Freedom to Choose Select Plans

Guaranteed

The Guaranteed plan covers your basic health care needs, plus prescription drugs. It provides coverage for the following benefits and benefit levels:

 

Prescription drugs (optional)

Drugs that by law require a prescription by a physician or other person entitled by law to prescribe them.

Co-insurance with drug card 80% to a maximum of $1,000 per person per calendar year

Co-insurance with no drug card 90% to a maximum of $1,000 per person per calendar year

Disposable needles for use with non-disposable insulin injection devices, lancets, test strips, and sensors for flash glucose monitoring machines

Prescription drugs not covered:

Drugs for the treatment of erectile dysfunction

Smoking cessation products

Homeopathic preparations, proprietary or patent medicines

Any drug that doesn’t have a drug identification number (DIN) as defined by the Food and Drugs Act, Canada

Note: if you live in Quebec, you are required to have drug coverage through your employer or the Quebec provincial plan, the Régie de l’assurance maladie du Québec (RAMQ).

 

Hospital accommodation

The difference in cost between private and standard ward accommodation in hospital if the private accommodation starts while insured under this plan and is for acute, convalescent or palliative care.

 

Paramedical services

Unless prohibited by law, Canada Life will pay for the portion of the cost of paramedical services that is not payable under a government plan.

Benefits payable for reasonable and customary charges for:

Treatment of muscle and bone disorders, including diagnostic x-rays, by a licensed chiropractor are limited to a maximum amount payable of $300 in a calendar year

Treatment of nutritional disorders by a registered dietician, are limited to a maximum amount payable of $300 in a calendar year

Treatment by a licensed osteopath, including diagnostic x-rays, are limited to a maximum amount payable of $300 in a calendar year

Treatment of movement disorders by a licensed physiotherapist are limited to a maximum amount payable of $300 in a calendar year

Treatment of foot disorders, including diagnostic x-rays, by a licensed podiatrist are limited to a maximum amount payable of $300 in a calendar year

Treatment by a registered psychologist or social worker are limited to a maximum amount payable of $300 in a calendar year

Treatment by a qualified massage therapist are limited to a maximum amount payable of $300 in a calendar year

Treatment of speech impairments by a qualified speech therapist are limited to a maximum amount payable of $300 in a calendar year

Treatment by a licensed naturopath are limited to a maximum amount payable of $300 in a calendar year

Treatment by a qualified acupuncturist are limited to a maximum amount payable of $300 in a calendar year

 

Vision care

Eye exams when performed by a licensed ophthalmologist or optometrist, 90% coverage up to $75 for one eye exam every 2 years.

 

Hearing aids

Hearing aids, including batteries, tubing and ear moulds provided at the time the hearing aid is purchased, to a maximum of $500 per person every five years.

 

Ambulance services

Ambulance service including air ambulance, if provided by a licensed ambulance company for transportation to the nearest centre where essential treatment is available.

 

Nursing care

In-home nursing care: Benefits payable are limited to:

The minimum number of hours per day or week

The level of skill needed to provide each essential nursing service

For nursing care, payable benefits are up to a maximum of 12 months, beginning on the first day of care. The maximum amount payable is $2,500. The maximums will be reinstated for a subsequent period of nursing care if :

It follows a period of at least six months during which no nursing care was needed
OR

It is required for a different and unrelated injury or sickness

Hospital care and in-home nursing care benefits aren’t payable for chronic care.

Nursing home care: Accommodation in a nursing home, if accommodation starts while insured under the Freedom to Choose health and dental insurance policy and is for acute, convalescent, chronic or palliative care. Coverage is for up to $50 per day, for 30 days per condition, per lifetime of the condition. Nursing home care must be approved by Canada Life prior to commencement of care.

 

Medical supplies, services, aids and appliances

The following supplies, when prescribed by a physician. For supplies available on a rental basis, Canada Life covers the rental cost, or at its discretion, the cost of purchase.

