Provincial Health Insurance
Traveling Out of Province
Eligible Extended Health Care Expenses
Not Eligible Extended Health Care Expenses

Extended Health Care

Provincial Health Insurance

You receive basic health care through your provincial plan within Canada. The costs of standard hospital ward accommodation, Medical Doctors’ fees and some other services are covered by your provincial plan.

Extended Health Care coverage provided by the Arts & Entertainment Plan® is intended to supplement, not replace, your provincial plan.

Provincial Health Insurance

For your own insurance protection, please ensure that your provincial health care coverage is always in effect.
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When you are Traveling or Residing Temporarily Outside your Province of Residence

AFBS does not provide emergency hospital or medical coverage, including Medical Doctors’ fees, for insured members who are traveling or residing temporarily outside their province of residence. However, Industrial Alliance Insurance and Financial Services Inc. provides a group policy for Travel Emergency Medical (TEM) to insured members of the Plan. Please ensure that this coverage is appropriate emergency hospital and medical coverage for you and your family if you plan to be outside of your province of residence. Should alternative protection be required you can consider Ingle International which can be found here. Note: Your group policy with Industrial Alliance cannot be used as an extension, or be extended by any other policy or private hospitalization plan. The group policy is null and void if you schedule or extend a trip beyond a 60 day duration.

Traveling Out of Province

Travel Emergency Medical is provided by Industrial Alliance Insurance and Financial Services Inc. please refer to the Travel Emergency Medical section under Benefit Details.
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Eligible Extended Health Care Expenses (including Vision/Paramedical Services)

Where coverage is available through the Province, the AFBS Program is secondary to any coverage/assistance provided by the Province as appropriate. Supporting documentation may be required.

“Eligible” expenses must be considered medically necessary for the treatment of an illness or injury and recommended by a Medical Doctor.

Extended Health Care (including Vision/Paramedical Care)

Standard Comprehensive
All Years Year One Year Two Subsequent Years
Reimbursement Percentage for each Insured Person 70% 70% 70% 70%
Annual Maximum for each Insured Person $5,000* $7,500* $7,500* $7,500*
Annual Maximum for each Insured Person for Vision/Paramedical Care $350 $500 $500 $750

*Maximum includes benefits paid for Vision/Paramedical Care

 

Your Arts & Entertainment Plan covers the following medical supplies and services:

