Miscellaneous Expense Benefit

To be eligible, the expenses must be the reasonable and customary charges and must be prescribed by a physician or a nurse practitioner (if authorized by provincial/territorial legislation), unless otherwise specified.

Durable equipment

New medical products and devices are constantly appearing on the market. However, not all items are eligible for reimbursement under the Plan. You should contact Canada Life before purchasing any new durable equipment to confirm whether the item is covered.

The Plan covers the rental or purchase (at Canada Life’s discretion) of cost-effective durable equipment that is:

  • manufactured specifically for medical use,
  • for use in the patient’s private residence, unless otherwise specified
  • approved by the Administrator for cost effectiveness and clinical value,
  • designated as medically necessary.

Reimbursement related to durable equipment will be limited to the cost of non-motorised equipment unless medically proven that the patient requires motorised equipment.

Durable equipment used for care

Eligible expenses include but are not limited to:

Devices for physical movement

Lifts or hoists

To transfer an individual in and out of bed or in and out of the bathroom. Limited to one in a lifetime and a maximum eligible expense equal to cost less all eligible lift/hoist repairs incurred prior to purchase.

Walkers

Limited to one every 5 years and a maximum eligible expense equal to cost less all eligible walker repair expenses incurred during the previous 5 years.

Not limited to use in private residence.

Wheelchairs

Limited to one every 5 years and a maximum eligible expense equal to cost less all eligible wheelchair repairs incurred during the previous 5 years (for dependent children, the 5 years maximum may not apply if purchase or replacement is medically necessary).

As of July 1, 2023, a new wheelchair purchased within the 5-year time limit may be eligible when the plan participant’s medical condition changes and requires a different type of chair.

If a patient’s medical condition changes and warrants a different type of chair within the same 5-year period, reimbursement will be for the amount of the new chair less the amount reimbursed for the previously claimed chair.

Not limited to use in private residence.

Devices for support and resting

Hospital beds

Limited to one in a lifetime and a maximum eligible expense equal to cost less all eligible hospital bed repairs incurred prior to purchase.

Therapeutic mattresses

Limited to one every 5 years and a maximum eligible expense equal to cost less all eligible therapeutic mattress repairs incurred during the previous five years.

Wheelchair cushions (e.g. Roho cushions)

Limited to one every 12 months and a maximum eligible expense of cost less all eligible wheelchair cushion repairs incurred during the previous 12 months.

Devices for monitoring

Apnea monitors

Limited to one in a lifetime and a maximum eligible expense equal to cost less all eligible apnea monitor repairs incurred prior to purchase.

A prescription is required.

Blood pressure monitor

A prescription is required.

Limited to one every 5 years and a maximum eligible expense equal to cost less all eligible blood pressure monitor repairs incurred during the previous five years.

Coagulation monitors

A prescription is required.

Limited to one every 5 years and a maximum eligible expense equal to cost less all eligible coagulation monitor repairs incurred during the previous five years.

Enuresis monitors

Limited to one in a lifetime and a maximum eligible expense equal to cost less all eligible enuresis monitor repairs incurred prior to purchase.

A prescription is required.

Heart monitors

A prescription is required.

Limited to one every 5 years and a maximum eligible expense equal to cost less all eligible heart monitor repairs incurred during the previous five years.

Oxygen saturation meter

A prescription is required.

Limited to one every 5 years and a maximum eligible expense equal to cost less all eligible oxygen saturation meter repairs incurred during the previous five years

Pulse oximeter

A prescription is required.

Limited to one every 5 years and a maximum eligible expense equal to cost less all eligible pulse oximeter repairs incurred during the previous five years.

Saturometer

A prescription is required.

Limited to one every 5 years and a maximum eligible expense equal to cost less all eligible saturometer repairs incurred during the previous five years.

Durable equipment used for treatment

Eligible expenses include but are not limited to:

Devices for mechanical and therapeutic support

Extremity pumps (lymphapress)

Limited to one in a lifetime and an eligible expense equal to cost less all eligible extremity pump repairs incurred prior to purchase.

Infusion pumps

Limited to one every 5 years and a maximum eligible expense equal to cost less all eligible infusion pump repairs incurred during the previous 5 years.