Diagnostic lab and x-ray services: Performed in the insured’s home province or territory

Breathing equipment: Oxygen and the equipment needed for its administration; intermittent positive pressure breathing machines; continuous positive airway pressure machines; apnea monitors for respiratory dysrhythmias; mist tents and nebulizers; chest percussors, drainage boards, sputum stands and tracheostoma tubes

Orthopedic equipment: Benefits payable for custom-made foot orthotics and custom-fitted orthopedic shoes, including modification to orthopedic footwear, are limited to $200 in a calendar year

Prosthetic equipment: External breast prostheses (once per insured person per calendar year), surgical brassieres (two per insured person per calendar year), artificial eyes, standard artificial limbs, cleft palate obturators, and internal breast prostheses to the amount payable for external breast prostheses

Mobility aids: Wheelchairs and power scooters when necessary to permit independent participation in daily living and repairs and rechargeable batteries for covered wheelchairs (limited to $1,500 per insured person per lifetime)

Diabetic equipment: Coverage for blood-glucose, flash glucose, and continuous glucose monitoring machines, including sensors and transmitters for continuous glucose monitoring machines, is limited to $500 per calendar year

Other medical supplies:

Canes

Walkers

Crutches

Parapodiums

Hospital beds

Bed rails

Trapeze bars

Head halters and traction apparatus

Colostomy and ileostomy supplies

Catheters and catheterization supplies

Food substitutes that must be administered through a tube feed process and the tube feeding pumps and pump sets

Transcutaneous nerve stimulators for the control of chronic pain (limited to $700 per insured person per lifetime)

Custom-made pressure supports for lymphedema

Custom-made compression hose (limited to 4 pairs per insured person per calendar year)

Extremity pumps for lymphedema or severe postphlebitic syndrome (limited to $1,500 per insured person per lifetime)

Custom-made burn garments

Elevated toilet seats

Shower chairs

Bathtub rails and standard commodes

Wigs for cancer patients undergoing chemotherapy (limited to $500 per insured person per lifetime)

Surgically implanted intraocular lenses

Eye glasses or contact lenses following eye surgery (limited to one pair following eye surgery)

 

Dental care

Dental accident treatment: Treatment from accidental injury to sound natural teeth. The accident must occur while the insured is covered under the Freedom to Choose health and dental insurance policy. Treatment must begin within 60 days after the injury and be performed by a dentist, oral surgeon or denturist.

Note: The Guaranteed plan covers dental accident treatment under health care services and supplies, but it does not cover dental care services and supplies.

Major dental: No coverage

 

Teledoc Medical Experts ®

Consultation services that put you in touch with the world’s best medical specialists to help with diagnosis and treatment planning for serious illnesses

 

General limitations and exceptions

No benefits will be paid under the Guaranteed plan for the following:

Services and supplies associated with the diagnosis or treatment of infertility or contraception (except oral contraceptives)

Dental care services and supplies associated with:

Congenital defects or developmental malformations in people 19 years of age or over

Temporomandibular joint disorders

Vertical dimension correction

Myofacial pain or orthodontic treatment

Expenses that private insurers are not permitted to cover by law

Services and supplies that the insured is entitled to without charge by law, or for which a charge is made only because the insured has insurance coverage

Services and supplies that don’t represent reasonable medical or dental treatment

Services and supplies associated with treatment performed for cosmetic purposes

Services and supplies associated with chronic care except those used for nursing home accommodation

Services or supplies associated with items covered under your policy, unless specifically listed as a covered health care or dental care service or supply

Services or supplies received outside Canada, except as provided by the emergency travel medical rider, if in force

Services or supplies received out-of-province in Canada unless:

The insured is covered by the government plan providing Medicare coverage in the insured’s home province or territory; and

Canada Life would have paid benefits for the same services or supplies if they had been received in the insured’s home province

Expenses arising from war (declared or undeclared), insurrection, acts of terrorism, and voluntary participation in a riot or civil unrest

Expenses arising from committing or attempting to commit an assault, battery or criminal offense, whether or not the insured was charged with a criminal offense