Accidental Dental Standard Comprehensive
Reimbursement 70% reimbursement per claim 70% reimbursement per claim
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • Details of the accident which are sufficient for AFBS to determine eligibility must be provided before any payment can be made under this benefit. Details could include pictures and/or witness statements outlining the nature of the accident, police reports, copies of hospital emergency records and/or information from the medical doctor or dentist who attended to the emergency.
  • Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year.
Air Ambulance to Hospital Standard Comprehensive
Reimbursement 70% reimbursement per claim up to a maximum of $4,000 70% reimbursement per claim up to a maximum of $4,000
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • Costs are limited to any amount that is not covered by your provincial health care plan for flights originating and terminating in your province of residence.
  • This benefit is not available for repatriation when an accident or illness occurs while travelling outside your province of residence.
  • This benefit is not available outside of Canada.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Artificial Eyes and Limbs* Standard Comprehensive
Reimbursement 70% reimbursement per claim up to a maximum of $5,000 every five Benefit Years, or every three years of continuous coverage for a dependent child under 18 years of age 70% reimbursement per claim up to a maximum of $5,000 every five Benefit Years, or every three years of continuous coverage for a dependent child under 18 years of age
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • *Requires an initial written confirmation from your medical doctor concerning the loss and which includes and clearly shows the doctor’s name, address and phone number.
  • Includes repair and replacement.
  • Includes myoelectric prosthesis.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Assistive Devices, Mobility aids and Medical Equipment Standard Comprehensive
Reimbursement
Abdominal, back or knee brace* 70% reimbursement per claim up to $500/knee Lifetime maximum and $500 for each of an abdominal or back brace Lifetime maximum*(3) 70% reimbursement per claim up to $500/knee Lifetime maximum and $500 for each of an abdominal or back brace Lifetime maximum*(3)
Apnea monitors for respiratory dysrhythmias* 70% reimbursement per claim up to a Lifetime maximum of $500* 70% reimbursement per claim up to a Lifetime maximum of $500*
Blood glucose monitoring machine 70% reimbursement per claim once every five Benefit Years(2) 70% reimbursement per claim once every five Benefit Years(2)
Colostomy or ostomy supplies where surgical stoma exists;
Tracheostoma tubes;
Urethral catheters;
Insulin infusion sets, test strips and needles.
70% reimbursement per claim 70% reimbursement per claim
CPAP (continuous positive airway pressure) machine* 70% reimbursement per claim up to a Lifetime maximum of $500* 70% reimbursement per claim up to a Lifetime maximum of $500*
CPAP and IPPB supplies 70% reimbursement per claim up to $100/Benefit Year 70% reimbursement per claim up to $100/Benefit Year
Devices and medical aids necessitated after surgery or hospitalization* Not covered 70% reimbursement per incident up to $750*. There is also a Lifetime maximum of $2,500(4)
External breast prosthesis when required as a result of a total or radical mastectomy* 70% reimbursement per claim up to a maximum of one/Benefit Year*(2) 70% reimbursement per claim up to a maximum of one/Benefit Year*(2)
Insulin infusion pump* 70% reimbursement per claim up to a Lifetime maximum of $1,000* 70% reimbursement per claim up to a Lifetime maximum of $1,000*
IPPB (intermittent positive airway pressure breathing) machine* 70% reimbursement per claim up to a Lifetime maximum of $500* 70% reimbursement per claim up to a Lifetime maximum of $500*
Light Therapy when SADD is diagnosed* 70% reimbursement per claim up to a Lifetime maximum of $200* 70% reimbursement per claim up to a Lifetime maximum of $200*
Stump socks 70% reimbursement per claim up to a maximum of 4 pair/Benefit Year 70% reimbursement per claim up to a maximum of 4 pair/Benefit Year
Support hose and compression stockings 70% reimbursement per claim up to a maximum of 4 pair/Benefit Year 70% reimbursement per claim up to a maximum of 4 pair/Benefit Year
Surgical brassieres* 70% reimbursement per claim up to a maximum of two/Benefit Year*(2) 70% reimbursement per claim up to a maximum of two/Benefit Year*(2)
TENS (transcutaneous nerve stimulator for chronic pain) machine* 70% reimbursement per claim up to a Lifetime maximum of $500* 70% reimbursement per claim up to a Lifetime maximum of $500*
Walker, casts, splints, walking cane, crutches, cervical collar, truss* 70% reimbursement per claim*(1) 70% reimbursement per claim*(1)