Traction kits

Limited to one in a lifetime and a maximum eligible expense equal to cost less all eligible traction kit repairs incurred prior to purchase.

Transcutaneous electric stimulators (TENS)

Limited to one every 10 years and a maximum eligible expense equal to cost less all eligible TENS repairs incurred during the previous 10 years.

Devices for aerotherapeutic support

Compressors

Limited to one every 5 years and a maximum eligible expense equal to cost less all eligible compressor repairs incurred during the previous 5 years.

CPAPs, BiPAPs or related dental appliances (where a CPAP or BiPAP cannot be tolerated)

Limited to one every 5 years and a maximum eligible expense equal to cost less all eligible rentals and purchases of CPAP, BiPAP or dental appliance incurred during the previous 5 years.

Nebulizers

Limited to one every 5 years and a maximum eligible expense equal to cost less all eligible maximist repairs incurred during the previous 5 years.

Servicing fees, repairs and replacement parts for CPAP and BiPAP machines

$500 per calendar year

Does not include expenses for cleaning supplies or warranties

If $300 for aerotherapeutic supplies was incurred before July 1, 2023, an additional $200 can be claimed for aerotherapeutic supplies purchased on or after July 1, 2023.

Ambulance transportation

Ambulance transportation

Air ambulance

Emergency air ambulance service to the nearest hospital equipped to provide the required treatment when the physical condition of the patient prevents the use of another means of transportation.

Ground ambulance

Licensed emergency ground ambulance service to the nearest hospital equipped to provide the required treatment when the physical condition of the patient prevents the use of another means of transportation, where medically necessary.

Diabetes treatment supplies

Diabetes treatment supplies

Blood glucose monitors

Blood glucose monitors for insulin dependent diabetics, and for non-insulin dependent diabetics if legally blind or colour blind, excluding repair or replacement during the 5 years period following the date of purchase of such equipment.

Continuous Glucose Monitor supplies

For people with Type I diabetes only

Maximum eligible expense of $3,000 per calendar year

Diabetic monitors

A prescription is required.

Eligible with or without an insulin pump

Coverage includes flash glucose monitors, continuous glucose monitors (for type 1 diabetics only), and standard glucose monitor devices.

Combined maximum eligible expense of $700 per 5 years

Diabetic testing supplies

Eligible for all diabetic types.

Effective July 1, 2023, the full amount of $3,000 for diabetic supplies will be available for the remainder of 2023.

Maximum eligible expense of $3,000 per calendar year.

Insulin jet injector devices

One insulin jet injector device for insulin dependent diabetics, limited to a maximum eligible expense of $1,000 during a 3 years period.

Needles and syringes are not eligible for the 3 years period following the date of purchase of an insulin jet injector device.

If $760 for an insulin jet injector was claimed in the last 3 years, an additional $240 can be claimed for an insulin jet injector purchased after July 1, 2023, and until the end of the 3 years period.

Insulin pumps

Insulin pumps and associated equipment, excluding repair or replacement during the 5 years period following the date of purchase of such equipment.

Hearing aids

Hearing aids

Batteries for hearing aids

Batteries are covered under an initial hearing aid purchase.

This benefit provides coverage for replacement hearing aid batteries.

Maximum eligible expense of $200 per calendar year

Hearing aids

Hearing aids and repairs to them, excluding batteries, limited to the maximum eligible expense of $1,500, less the cost of all eligible hearing aid claims made in the previous 5 years.

The initial purchase of hearing aids if required as a direct result of surgery or an accident where the purchase is made within six months of such accident or surgery. This benefit is not subject to any limits other than reasonable and customary. The six-month time limit may be extended if, as determined by the Administrator, the purchase could not have been made within the time frame specified.

If $1,000 was claimed for hearing aids in the last 5 years, an additional $500 can be claimed for expenses incurred after July 1, 2023, until the end of the 5-year limit.

Other miscellaneous expenses

Other miscellaneous expenses

Artificial limbs

Temporary artificial limbs.

