No repayment will be made for expenses resulting from:
1. Any changes or services, treatment or supplies:
- from which there would be no charge except for the existence of insurance;
- which are performed or provided by an immediate family member or person who lives with the patient;
- which are provided while confined in a hospital on an in-patient basis;
- which are not specified as an Eligible Expense under this plan.
2. Services, treatments, or supplies eligible under this Plan and payable under any government plan, whether or not the claimant is covered under such a plan. The underwriter will only consider that amount of an eligible expense which is over and above the amount that would be payable by the government plan.
3. Any injury or illness for which the person is entitled to benefits under any Workers’ Compensation Act.
4. Travel for health reasons or periodic health examinations required for a third party.
5. Cosmetic surgery or treatment (when so classified by the underwriter) unless such surgery or treatment is for accidental injuries and commenced within 90 days of an accident.
6. Charges levied by a physician or dentist for completion of medical reports and forms, time spent travelling, broken appointments, transportation costs, room rental charges, or for advice given by telephone or other means of telecommunication.
7. Drugs, sera, injectables, and supplies which are not covered by Health Canada (Food and Drugs) or are experimental or limited in uses or not so approved.
8. Experimental medical procedures or treatment methods not approved by the Canadian Medical Association and the Newfoundland and Labrador Medical Association or the appropriate medical specialty society.
9. Charges for intrauterine devices and diaphragms.
10. Expenses incurred for surgically implanted prostheses.
11. Wheelchairs adapted or designed for sports activities.
12. Monitoring devices such as stethoscopes and similar equipment and domestic appliances such as stethoscopes and similar equipment and domestic appliances such as air purifiers, humidifiers, whirlpools, and other similar equipment.
13. Equipment such as “Obus form” type.
14. Diapers for incontinence.
15. Dental services and supplies for the purposes of full mouth reconstructions, for vertical dimension correction, or for any other temporomandibular joint dysfunction.
16. Eligible expenses which result directly or indirectly from the following:
- Committing, or attempting to commit a criminal offence
- War, whether the war be declared or not, or service in the armed forces of any country, or participation in a riot, insurrection or civil commotion
17. No reimbursement will be made for:
- Hormones and injections used in the treatment of obesity
- Sclerosing injections used in the treatment of varicosities, telangiectasia, and minor dilation when this treatment is primarily for cosmetic and not therapeutic purposes