Provincial Health Insurance
Traveling Out of Province
Eligible Extended Health Care Expenses
Paramedical Practitioner Guidelines
Not Eligible Extended Health Care Expenses
Reimbursement Review

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.
Back to top

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.

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.
Back to top

Eligible Extended Health Care Expenses (including Vision/Paramedical Services)

Where coverage is available through the Province, the AFBS Plan 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 Associate Plan
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.
  • Any claim scenario must be reported within the Benefit Year in which the accident occurred for it to be considered eligible and must be followed by a treatment plan.
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 meter, continuous glucose monitor reader, insulin infusion sets, test strips and needles 70% reimbursement per claim 70% reimbursement per claim
Continuous glucose monitor starter kit (reader & initial sensors) (i.e. FreeStyle Libre Flash)
Continuous glucose monitor sensors 		70% reimbursement up to a maximum of once every three Benefit Years up to a maximum of $250 70% reimbursement up to a maximum of once every three Benefit Years up to a maximum of $250
70% reimbursement up to a maximum of $1,000 per Benefit Year
Colostomy or ostomy supplies where surgical stoma exists;
Tracheostoma tubes;
Urethral catheters 		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
Must have a compression factor of 15mmHG or greater indicated on the receipt		 70% reimbursement per claim up to a maximum of 4 pair/Benefit Year
Must have a compression factor of 15mmHG or greater indicated on the receipt
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.
  • See for eligible practitioners.
  • 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 your province of residence.
  • 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, details everything being done, 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 your province of residence.
  • 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.
  • See for eligible practitioners.
  • 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
  • Reimbursement to family members or companions will not be considered.

◊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
(Psychological counselling appointments with a recognized practitioner)		 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.
  • See for eligible practitioners.
    PLEASE NOTE: Counselling services are also provided through the Member and Family Assistance Plan (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 three Benefit Years which includes the medical condition for which you are being treated and clearly shows the doctor’s name, address and phone number.
  • See for eligible practitioners.
  • 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 immediately following 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.
  • 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
Vaccinations Standard Comprehensive
Reimbursement 70% reimbursement per claim. 70% reimbursement per claim.
Important Information about this benefit Reimbursement is based on the usual and customary cost of these items as determined by AFBS. Reimbursement is based on the usual and customary cost of these items as determined by AFBS.
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 eyeglasses (clear or tinted lenses), (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
  • Annual consideration is given at the full discretion of AFBS. Medical proof of a *significant visual acuity change will be required prior to AFBS granting annual benefit reimbursement considerations.
    *Significant changes are those which require your health provider to report it to the Ministry of Transportation.
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
Back to top

Paramedical Practitioner Guidelines

The Arts & Entertainment Plan provides reimbursement, up to specified limits, when medically necessary services are provided by a paramedical practitioner recognized by AFBS as indicated below. To avoid a claim for reimbursement being denied, members are encouraged to check the practitioner’s credentials and to obtain any clarification that may be needed from AFBS prior to services being provided.

Regulated paramedical practitioners which are included in your plan:

Many of the paramedical practitioner professions are provincially regulated with their services recognized by the Canada Revenue Agency (CRA) as an eligible medical expense. When provincial regulation is in place, only the services of paramedical practitioners in good standing with their provincial regulatory body are eligible for reimbursement.The following list confirms, as per the CRA website, which medical practitioners are regulated and recognized. For more information or updates on CRA eligible medical expenses/providers please refer to canada.ca .

  • Acupuncture (R.Ac, R.TCM.P, Dr. TCM) - British Columbia, Alberta, Ontario, Quebec, Newfoundland & Labrador
  • Chiropodist (D CH, D Pod M) - Manitoba, Ontario, New Brunswick
  • Chiropractor (DC) - All provinces (except Northwest and Nunavut territories)
  • Dietician (RD) - All provinces (except all territories)
  • Massage Therapy (RMT) - British Columbia, Ontario, New Brunswick, Prince Edward Island, Newfoundland & Labrador
  • Naturopathic Doctor (N.D.) - British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia
  • Optometrist (O.D.) - All provinces
  • Physiotherapist (PT) - All provinces (except Northwest and Nunavut territories)
  • Podiatrist (DPM) - British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick

Regulated Mental Health practitioners providing counselling services that are included in your plan:

  • Social Worker (MSW) - All provinces (except all territories)
  • Registered (or Licensed) Counselling Therapist - New Brunswick, Nova Scotia, PEI
  • Registered Psychologist (C.Psych, C.Psych.Assoc, R.Psych) - All provinces (except Yukon)
  • Registered Psychotherapist (RP) - Ontario and Quebec

To practice psychotherapy in Quebec, the practitioner must hold a psychotherapy permit issued by the Ordre des psychologies du Québec and be associated with the:

  • Order of Social Workers and Family Therapists (OTSTCFQ), or hold the professional designation of:
  • Conseuiller/counseillère d’orientation psychothérapeute (c.o. psychothérapeute)
  • Orienteur psychothérapeute
  • Orienteur professionnel psychothérapeute (o.p. or c.o.p. psychothérapeute)

Unregulated paramedical practitioners included in your plan:

When provincial regulation is NOT in place, only the services of paramedical practitioners which are individually and by association with an organization to be ‘regulated like’ are eligible for reimbursement. If you are unsure if your provider is recognized by AFBS, please have this reviewed before you incur a claim.