Permanent artificial limbs, to replace temporary artificial limbs, and replacements thereof but not within:

  • 5 years of the last purchase in the case of a member or dependant over 21 years of age, or
  • 1 year of the last purchase in the case of a dependant 21 years of age or less,

unless medically proven that growth or shrinkage of surrounding tissue requires replacement of the existing prosthesis.

Braces

Braces, including repairs, which contain either metal or hard plastic, excluding dental braces and braces used primarily for athletic use.

Breast prostheses

Breast prostheses following mastectomy and a replacement provided 2 years have elapsed since the last purchase.

Burn apparel

Elasticised apparel for burn victims.

Gender Affirmation

Coverage for certain services and procedures designed to support and affirm an individual’s gender identity, or to remove gender identity. This benefit includes procedures and services that are not covered by the individual’s provincial/territorial health plan. The services must be rendered in the patient’s country of residence.

To be considered for coverage, the person must:

  • Be aged 18 or older.
  • Under the care of a physician for gender affirmation
  • Exhaust all available coverage offered by the province or territory of residence.
  • Have all procedures considered medically necessary by the attending physician/ nurse practitioner.
  • Obtain prior approval by completing a Gender Affirmation Application Form to be completed by both the covered person and the attending physician/ nurse practitioner and submitted to the plan administrator for review.

Maximum eligible expense of $75,000 per lifetime

Incontinence supplies

Catheters and drainage bags for incontinent, paraplegic or quadriplegic patients.

Injectable lubricants for joint pain and arthritis

A prescription is required.

Not eligible for cosmetic purposes.

Maximum eligible expense of $600 per calendar year.

Medical supplies

Trusses, crutches, splints, casts and cervical collars.

Colostomy, ileostomy and tracheostomy supplies.

Bandages and surgical dressings required for the treatment of an open wound or ulcer.

Needles and syringes for injectable drugs

A prescription is required.

The prescription will be valid for 3 years.

Maximum eligible expense of $200 per calendar year

Orthopaedic brassieres

Orthopaedic brassieres, limited to a maximum eligible expense of $200 in a calendar year.

Orthopaedic shoes

Orthopaedic shoes, which are an integral part of a brace or are specially constructed for the patient, including modifications to such shoes, provided the shoes or modification is prescribed in writing by a physician, podiatrist, or a nurse practitioner, limited to a maximum eligible expense in any one calendar year of $250.

The prescription is valid for one year.

If $150 for orthopedic shoes was incurred before July 1, 2023, an additional $100 can be claimed for orthopedic shoes purchased on or after July 1, 2023.

Orthotics

Orthotics and repairs to them, prescribed in writing by a physician, nurse practitioner or podiatrist, and dispensed by an eligible provider, as determined by the Plan Administrator. Limited to one pair in a calendar year.

The prescription is valid for three years.

Oxygen

Oxygen and its administration.

Penile implants

Penile prosthesis implants, excluding those eligible under the Gender Affirmation Surgery Benefit.

Support hose

Elasticised support stockings manufactured to individual patient specifications or having a minimum compression of 30 millimetres.

Wigs

Wigs, when the patient is suffering from total hair loss as the result of an illness, limited to a maximum eligible expense of $1,500 every five years.

If $1,000 was claimed for wigs in the last 5 years, an additional $500 can be claimed for wigs after July 1, 2023, until the end of the 5-year time limit.

Exclusions:

No benefit is payable for:

  • Items purchased primarily for athletic use;
  • Ambulance services for a medical evacution considered eligible under the out-of-province benefit;
  • Expenses incurred under any of the conditions listed under General Exclusions and Limitations;
  • Durable equipment that is:
    • An accessory to an eligible device;
    • A modification to the patient’s home (bar, ramp, mat, elevator, etc.);
    • Used for diagnostic or monitoring purposes (unless specifically provided under Eligible Expenses);
    • An implant (unless specifically provided under Eligible Expenses);
    • Bathroom safety equipment;
    • An air conditioner;
  • Ongoing supplies associated with durable equipment, except as specifically provided under eligible expenses;
  • Durable equipment that is used to prevent illness, disease or injury;
  • Devices for a treatment considered to be experimental;
  • The portion of charges covered by a provincial/territorial health insurance plan or program, regardless of whether the member is a participant of the plan or program.