Expenses incurred as a result of or a loss resulting from or associated with a self-inflicted injury or attempted suicide, while sane or insane

Benefits payable under Freedom to Choose health and dental insurance for health care and dental care services and supplies eligible under any government plan are limited to any deductible and co-insurance amounts the insured is required to pay under the government plan. A government plan means a plan that provides drugs, health, dental or vision coverage and is legislated, funded, or administered by a government

 

Specific limitations and exceptions

The above are the general limitations and exceptions that apply to Freedom to Choose health and dental insurance. These plans also contain specific limitations and exceptions that apply to specific coverage. For example, coverage is not provided for air-fluidized beds or for special wheelchair features primarily for participation in sports.

These are examples only and further specific limitations and exceptions apply. Please read your policy carefully when you receive it, as it contains important definitions, limitations and exceptions.

Guaranteed Plus

The Guaranteed plus plan — our most popular — offers a wide range of health care benefits, including dental care coverage and prescription drugs. It provides coverage for the following benefits and benefit levels:

 

Prescription drugs (Optional)

Drugs that by law require a prescription by a physician or other person entitled by law to prescribe them.

Co-insurance with drug card 85% to a maximum of $1,500 per person, per calendar year

Co-insurance with no drug card 100% to a maximum of $1,500 per person, per calendar year

Disposable needles for use with non-disposable insulin injection devices, lancets, test strips, and sensors for flash glucose monitoring machines

Coverage is not provided for certain prescription drugs such as:

Drugs for the treatment of erectile dysfunction

Smoking cessation products

Homeopathic preparations, proprietary or patent medicines

Any drug that does not have a drug identification number (din) as defined by the Food and Drugs Act, Canada

Note: if you live in Quebec, you are required to have drug coverage through your employer or the Quebec provincial plan, the Régie de l’assurance maladie du Québec (RAMQ).

 

Hospital accommodation

The difference in cost between private and standard ward accommodation in hospital if the private accommodation starts while insured under this plan and is for acute, convalescent or palliative care.

 

Paramedical services

Unless prohibited by law, Canada Life will pay for the portion of the cost of paramedical services that is not payable under a government plan.

Benefits payable for reasonable and customary charges for:

Treatment of muscle and bone disorders, including diagnostic x-rays, by a licensed chiropractor are limited to a maximum amount payable of $350 in a calendar year

Treatment of nutritional disorders by a registered dietician, are limited to a maximum amount payable of $350 in a calendar year

Treatment by a licensed osteopath, including diagnostic x-rays, are limited to a maximum amount payable of $350 in a calendar year

Treatment of movement disorders by a licensed physiotherapist are limited to a maximum amount payable of $350 in a calendar year

Treatment of foot disorders, including diagnostic x-rays, by a licensed podiatrist are limited to a maximum amount payable of $350 in a calendar year

Treatment by a registered psychologist or social worker are limited to a maximum amount payable of $350 in a calendar year

Treatment by a qualified massage therapist are limited to a maximum amount payable of $350 in a calendar year

Treatment of speech impairments by a qualified speech therapist are limited to a maximum amount payable of $350 in a calendar year

Treatment by a licensed naturopath are limited to a maximum amount payable of $350 in a calendar year

Treatment by a qualified acupuncturist are limited to a maximum amount payable of $350 in a calendar year

 

Vision care

100% up to $200 per person every 2 years for glasses and contact lenses required to correct vision when provided by a licensed ophthalmologist, optometrist or optician; and laser eye surgery when performed by a licensed ophthalmologist.

One eye exam every 2 years when performed by a licensed ophthalmologist or optometrist.

 

Hearing aids

Hearing aids, including batteries, tubing and ear moulds provided at the time the hearing aid is purchased, to a maximum of $500 per person every 5 years

 

Ambulance services

Ambulance service including air ambulance, if provided by a licensed ambulance company for transportation to the nearest centre where essential treatment is available.

