glasses, contact lenses, and laser eye surgery, depending upon the insurer and the plan.
Global Medical Assistance offers worldwide coverage for travellers in emergency medical situations and may include doctors' services, hospital expenses, emergency medical transportation, and family support services.
Cost Plus is a fee-for-service plan that can provide up to 100% coverage for designated employees and coverage may be extended to non-traditional dependents such as parents or grandparents, providing they qualify as dependents under the Canada Revenue Agency Income Tax Act. Claims are initially paid under the Group Benefits Plan and any unpaid balances are then processed under Cost Plus, reimbursing the plan member for any out of pocket medical, drug, dental and vision care expenses that are not covered under their plan design. Premiums may be tax-deductible business expenses and benefits may be non-taxable income for the employee.
Contact the Blevins Team for more information.