Expenses incurred when services are provided by members in good standing with the following organizations are eligible for reimbursement under the Arts & Entertainment Plan up to the specified limits.

Practitioners who are not members of one of the organizations listed below and who feel their credentials are equivalent to that of a regulated practitioner may request a review for inclusion to AFBS.

Reviews for coverage inclusion require confirmation of all of the following:

From the individual:

  • Education and training requirements similar to professionals in regulated provinces including the minimum hrs;

From the organization:

  • Continuing education requirements;
  • Standards of practice to which its members must adhere;
  • A code of ethics to which its members must adhere;
  • A scope of practice that is available to the public; and
  • A formal disciplinary and complaint review process.
Massage Therapist  
Alberta Massage Therapist Association of Alberta (MTAA)
Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA)
Certified Registered Massage Therapist Association (CRMTA) holding an Active membership
Saskatchewan Massage Therapist Association of Saskatchewan (MTAS)
Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA)
Manitoba Massage Therapy Association of Manitoba Inc. (MTAM)
Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA)
Quebec Fédération québécoise des massothérapeutes (FQM)
Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA)
The RITMA Association (RITMA)
Nova Scotia Massage Therapists' Association of Nova Scotia (MTANS)
Massage Therapists and Wholistic Practitioners’ Association of the Maritimes (MTWPAM)
Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA)
Northwest Territories, Yukon & Nunavut Northwest Territories Massage Therapists Association (NWTMTA)
Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA)

Acupuncturist  
National
Nova Scotia		 Chinese Medicine and Acupuncture Association of Canada (CMAAC)
Acupuncture and Traditional Chinese Medicine Association of Nova Scotia (ATCMANS)

Naturopathic Doctor  
Quebec Quebec Association of Naturopathic Medicine (QANM)
Confédération des Praticiens en Médecine Douce du Québec (CPMDQ)
The RITMA Association (RITMA)
Newfoundland & Labrador
New Brunswick
Northwest Territories
Prince Edward Island
Yukon		 Newfoundland and Labrador Association of Naturopathic Doctors (NLAND)
New Brunswick Association of Naturopathic Doctors (NBAND)
Northwest Territories Association of Naturopathic Doctors (NTAND)
Prince Edward Island Association of Naturopathic Doctors (PEIAND)
Yukon Association of Naturopathic Doctors (YAND)

Osteopath  
National Canadian Federation of Osteopaths (CFO)
National Manual Osteopathic Society (NMOS)
Osteopathy Canada – Provincial Affiliates (OSTCAN)
Osteopathic International Alliance (OIA)
British Columbia Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA)
OsteopathyBC
Alberta Alberta Association of Osteopathic Manual Therapists (AAOMT)
Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA)
Saskatchewan Saskatchewan Association of Osteopaths (SAO)
Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA)
Manitoba Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA)
Manitoba Association of Osteopathic Manual Therapists (MAOMT)
Ontario Ontario Association of Osteopathic Manual Practitioners (OAO)
Ontario Federation of Osteopathic Professionals (OFOP)
Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA)
Quebec Association québécoise des ostéopathes (AQO)
Ostéopathie Québec
The RITMA Association (RITMA)
New Brunswick Association of Osteopaths of New Brunswick (AONB)
Nova Scotia Nova Scotia Association of Osteopaths (NSAO)
Yukon Yukon Osteopathic Association (YOA)

Counselling Practitioner  
British Columbia Registered Clinical Counsellor (RCC)
Provinces and Territories Canadian Certified Counsellor (CCC)
Master Practitioner in Clinical Counselling (MPCC)
Registered Marriage and Family Therapist (RMFT)
Registered Therapeutic Counsellor (RTC)
All Provinces Canadian Certified Addiction Counsellors (CCAC)

Podiatrist  
Prince Edward Island The Prince Edward Island Podiatry Association (PEIPA)
Nova Scotia Nova Scotia Podiatry Association (NSPA)
Newfoundland & Labrador Newfoundland and Labrador Federation of Podiatric Medicine (NLFPM)

This list is subject to change.

Back to top

Not Eligible Extended Health Care 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.
  • Spa packages, gratuities, gift certificates, bulk purchases, Groupon or similar services.
  • Dispensing, shipping, delivery, same day or duplicate fees.
  • Medical doctor’s fees not covered by your provincial health care plan.

Not Eligible Extended Health Care Expenses

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

Reimbursement Review

Extended Health Care

If you believe there is a problem with your reimbursement amount, AFBS must be advised within 45 days of the date the Explanation of Benefits was issued. If, following this review, your concern remains, a written request for further review may be made and must be received at AFBS within 30 days of receipt of its initial review response.

Please remember that not all medically necessary services, supplies, prescriptions or dental procedures are eligible for reimbursement, there are claim submission deadlines and AFBS staff ensure a consistent approach to reimbursement, which is applied across all the insured membership.

If you wish to pursue the matter further complaints can be sent to the OmbudService for Life & Health Insurance.

Information about OLHI can be found at www.olhi.ca. Or contact them at (Canada) 1-888-295-8112, (Quebec) 1-866-582-2088.

Address:
802 -20 Adelaide St E, PO Box 29
Toronto, ON
M5C 2T6

Back to top