 

Nursing care

In-home nursing care: Benefits payable are limited to:

The minimum number of hours per day or week

The level of skill needed to provide each essential nursing service

For nursing care, payable benefits are up to a maximum of 12 months, beginning on the first day of care. The maximum amount payable is $3,000. The maximums will be reinstated for a subsequent period of nursing care if :

It follows a period of at least six months during which no nursing care was needed
OR

It is required for a different and unrelated injury or sickness

Hospital care and in-home nursing care benefits aren’t payable for chronic care.

Nursing home care: Accommodation in a nursing home, if accommodation starts while insured under the Freedom to Choose health and dental insurance policy and is for acute, convalescent, chronic or palliative care. Coverage is for up to $50 per day, for 30 days per condition, per lifetime of the condition. Nursing home care must be approved by Canada Life prior to commencement of care.

 

Medical supplies, services, aids and appliances

The following supplies, when prescribed by a physician. For supplies available on a rental basis, Canada Life covers the rental cost, or at its discretion, the cost of purchase.

Diagnostic lab and x-ray services: Performed in the insured’s home province or territory

Breathing equipment: Oxygen and the equipment needed for its administration; intermittent positive pressure breathing machines; continuous positive airway pressure machines; apnea monitors for respiratory dysrhythmias; mist tents and nebulizers; chest percussors, drainage boards, sputum stands and tracheostoma tubes

Orthopedic equipment: Benefits payable for custom-made foot orthotics and custom-fitted orthopedic shoes, including modification to orthopedic footwear, are limited to $250 in a calendar year

Prosthetic equipment: External breast prostheses (once per insured person per calendar year), surgical brassieres (two per insured person per calendar year), artificial eyes, standard artificial limbs, cleft palate obturators, and internal breast prostheses to the amount payable for external breast prostheses

Mobility aids: Wheelchairs and power scooters when necessary to permit independent participation in daily living and repairs and rechargeable batteries for covered wheelchairs (limited to $1,500 per insured person per lifetime)

Diabetic equipment: Coverage for blood-glucose, flash glucose, and continuous glucose monitoring machines, including sensors and transmitters for continuous glucose monitoring machines, is limited to $1,000 per calendar year

Other medical supplies:

Canes

Walkers

Crutches

Parapodiums

Hospital beds

Bed rails

Trapeze bars

Head halters and traction apparatus

Colostomy and ileostomy supplies

Catheters and catheterization supplies

Food substitutes that must be administered through a tube feed process and the tube feeding pumps and pump sets

Transcutaneous nerve stimulators for the control of chronic pain (limited to $700 per insured person per lifetime)

Custom-made pressure supports for lymphedema

Custom-made compression hose (limited to 4 pairs per insured person per calendar year)

Extremity pumps for lymphedema or severe postphlebitic syndrome (limited to $1,500 per insured person per lifetime)

Custom-made burn garments

Elevated toilet seats

Shower chairs

Bathtub rails and standard commodes

Wigs for cancer patients undergoing chemotherapy (limited to $500 per insured person per lifetime)

Surgically implanted intraocular lenses

Eye glasses or contact lenses following eye surgery (limited to one pair following eye surgery)

 

Dental care

Treatment from accidental injury to sound natural teeth. The accident must occur while the insured is covered under the Freedom to Choose health and dental insurance policy. Treatment must begin within 60 days after the injury and be performed by a dentist, oral surgeon or denturist.

Routine dental: Covered at 80% to a maximum of $1,000 per person, per calendar year

Diagnostic services: One complete oral examination per insured person every three years; oral pathology, periodontal, surgical, prosthodontic and endodontic examinations; limited oral and periodontal examinations limited to twice per year per insured person; specific and emergency examinations; one complete series of intra-oral radiographs per insured person every three years; intra-oral radiographs to a maximum of 15 films and one panoramic radiograph per insured person every three years when not provided in the same year as a complete series; sialography; extra-oral radiographs other than panoramic and sialography; radiopaque dyes used to demonstrate lesions; interpretation of radiographs or models from another source; microbiological, histological, cytological, and pulp vitality tests and laboratory services

