This benefit is designed to supplement your Government Hospital Insurance Plan, which provides coverage at the standard ward level only. The following services are covered at 100% under your Medavie Blue Cross plan.
Private / Semi-Private Accommodation – charges for the difference between the normal charges for public ward accommodation in the hospital and the normal charges for private / semi-private accommodation actually occupied in that hospital when the participant becomes confined in that hospital on the advice of a physician and such confinement is medically necessary.
Out-Patient Hospital Services – the plan pays for any out-patient services not covered by your Government plan.
Licensed Nursing Home – charges for room and board up to $20 (maximum reimbursement $16) per day. This benefit is applicable to active teachers only.
Professional Ambulance Service – charges for licensed professional ground ambulance transportation to or from the nearest hospital able to provide the care required when, due to the medical condition of the participant, no other form of transportation can be utilized. Charges for transportation to and from scheduled appointments are not covered.
The Following Are Not Covered:
- Charges for hospital accommodation incurred during any time the participant is not under the active treatment and care of a physician.
- Charges for chronic, convalescent, respite or custodial care, regardless of whether such care is provided in a chronic care bed or active treatment bed of a hospital.
- Charges for services provided in a nursing or convalescent home or special institution for the treatment of alcoholism or drug addiction.
Charges for any period beyond the date which the participant can be medically discharged from the hospital as determined by the attending physician.