The plan pays 80% of eligible expenses subject to certain restrictions and limitations.
- Transportation when recommended by a medical doctor to and from the nearest medical or surgical specialist, or to and from the nearest hospital for special hospital services, is subject to a ground transportation deductible of 500 kilometres per calendar year for each insured member. If transportation is in a private automobile, the eligible expense will be $0.15 per kilometre. Payment is based on the lowest cost transportation available. The maximum transportation benefit is $1,000 per Insured Person per calendar year. The cost for transportation outside Newfoundland and Labrador will only be considered if the treatment is not available in Newfoundland and Labrador. The patient must be referred by a specialist in Newfoundland and Labrador, who would have to give reason for such referral. Transportation must originate in the Province of Newfoundland and Labrador.
- Diagnostic procedures, radiology, radium, administration of anaesthetics, blood transfusions including supply of plasma and blood, and oxygen (including the equipment necessary for its administration).
- With a written prescription, the purchase of trusses, braces, crutches, canes, walkers, and artificial limbs or eyes. Compression stockings less than 20 mg are payable at 80% to a maximum of $50 per calendar year. If compression is greater than 20 mg, a maximum of four pairs of stockings will be paid per calendar year. This benefit includes orthopaedic shoes that are part of a brace provided they are on a written prescription. If the orthopaedic shoes do not form part of a brace, the benefit percentage is limited to 80% to a maximum payment of $200 per calendar year. With a written prescription, this benefit also includes custom made orthotic inserts to a maximum of two pairs every three calendar years.
- Rental, or, at the underwriter’s option, purchase of a wheelchair, hospital bed or respirator/ventilator. Standard wheelchair maximum payment $2,400. Electric wheelchair maximum payment $8,000. Hospital bed maximum payment $2,000.
- Dental treatment for the repair of damage resulting directly from an accidental injury to natural teeth. The treatment must be rendered within twelve (12) months following the accident, and coverage, as well as the policy, must still be in force. Payment will be made based on the amount for the least expensive procedure which will provide a professionally adequate result.
- Charges for physician services for medically necessary services outside the province, on the referral of a specialist, provided such treatment is not available in the province. For referral outside Canada, the service must not be available in Canada. The maximum payment per person per calendar year for referral treatment outside Canada is $5,000.
- Private duty nursing services which are deemed to be within the practice of nursing and which are provided in the patient’s home by a registered nurse. Eligible expenses are subject to a maximum payment of $10,000 per person per calendar year. Charges for the following services are not eligible:
- service provided for custodial care, homemaking, duties or supervision;
- service performed by a nursing practitioner who is an immediate family member or lives with the patient;
- services performed while the patient is confined in a hospital, nursing home or similar institutions;
- service which can be performed by a person of lesser qualification, a relative, friend, or a member of the patient’s household. The Plan Administrator, Johnson Inc., requires that an “Authorization Form for Registered Nurse at Home” be completed.
- Purchase of two hearing aids per insured (one per ear) to a maximum payment of $1000 per hearing aid in any three (3) consecutive calendar years.
- Fees of an oral surgeon other than for dental services for visits and consultations, up to a maximum payment of $50 per visit and limited to a maximum of two (2) visits per calendar year.
- Purchase of Transcutaneous Nerve Stimulators to a lifetime maximum of $700.
- Bandages, gauzes, incontinent pads and mattress pads, on the written prescription of a physician.
- Wigs or hairpieces required as a result of medical treatment or alopecia up to a maximum payment of $1,500 per person in any five (5) consecutive calendar years.
- Water purification system and valve used in connection with a dialysis machine.
- Ambulance services when medically required.
- Professional services of the following licensed, certified or registered paramedical practitioners (when operating within their recognized fields) up to the levels specified in the following chart:
|Practitioner||Total yearly maximum
payable per person
Registered Social Worker
|*Also eligible is a payment of up to $100 for the surgical removal of toe nails or the excision of plantar warts.
**Also eligible is up to $15 for one x-ray annually.
*** Under some circumstances, benefits may not be payable until the government plan concerned has paid its yearly maximum.