Preventative services: Prophylaxis and topical application of fluoride twice per insured person per year pit and fissure sealants on bicuspids and permanent molars once per insured person every five years; space maintainers and maintenance of space maintainers; appliances for the control of harmful habits; finishing restorations; interproximal disking and recontouring of teeth

Minor restorative services: Caries, trauma and pain control; amalgam and tooth-coloured posts for fillings; retentive pins and prefabricated posts for fillings and prefabricated crowns for primary teeth

Denture maintenance: One denture reline, rebase and resilient liner in relined or rebased dentures per insured person every three years

Oral surgery: Removal of teeth; surgical exposure of teeth; minor alveoplasty, gingivoplasty and stomatoplasty for remodelling and recontouring oral tissues; surgical incisions; surgical excision of tumours, cysts, and granulomas; treatment of fractures, including related bone grafts to the jaw; treatment of maxillofacial deformities, including related bone grafts to the jaw and cheiloplasty and palatal obturators

Adjunctive services: Minor remedies for relief of dental pain, therapeutic injections and anaesthesia required in relation to covered services

Endodontic services: Procedures described in the endodontic section of the Canadian Dental Association Uniform System of Coding and List of Services. Root canal therapy on permanent teeth is limited to one course of treatment per tooth

Periodontal services: Procedures described in the periodontal section of the Canadian Dental Association Uniform System of Coding and List of Services. Both scaling and root planing are limited to a combined maximum of six 15-minute time units per insured person per year. Both occlusal adjustment and equilibration are limited to a combined maximum of six 15-minute time units per insured person per year

Major dental: No coverage (optional major dental services and supplies benefit available)

 

Teledoc Medical Experts ®

Consultation services that put you in touch with the world’s best medical specialists to help with diagnosis and treatment planning for serious illnesses

 

General limitations and exceptions

No benefits will be paid under the Guaranteed plus plan for the following:

Services and supplies associated with the diagnosis or treatment of infertility or contraception (except oral contraceptives)

Dental care services and supplies associated with congenital defects or developmental malformations in people 19 years of age or over, temporomandibular joint disorders, vertical dimension correction, myofacial pain or orthodontic treatment

Expenses that private insurers are not permitted to cover by law

Services and supplies that the insured is entitled to without charge by law, or for which a charge is made only because the insured has insurance coverage

Services and supplies that do not represent reasonable medical treatment or reasonable dental treatment

Services and supplies associated with treatment performed for cosmetic purposes Services and supplies associated with chronic care except those used for Nursing Home accommodation

Services or supplies associated with items covered under your policy, unless specifically listed as a covered health care or dental care service or supply

Services or supplies received outside Canada, except as provided by the emergency travel medical rider, if in force

Services or supplies received out-of-province in Canada unless:

The insured is covered by the government plan providing Medicare coverage in the insured’s home province or territory; and

Canada Life would have paid benefits for the same services or supplies if they had been received in the insured’s home province.

Expenses arising from war, declared or undeclared, insurrection, acts of terrorism, voluntary participation in a riot or civil unrest

Expenses arising from committing or attempting to commit an assault, battery or criminal offense, whether or not the insured was charged with a criminal offense

Expenses incurred as a result of or a loss resulting from or associated with a self-inflicted injury or attempted suicide, while sane or insane

Benefits payable under Freedom to Choose health and dental insurance for health care and dental care services and supplies eligible under any government plan are limited to any deductible and co-insurance amounts the insured is required to pay under the government plan. A government plan means a plan that provides drugs, health, dental or vision coverage and is legislated, funded, or administered by a government

 

Specific limitations and exceptions

The above are the general limitations and exceptions that apply to Freedom to Choose health and dental insurance. These plans also contain specific limitations and exceptions that apply to specific coverage. For example, coverage is not provided for air-fluidized beds or for special wheelchair features primarily for participation in sports.

These are examples only and further specific limitations and exceptions apply. Please read your policy carefully when you receive it, as it contains important definitions, limitations and exceptions.

