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Extended Health Benefits

Employee Benefits


Flex Plan:

This benefit is covered under Flex Options 2, 3 and 4.


Purpose of Extended Health Benefits

Extended Health Care is designed to supplement provincial Medicare. In addition to the Ambulance and Hospital coverage, as an eligible employee you will be reimbursed for necessary and reasonable health expenses, incurred by you or your eligible family members, which are not covered by the Government Plan.

For information relating to Claiming Benefits, Co-ordination of Benefits, Exclusions, Family Member Eligibility, e-service, etc. please go to the Health Benefits Home Page.

Included here is general information relating to the University of Winnipeg employee benefits. The information is intended as a summary of the main provisions of the various benefits, presented in non-technical language. The terms and conditions under which the benefits are provided, are governed by the appropriate group policy, contract, or plan text and any relevant Collective Agreement and in any dispute the legal document will take precedence over the information provided here.



Deductible & Reimbursement

Refer to the Flex Plan Option Summary for reimbursement maximums based on Flex Option.

Flex Options 2 and 4

For Drugs only, there is a dispensing fee deductible.  You will be required to pay a deductible equal to the dispensing fee each time you fill a prescription.  Reimbursement is subject to reasonable and customary expenses for eligible health services, up to the maximum, where applicable.

Flex Option 3

There is a deductible of $25 per employee (single, couple or family coverage) in each calendar year. Once the deductible amount has been met, you will be reimbursed for reasonable and customary expenses for eligible health services, up to the maximum, where applicable.




Accidental Dental Treatment

Charges for dental treatment resulting from accidental injury to jaw or natural teeth. Dental treatment must commence within 90 days of accident and the amount payable will be based on the Manitoba Dental Fee Guide.




Blood & Blood Plasma

Charges for blood and blood plasma if not available free of charge.




Cardiac Rehabilitation

A lifetime maximum benefit payment of up to $500 for Cardiac patients requiring the treatment under a recognized cardiac rehabilitation program prescribed by the attending physician.




Drugs

Charges for drugs or medicines including serums, injectables, and insulin which are sold on the written prescription of a Medical Practitioner and dispensed by a Licensed Pharmacist. To be considered eligible, these drugs or medicines must be listed in the most current edition of the applicable Provincial Drug Plan Benefits List, or where there is no Provincial Drug Plan Benefits List, in a Drug Plan Benefits List developed by Blue Cross. Benefits payable will be integrated with those available from any government sponsored Provincial Drug Plan, with reimbursement being is limited to the applicable Provicial Drug Plan deductible.

Prescription Drug Claims and Dispensing Fees




Health Practitioners

Paramedical coverage includes charges for treatment by a licensed Acupuncturist, Athletic Therapist, Chiropractor, Massage Therapist, Occupational Therapist and Physiotherapist.

Refer to the Flex Plan Option Summary for reimbursement rates and maximums based on Flex Option.




Hearing Aids

Charges for purchase or repair of hearing aids when prescribed by an Otologist or clinical Audiologist, up to a maximum of $500 per person during any five consecutive year period. Charges for regular maintenance, batteries or recharging devices are not eligible expenses.

Refer to the Flex Plan Option Summary for reimbursement rates based on Flex Option.




Medical Appliances

Charges for rental or purchase or repair of:

  • an iron lung, wheelchair, respirator, oxygen equipment or hospital-type bed as prescribed by the attending physician, to a lifetime maximum benefit payable of $1,000 per item (prior approval of Blue Cross is required)

  • walker when prescribed by the attending physician

  • other prescribed medical equipment (prior approval of Blue Cross is required) up to a lifetime maximum benefit payment of $250 per person.



Nutritional Counselling/Dietitian

Charges for the services of a registered dietitian upon referral by a physician.

Refer to the Flex Plan Option Summary for reimbursement rates and maximums based on Flex Option.




Orthopedic Shoes & Modifications to Orthopedic Shoes

Charges for orthopedic shoes custom made from a mould or stock shoes which are modified (excluding orthotics or insoles, removable or permanently-affixed) to accommodate, relieve or remedy a mechanical foot defect or abnormality. Payment is limited to one pair per person per calendar year.

Charges for orthopedic shoes modifications (excluding orthotics or insoles, removable or permanently-affixed) to accommodate, relieve or remedy a mechanical foot defect or abnormality.

A copy of a prescription from the attending Physician or Podiatrist, including a medical diagnosis along with a detailed description of the orthopedic shoe and modifications(s) is required. Boots, sandals or sport specific footwear are not eligible.




Podiatry

Charges for diagnosis and treatment by a Licensed Podiatrist.

Refer to the Flex Plan Option Summary for reimbursement rates and maximums based on Flex Option.




Private Duty Nursing

Charges for private duty nursing visits by a professional registered nurse (not a relative) during the twelve months immediately following discharge from the hospital either in the hospital or home as recommended by the attending physician.

Refer to the Flex Plan Option Summary for reimbursement rates and maximums based on Flex Option.




Prosthetic & Remedial Equipment

Upon written prescription of the attending physician, charges for artificial limbs and eyes, splints, casts, trusses, crutches, braces, lumbar-sacro supports, corsets, traction equipment, knee braces, cervical collars, and compression garments. Charges for prescribed breast prosthesis and surgical bras up to a maximum benefit of $100 per single prosthesis or bra and $200 per double prosthesis or bra per calendar year.




Psychological Counselling

Charges for the services of a Registered Clinical Psychologist when referred by a physician. Includes the services of Aurora Family Therapy Centre (physician referral not required).

Refer to the Flex Plan Option Summary for reimbursement rates and maximums based on Flex Option.




Travel Health Care

Emergency medical, surgical and hospital services, required as a result of an emergency or illness when outside of Manitoba. There is no coverage for 'elective' treatment when you leave Manitoba to seek medical treatment elsewhere. This benefit is integrated with coverage provided under the Manitoba Health plan and is limited to a maximum of $2,500 per person per calendar year. Additional coverage for U.S.A. or International travel is recommended. This benefit mainly applies to eligible employees who no longer have coverage under the comprehensive Travel Health Plan.




Wigs

Upon written prescription of the attending physician, charges for wigs and hairpieces, up to a lifetime maximum of $1,000 per person.




Extended Health Benefits Exclusions

The following exclusions and limitations are specific to the Extended Health Benefits plan. For General Exclusions that are applicable to all health benefits please refer to the Health Benefits Home Page.

Blue Cross will not pay for the following:

  1. Any drug or medicine not listed in the most current Manitoba Drug Benefits and Interchangeability Formulary (or in the case of non-Manitoba residents, the applicable provincial drug plan formulary or Blue Cross formulary) regardless of whether the prescription has been issued by a physician and dispensed by a pharmacist.
  2. Orthodontic services.
  3. Services related to the treatment of Temporo-Mandibular Joint dysfunction.
  4. Dental implants.
  5. In excess of a 100-day supply for any drug or medicine.


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