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • Reimbursement is based on the usual and customary cost of these items as determined by AFBS and is subsequent to any provincial plan coverage that may be available.
  • Limited to only those items specified above under Assistive Devices, Mobility aids and Medical Equipment;
  • * Requires a written recommendation from your medical doctor or nurse practitioner which includes the medical condition for which you are being treated and clearly shows the doctor/nurse practitioner’s name, address and phone number.
    (1)Receipts issued by a hospital will be accepted without the usual recommendation. (2)An initial medical recommendation may be required.
  • (3)Excludes binders, supports, elasticized braces, belts and backrests.
  • (4)Excludes home renovations including lifts, grab bars and poles.
  • (5)Must be prescribed by one of: Medical Doctor (MD), Podiatrist (DPM), Chiropodist (d CH or D Pod M). Further, the product must be dispensed by one of the following providers and include the biomechanical assessment as well as an itemized receipt listing all the items and modifications. Recognized providers are: Orthotist (CO or CPO(c )), Pedorthist (C Ped(c) or C Ped (MC)), Podiatrist (DPM), Chiropodist (D CH od D Pod M).
  • Both the name and qualifications of the prescribing specialist and provider must be clearly noted.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Audiologist or Speech Therapist* Standard Comprehensive
Reimbursement 70% reimbursement per claim up to a maximum of $25 each visit 70% reimbursement per claim for services provided up to a Benefit Year combined maximum (both practitioners) of $750
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • Reimbursement requires either a pathological or audiological impediment.
  • *Requires a written recommendation from your medical doctor each Benefit Year which includes the medical condition for which you are being treated and clearly shows the doctor’s name, address and phone number.
  • Standard is subject to a $350 cumulative Benefit Year reimbursement maximum with respect to the following services and/or supplies: registered psychologist, naturopath, homeopath, registered massage therapist, acupuncturist, chiropractor, chiropodist, osteopath, podiatrist, physiotherapist, audiologist, speech therapist, dietician, traditional Chinese medicine.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Chiropodist, Chiropractor, Podiatrist or Osteopath Standard Comprehensive
Reimbursement 70% reimbursement per claim up to a maximum of $25 each visit 70% reimbursement per claim up to a maximum of $45 each visit
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • Services must be provided within the scope of the practitioner’s license/designation for which a receipt for reimbursement is being submitted.
  • Reimbursement is based on the usual and customary cost of this service as determined by AFBS.
  • Standard is subject to a $350 cumulative Benefit Year reimbursement maximum with respect to the following services and/or supplies: psychologist, naturopath, homeopath, registered massage therapist, acupuncturist, chiropractor, chiropodist, osteopath, podiatrist, physiotherapist, audiologist, speech therapist, dietician, traditional Chinese medicine.
  • Comprehensive is subject to a $500 (years 1 and 2) and $750 (subsequent years)cumulative Benefit Year reimbursement maximum with respect to the following services and/or supplies: psychologist, naturopath, homeopath, registered massage therapist, acupuncturist, chiropractor, chiropodist, osteopath, podiatrist, dietician, traditional Chinese medicine
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Emergency Ground Ambulance to Hospital Standard Comprehensive
Reimbursement 70% reimbursement per claim 70% reimbursement per claim
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • Reimbursement is based on any co-payment amount required by your province of residence.
  • Scheduled use of ambulance services is excluded.
  • This benefit is not available outside of Canada.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Fertility Testing* Standard Comprehensive
Reimbursement Not covered 70% reimbursement per claim up to a Lifetime maximum of $2,500
Important Information about this benefit
  • This is a covered Extended Health Care expense where specified.
  • *Requires a written recommendation from your medical doctor which indicates the examination and clearly shows the doctor’s name, address and phone number.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Hearing Aids* Standard Comprehensive
Reimbursement 70% reimbursement per claim up to $500/ear every four Benefit Years – adult or every two Benefit Years - child 70% reimbursement per claim up to $500/ear every four Benefit Years – adult or every two Benefit Years - child