Guaranteed Elite

The Guaranteed elite plan offers higher coverage levels for health care, plus prescription drugs and major dental coverage. It provides coverage for the following benefits and benefit levels:

 

Prescription drugs

Drugs that by law require a prescription by a physician or other person entitled by law to prescribe them.

Pay direct Drug Card

90% to a maximum of $2,400 per person, per calendar year

Disposable needles for use with non-disposable insulin injection devices, lancets, test strips, and sensors for flash glucose monitoring machines

Coverage is not provided for certain prescription drugs such as:

Drugs for the treatment of erectile dysfunction

Smoking cessation products

Homeopathic preparations, proprietary or patent

Any drug that does not have a drug identification number (din) as defined by the Food and Drugs Act, Canada

Note: if you live in Quebec, you are required to have drug coverage through your employer or the Quebec provincial plan, the Régie de l’assurance maladie du Québec (RAMQ).

 

Hospital accommodation

The difference in cost between private and standard ward accommodation in hospital if the private accommodation starts while insured under this plan and is for acute, convalescent or palliative care.

 

Paramedical services

Unless prohibited by law, Canada Life will pay for the portion of the cost of paramedical services that is not payable under a Government Plan.

Benefits payable for reasonable and customary charges for:

Treatment of muscle and bone disorders, including diagnostic x-rays, by a licensed chiropractor are limited to a maximum amount payable of $400 in a calendar year

Treatment of nutritional disorders by a registered dietician, are limited to a maximum amount payable of $400 in a calendar year

Treatment by a licensed osteopath, including diagnostic x-rays, are limited to a maximum amount payable of $400 in a calendar year

Treatment of movement disorders by a licensed physiotherapist are limited to a maximum amount payable of $400 in a calendar year

Treatment of foot disorders, including diagnostic x-rays, by a licensed podiatrist are limited to a maximum amount payable of $400 in a calendar year

Treatment by a registered psychologist or social worker are limited to a maximum amount payable of $400 in a calendar year

Treatment by a qualified massage therapist are limited to a maximum amount payable of $400 in a calendar year

Treatment of speech impairments by a qualified speech therapist are limited to a maximum amount payable of $400 in a calendar year

Treatment by a licensed naturopath are limited to a maximum amount payable of $400 in a calendar year

Treatment by a qualified acupuncturist are limited to a maximum amount payable of $400 in a calendar year

 

Vision care

90% up to $275 per person every 2 years for glasses and contact lenses required to correct vision when provided by a licensed ophthalmologist, optometrist or optician; and laser eye surgery when performed by a licensed ophthalmologist.

One eye exam every 2 years when performed by a licensed ophthalmologist or optometrist.

 

Hearing aids

Hearing aids, including batteries, tubing and ear moulds provided at the time the hearing aid is purchased, 90% to a maximum of $800 per person every 5 years.

 

Ambulance services

Ambulance service including air ambulance, if provided by a licensed ambulance company for transportation to the nearest centre where essential treatment is available.

 

Nursing care

In-home nursing care: Benefits payable are limited to the minimum number of hours per day or week and level of skill needed to provide each essential nursing service.

Benefits payable for nursing care are payable for a maximum of 12 months, beginning on the first day of care. The maximum amount payable is $4,000. The maximums will be reinstated for a subsequent period of nursing care if :

It follows a period of at least six months during which no nursing care was needed; or

It is required for a different and unrelated Injury or Sickness.

Hospital care, In-home nursing care and home health aide care benefits are not payable for chronic care.

Nursing Home Care: Accommodation in a nursing home, if accommodation starts while insured under the Freedom to Choose health and dental insurance policy and is for acute, convalescent, chronic or palliative care. Coverage is for up to $50 per day, for 30 days per condition, per lifetime of the condition. Nursing home care must be approved by Canada Life prior to commencement of care.

 

Medical supplies, services, aids and appliances

The following supplies, when prescribed by a physician. For supplies available on a rental basis, Canada Life covers the rental cost, or at its discretion, the cost of purchase.

