Group Health Insurance – Medical Supplies and Services

 
Almost all group insurance health plans provide coverage for medical supplies and services to assist employees recovering/living with a disability due to illness or injury. These benefits provide coverage for the purchase, rental and repair for devices such as wheelchairs, crutches, elastic stockings and orthopedic shoes. These benefits are included under the provisions of a health care plan and are typically subject to any applicable deductible or coinsurance provisions. Coverage is limited to a maximum amount payable per covered person and for a limited amount of time (typically 12 months).
 
Group health plans offer converge for a wide range of supplies and services, however coverage is limited only to those items/amounts that are not covered under the provincial health insurance plan. Additionally, items covered are often subject to a doctor’s approval/recommendation.
Typical services covered are listed below:
 
  • Orthopedic equipment (shoes, splints, braces)
  • Mobility aids (canes, walkers, crutches, trusses and wheelchairs - includes repairs)
  • Repertory equipment (oxygen, equipment)
  • Kidney dialysis equipment
  • Prosthetic equipment (artificial eyes, artificial limbs, external breast prosthesis - include repair)
  • Other medical supplies (hospital beds, catheters, hypodermic needles, eye glasses/contact lenses following eye surgery, wigs)
  • Oxygen, blood, blood products and transfusion
It is also important to mention that the type of device eligible for coverage is limited as well. The limitation extends to equipment that is necessary given the illness/disability of the covered employee (coverage of standard equipment). Equipment for personal comfort, convenience, exercise, safety, self-help, or environmental control items or items used for reasons other than medical are excluded.

Category: Group Benefits