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • Reimbursement is subsequent to any provincial plan coverage that may be available.
  • *Requires an initial written recommendation from your medical doctor which includes the medical condition for which you are being treated and clearly shows the doctor’s name, address and phone number.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Home Care following hospitalization* Standard Comprehensive
Reimbursement Not covered 70% reimbursement up to $30/day to a maximum of 30 days
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • Provides reimbursement when medically necessary for on-going recovery following hospitalization.
  • *With each occurrence, requires a written recommendation from your medical doctor which includes the medical condition for which you are being treated and clearly shows the doctor’s name, address and phone number.
  • Services require pre-approval by AFBS.
  • The provider must be supervised by an organization recognized to provide home care and be a licensed practical nurse (LPN), registered nurse (RN), registered nursing assistant (RNA), Personal Service Worker (PSW), Victorian Order of Nurses (VON) or other health care provider as deemed appropriate by your Medical Doctor and AFBS.
  • Excludes reimbursement to family members or companions.
  • Reimbursement from AFBS is subsequent to any provincial plan coverage that may be available.
  • Must be preceded by surgery (excluding cosmetic surgery) requiring at least one night of hospitalization or three days acute care hospitalization or following physical rehabilitation in a medical facility designated to provide these services.
  • This benefit must be used with 90 days following discharge.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Hospital Bed* Standard Comprehensive
Reimbursement 70% reimbursement per claim, combined with Medical Equipment and Assistive Devices up to a maximum of $2,500 each Benefit Year. Lifetime maximum $1,500 70% reimbursement per claim up to a Lifetime maximum $1,500
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • *With each submission, requires a written recommendation from your medical doctor which includes the medical condition for which the medical equipment is required and clearly shows the doctor’s name, address and phone number.
  • Reimbursement can be applied towards either rental or purchase costs.
  • Reimbursement is based on the usual and customary cost of the equipment as determined by AFBS;
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Hospital Room Costs Standard Comprehensive
Reimbursement 70% reimbursement per claim for the first 5 days, 100% thereafter, semi-private only, $150/day max 70% reimbursement per claim for the first 5 days, 100% thereafter, semi-private only, no per day max
Important Information about this benefit
  • This is a covered Extended Health Care expense where specified.
  • Reimbursement is limited to the difference between standard ward accommodation and the covered daily room cost rate when an accredited hospital is providing acute care.
  • When an accredited hospital provides physical rehabilitation services immediately following acute care of at least three days, room costs as indicated above will also be eligible for reimbursement.
  • The cost of additional amenities or services for which the hospital may charge are excluded.
  • Room costs incurred in any of a convalescent, long term care, nursing home or a facility that primarily provides treatment for addiction(s) are NOT COVERED.
  • This benefit is not available outside of Canada.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Naturopathic or Homeopathic doctor Standard Comprehensive
Reimbursement 70% reimbursement per claim up to a maximum of $25 each visit 70% reimbursement per claim up to a maximum of $45 each visit
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • With respect to the services of a naturopathic doctor, the practitioner must be a member in good-standing and registered/licensed by the provincial College of Naturopaths when practicing in BC, AB. SK. MB. ON and NS. In all other provinces the Naturopath must have completed at least 4,200 hours of training, be qualified within their province of practice to use the designation Naturopathic Doctor or N.D and be a member in good-standing of the Canadian Association of Naturopathic Doctors (CAND) or other such body that incorporates a code of ethics, disciplinary review and continuing education.
  • With respect to a homeopathic doctor, the practitioner must be a member in good-standing of the Canadian Society of Homeopaths.
  • Reimbursement is based on the usual and customary cost of this service as determined by AFBS.
  • Reimbursement of remedies, vitamins, supplements, supplies or other peripheral services are excluded.