Diagnostic lab and x-ray services: Performed in the insured’s home province or territory

Breathing equipment: Oxygen and the equipment needed for its administration; intermittent positive pressure breathing machines; continuous positive airway pressure machines; apnea monitors for respiratory dysrhythmias; mist tents and nebulizers; chest percussors, drainage boards, sputum stands and tracheostoma tubes

Orthopedic equipment: Custom-made foot orthotics and custom-fitted orthopaedic shoes (limited to a maximum for each insured person, per calendar year, of $500) braces, casts, splints, cervical collars, external electro spinal stimulators for the correction of scoliosis, non-union bone stimulators and prone standers

Prosthetic equipment: External breast prostheses (once per insured person per calendar year), surgical brassieres (two per insured person per calendar year), artificial eyes, standard artificial limbs, cleft palate obturators, and internal breast prostheses to the amount payable for external breast prostheses

Mobility aids: Wheelchairs and power scooters when necessary to permit independent participation in daily living and repairs and rechargeable batteries for covered wheelchairs (limited to $1,500 per insured person per lifetime)

Diabetic equipment: Coverage for blood-glucose, flash glucose, and continuous glucose monitoring machines, including sensors and transmitters for continuous glucose monitoring machines, is limited to $1,500 per calendar year

Other medical supplies:

Canes

Walkers

Crutches

Parapodiums

Hospital beds

Bed rails

Trapeze bars

Head halters and traction apparatus

Colostomy and ileostomy supplies

Catheters and catheterization supplies

Food substitutes that must be administered through a tube feed process and the tube feeding pumps and pump sets

Transcutaneous nerve stimulators for the control of chronic pain (limited to $700 per insured person per lifetime)

Custom-made pressure supports for lymphedema

Custom-made compression hose (limited to 4 pairs per insured person per calendar year)

Extremity pumps for lymphedema or severe postphlebitic syndrome (limited to $1,500 per insured person per lifetime)

Custom-made burn garments

Elevated toilet seats

Shower chairs

Bathtub rails and standard commodes

Wigs for cancer patients undergoing chemotherapy (limited to $500 per insured person per lifetime)

Surgically implanted intraocular lenses

Eye glasses or contact lenses following eye surgery (limited to one pair following eye surgery)

 

Dental care

Treatment from accidental injury to sound natural teeth. The accident must occur while the insured is covered under the Freedom to Choose health and dental insurance policy. Treatment must begin within 60 days after the injury and be performed by a dentist, oral surgeon or denturist.

Routine dental: Covered at 85% to a maximum of $2,000 per person per calendar year.

Diagnostic services: One complete oral examination per insured person every three years; oral pathology, periodontal, surgical, prosthodontic and endodontic examinations; limited oral and periodontal examinations limited to twice per year per insured person; specific and emergency examinations; one complete series of intra-oral radiographs per insured person every three years; intra-oral radiographs to a maximum of 15 films and one panoramic radiograph per insured person every three years when not provided in the same year as a complete series; sialography; extra-oral radiographs other than panoramic and sialography; radiopaque dyes used to demonstrate lesions; interpretation of radiographs or models from another source; microbiological, histological, cytological, and pulp vitality tests and laboratory services

Preventative services: Prophylaxis and topical application of fluoride twice per insured person per year pit and fissure sealants on bicuspids and permanent molars once per insured person every five years; space maintainers and maintenance of space maintainers; appliances for the control of harmful habits; finishing restorations; interproximal disking and recontouring of teeth

Minor restorative services: Caries, trauma and pain control; amalgam and tooth-coloured posts for fillings; retentive pins and prefabricated posts for fillings and prefabricated crowns for primary teeth

Denture maintenance: One denture reline, rebase and resilient liner in relined or rebased dentures per insured person every three years

Oral surgery: Removal of teeth; surgical exposure of teeth; minor alveoplasty, gingivoplasty and stomatoplasty for remodelling and recontouring oral tissues; surgical incisions; surgical excision of tumours, cysts, and granulomas; treatment of fractures, including related bone grafts to the jaw; treatment of maxillofacial deformities, including related bone grafts to the jaw and cheiloplasty and palatal obturators