  • Standard is subject to a $350 cumulative Benefit Year reimbursement maximum with respect to the following services and/or supplies: registered psychologist, naturopath, homeopath, registered massage therapist, acupuncturist, chiropractor, chiropodist, osteopath, podiatrist, physiotherapist, audiologist, speech therapist, dietician, traditional Chinese medicine.
  • Comprehensive is subject to a $500 (years 1 and 2) and $750 (subsequent years) cumulative Benefit Year reimbursement maximum with respect to the following services and/or supplies: psychologist, naturopath, homeopath, registered massage therapist, acupuncturist, chiropractor, chiropodist, osteopath, podiatrist, dietician, traditional Chinese medicine
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Orthotics Standard Comprehensive
Reimbursement Not covered 70% reimbursement per claim up to a Benefit Year maximum of $150
Important Information about this benefit
  • This is a covered Extended Health Care expense where specified.
  • Orthotics must be prescribed by one of: Medical Doctor (MD), Podiatrist (DPM), Chiropodist (d CH or D Pod M). Further, the product must be dispensed by one of the following providers and include the biomechanical assessment as well as an itemized receipt listing all the items and modifications. Recognized providers are: Orthotist (CO or CPO(c )), Pedorthist (C Ped(c) or C Ped (MC)), Podiatrist (DPM), Chiropodist (D CH od D Pod M).
  • Both the name and qualifications of the prescribing specialist and provider must be clearly noted.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Oxygen Set* Standard Comprehensive
Reimbursement 70% reimbursement per claim, combined with medical equipment and assistive devices up to a maximum of $2,500 each benefit Year 70% reimbursement per claim
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • *Requires an initial written recommendation from your medical doctor which includes the medical condition for which the medical equipment is required and clearly shows the doctor’s name, address and phone number.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Physiotherapist* Standard Comprehensive
Reimbursement 70% reimbursement per claim up to a maximum of $25 each visit 70% reimbursement per claim up to a Benefit Year maximum of $750
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • *Requires a written recommendation from your medical doctor, each Benefit Year, which includes the medical condition for which you are being treated and clearly shows the doctor’s name, address and phone number.
  • Services must be provided within the scope of the practitioner’s license/designation for which a receipt for reimbursement is being submitted.
  • Reimbursement is based on the usual and customary cost of this service as determined by AFBS.
  • Reimbursement of peripheral services and supplies is excluded.
  • Standard is subject to a $350 cumulative Benefit Year reimbursement maximum with respect to the following services and/or supplies: psychologist, naturopath, homeopath, registered massage therapist, acupuncturist, chiropractor, chiropodist, osteopath, podiatrist, physiotherapist, audiologist, speech therapist, dietician, traditional Chinese medicine.
  • Comprehensive is subject to a $750 Benefit Year max.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Private Duty Nursing following hospitalization* Standard Comprehensive
Reimbursement 70% reimbursement per claim, combined with medical equipment and assistive devices up to a maximum of $2,500 each Benefit Year 70% reimbursement per claim, up to a maximum of $2,500 each Benefit Year
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • Provides reimbursement when medically necessary for on-going recovery or when required for in-home palliative end-of-life support.
  • *With each occurrence, requires a written recommendation from your medical doctor which includes the medical condition for which you are being treated and clearly shows the doctor’s name, address and phone number.
  • Services require pre-approval by AFBS.
  • The provider must be a licensed practical nurse (LPN), registered nurse (RN), or registered nursing assistant (RNA).
  • Reimbursement from AFBS is subsequent to any provincial plan coverage that may be available.
  • Services must be put in place immediately following hospital discharge and may be extended over a period not exceeding 45 days.
  • Excludes reimbursement to family members or companions.
  • Excludes support required as a result of cosmetic surgery or procedures.
  • This is not a long-term care benefit.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Palliative support is payable during one occasion only. The three year and annual maximums will apply, however, the hospitalization and 45-day maximum requirements may be waived by AFBS.

Registered Dietician* Standard Comprehensive
Reimbursement 70% reimbursement per claim up to a maximum of $25 each visit 70% reimbursement per claim up to a maximum of $45 each visit
Important Information about this benefit
  • This is a covered Extended Health Care expense where specified.
  • Reimbursement of remedies, vitamins, supplements, supplies, tests and other peripheral services are excluded.
  • *Requires a written recommendation from your medical doctor, each Benefit Year, which includes the medical condition for which you are being treated and clearly shows the doctor's name, address, and phone number.
  • Standard is subject to a $350 cumulative Benefit Year reimbursement maximum with respect to the following services and/or supplies: registered psychologist, naturopath, homeopath, registered massage therapist, acupuncturist, chiropractor, chiropodist, osteopath, podiatrist, physiotherapist, audiologist, speech therapist, dietician, traditional Chinese medicine.
  • Comprehensive is subject to a $500 (years 1 and 2) and $750 (subsequent years) cumulative Benefit Year reimbursement maximum with respect to the following services and/or supplies: psychologist, naturopath, homeopath, registered massage therapist, acupuncturist, chiropractor, chiropodist, osteopath, podiatrist, dietician, traditional Chinese medicine.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Registered/Licensed Psychologist Standard Comprehensive
Reimbursement 70% reimbursement per claim up to a maximum of $25 each visit* 70% reimbursement per claim up to a maximum of $45 each visit**
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • The practitioner must be registered/licensed by the provincial College of Psychologists in which (s)he provides counselling services.
    PLEASE NOTE: Counselling services are also provided through the Member and Family Assistance Program (MFAP).
  • Reimbursement is based on the usual and customary cost of this service as determined by AFBS.
  • *Standard is subject to a $350 cumulative Benefit Year reimbursement maximum with respect to the following services and/or supplies: registered psychologist, naturopath, homeopath, registered massage therapist, acupuncturist, chiropractor, chiropodist, osteopath, podiatrist, physiotherapist, audiologist, speech therapist, dietician, traditional Chinese medicine.
  • **Comprehensive is subject to a $500 (years 1 and 2) and $750 (subsequent years) cumulative Benefit Year reimbursement maximum with respect to the following services and/or supplies: psychologist, naturopath, homeopath, registered massage therapist, acupuncturist, chiropractor, chiropodist, osteopath, podiatrist, dietician, traditional Chinese medicine.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Registered Massage Therapist, Registered Acupuncturist* Standard Comprehensive
Reimbursement 70% reimbursement per claim up to a maximum of $25 each visit 70% reimbursement per claim up to a maximum of $45 each visit
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • *SPECIAL NOTE: With respect to massage therapy and acupuncture, a written recommendation is required from your medical doctor every Benefit Year which includes the medical condition for which you are being treated and clearly shows the doctor’s name, address and phone number.
  • Services must be provided within the scope of the practitioner’s license/designation for which a receipt for reimbursement is being submitted.
  • Reimbursement is based on the usual and customary cost of this service as determined by AFBS.
  • Reimbursement of peripheral services and supplies is excluded.
  • Standard is subject to a $350 cumulative Benefit Year reimbursement maximum with respect to the following services and/or supplies: registered psychologist, naturopath, homeopath, registered massage therapist, acupuncturist, chiropractor, chiropodist, osteopath, podiatrist, physiotherapist, audiologist, speech therapist, dietician, traditional Chinese medicine.
  • Comprehensive is subject to a $500 (years 1 and 2) and $750 (subsequent years) cumulative Benefit Year reimbursement maximum with respect to the following services and/or supplies: registered psychologist, naturopath, homeopath, registered massage therapist, acupuncturist, chiropractor, chiropodist, osteopath, podiatrist, dietician, traditional Chinese medicine
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Special vision care benefit after cataract surgery * Standard Comprehensive
Reimbursement Not covered Lifetime maximum of $500/eye
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • Requires medical confirmation of the date of cataract surgery from your treating medical doctor including and clearly showing the doctor’s name, address and phone number.
  • Receipts must be submitted for any of a corrective lens, contact lens or prosthetic lens required as a result of the cataract surgery and which are not covered by your provincial health plan.
  • Any laser vision surgery follow-up is excluded.
  • Medical doctor or medical office fees are excluded.
  • This benefit is payable in addition to any vision care benefits payable.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Vision Care Standard Comprehensive
Reimbursement 70% reimbursement up to $150 every two Benefit Years, combined with paramedical services up to $350 every benefit year 70% reimbursement per claim up to $325 every two Benefit Years, combined with paramedical services up to $500 every benefit year for years 1 and 2 and $750 in subsequent years
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • Reimbursement is limited to eye examinations provided by an Optometrist or Ophthalmologist, laser eye surgery and the purchase of prescription glasses (excluding sunglasses or safety glasses) or contact lenses.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Wheelchair* Standard Comprehensive
Reimbursement 70% reimbursement per claim, combined with Medical Equipment and Assistive Devices up to a maximum of $2,500 each Benefit Year. Lifetime maximum $1,000 70% reimbursement per claim up to a Lifetime maximum $1,000
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • *With each submission, requires a written recommendation from your medical doctor which includes the medical condition for which the medical equipment is required and clearly shows the doctor’s name, address and phone number.
  • Reimbursement can be applied towards either rental or purchase costs.
  • Reimbursement is based on the usual and customary cost of the equipment as determined by AFBS;
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
Wigs* Standard Comprehensive
Reimbursement 70% reimbursement per claim up to a lifetime maximum of $1,000, only for cancer patients undergoing treatment 70% reimbursement per claim up to a lifetime maximum of $1,000, only for cancer patients undergoing treatment
Important Information about this benefit
  • This is a covered Extended Health Care expense.
  • *With each submission, requires a written recommendation from your medical doctor which includes the medical condition for which you are being treated and clearly shows the doctor’s name, address and phone number.
  • There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year
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Not Eligible Extended HealthCare Expenses

Services and supplies which are not specifically listed as a covered expense are not eligible for reimbursement through the Arts & Entertainment Plan®. The following are also ineligible for reimbursement:

  • Payment of the provincial health care premium.
  • Services payable through any provincial hospital plan or provincial health care plan, WSIB/Workers’ Compensation, other government agencies, other insurers or other sources.
  • Medical Doctors’ fees for completing claim forms or reports, missed appointments, or examinations to obtain insurance coverage.
  • Standard hospital ward accommodation.
  • Cosmetic surgery.
  • Travel for health reasons or rest cures.
  • Bodily injury resulting from war, insurrection or riot.
  • Coverage for eligible dependants unless the member has elected to insure them and paid the appropriate premium.
  • Out-of-country bills for hospital or Medical Doctors’ fees.
  • Surgeries performed privately and outside of provincial health care plans.

Not Eligible Extended Health Care Expenses

Services and supplies which are not specifically listed as a covered expense are not eligible for reimbursement
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