Adjunctive services: Minor remedies for relief of dental pain, therapeutic injections and anaesthesia required in relation to covered services

Endodontic services: Procedures described in the endodontic section of the Canadian Dental Association Uniform System of Coding and List of Services. Root canal therapy on permanent teeth is limited to one course of treatment per tooth

Periodontal services: Procedures described in the periodontal section of the Canadian Dental Association Uniform System of Coding and List of Services. Both scaling and root planing are limited to a combined maximum of six 15-minute time units per insured person per year. Both occlusal adjustment and equilibration are limited to a combined maximum of six 15-minute time units per insured person per year

Major dental: Covered at 50% to a maximum of $1,000 per person per calendar year.

Crowns and onlays: Metal, plastic, porcelain and ceramic crowns, onlays, posts, cores, pins and copings related to covered crowns. Coverage for crowns on molars is limited to the cost of metal crowns

Dentures: Dentures, including over dentures, when required to replace one or more teeth extracted while the Freedom to Choose health and dental insurance policy is in force

Denture-related surgery: The following denture-related surgical services for remodelling and recontouring oral tissues: remodelling, excisions, removal, reduction or augmentation of the alveolar bone, remodelling of the flooring of the mouth, vestibuloplasty, reconstruction of the alveolar ridge, extensions of mucous folds and related surgical grafts

Appliance maintenance: One denture remake per insured person every three years and one denture adjustment per insured person per year, denture repairs and additions, tissue conditioning and resetting of denture teeth

 

Teledoc Medical Experts ®

Consultation services that put you in touch with the world’s best medical specialists to help with diagnosis and treatment planning for serious illnesses

 

General limitations and exceptions

No benefits will be paid under the Guaranteed elite plan for the following:

Services and supplies associated with the diagnosis or treatment of infertility or contraception (except oral contraceptives)

Dental care services and supplies associated with congenital defects or developmental malformations in people 19 years of age or over, temporomandibular joint disorders, vertical dimension correction, myofacial pain or orthodontic treatment.

Expenses that private insurers are not permitted to cover by law.

Services and supplies that the insured is entitled to without charge by law, or for which a charge is made only because the insured has insurance coverage.

Services and supplies that do not represent reasonable medical treatment or reasonable dental treatment.

Services and supplies associated with treatment performed for cosmetic purposes services and supplies associated with chronic care except those used for nursing home accommodation.

Services or supplies associated with items covered under your policy, unless specifically listed as a covered health care or dental care service or supply.

Services or supplies received outside Canada, except as provided by the emergency travel medical rider, if in force.

Services or supplies received out-of-province in Canada unless:

The insured is covered by the Government Plan providing Medicare coverage in the insured’s home province or territory; and

Canada Life would have paid benefits for the same services or supplies if they had been received in the insured’s home province.

Expenses arising from war, declared or undeclared, insurrection, acts of terrorism, voluntary participation in a riot or civil unrest.

Expenses arising from committing or attempting to commit an assault, battery or criminal offense, whether or not the insured was charged with a criminal offense.

Expenses incurred as a result of or a loss resulting from or associated with a self-inflicted injury or attempted suicide, while sane or insane.

Benefits payable under Freedom to Choose health and dental insurance for health care and dental care services and supplies eligible under any government plan are limited to any deductible and co-insurance amounts the insured is required to pay under the government plan. A government plan means a plan that provides drugs, health, dental or vision coverage and is legislated, funded, or administered by a government.

 

Specific limitations and exceptions

The above are the general limitations and exceptions that apply to Freedom to Choose health and dental insurance. These plans also contain specific limitations and exceptions that apply to specific coverage. For example, coverage is not provided for air-fluidized beds or for special wheelchair features primarily for participation in sports.

These are examples only and further specific limitations and exceptions apply. Please read your policy carefully when you receive it, as it contains important definitions, limitations and exceptions.