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Options and Options Plus

Options & Options Plus

Options is an affordable personal health plan that protects you and your family from the costs of serious illness.

The plan features:

  • Coverage for routine expenses, like eyeglasses, dental costs or antibiotics
  • No overall maximum on the drug module
  • Financial protection should you develop serious illness

Options Plus is our most comprehensive plan, with increased coverage and added hospital and travel benefits.

The plan features (links to details are below):

  • Semi-private hospital covered at 100% or $30/day hospital cash
  • Travel covered at 100% for up to 30-day trips
  • Accidental Death & Dismemberment benefits: $15,000 for member, spouse and $5,000 per dependent child

​Principal Benefits

(Required)

Options

Accidental death and dismemberment benefit

Benefit in the event of accidental death of a participant or accidental loss as described in the policy.

  • $10,000 member, spouse or cohabitant.
  • $5,000 dependent child. 
  • This benefit ends at age 65.


Extended health benefits

Accidental dental

  • 70% reimbursement for accidental injury to natural teeth up to a lifetime maximum of $7,000.

Ambulance or ambulance attendant

  • 70% reimbursement for emergency ambulance services up to a maximum of $420 in a calendar year.
  • Allowance for an accompanying nurse (if necessary) up to a maximum of $280 in a calendar year.

Braces and splints

  • 70% reimbursement for cervical collars, splints and braces when prescribed by a physician for musculoskeletal deficiency.

Diabetic supplies

  • 70% reimbursement for any syringes, needles, swabs, blood and urine testing supplies.
  • 70% reimbursement for a blood glucose monitor up to a maximum of $70 every 5 consecutive calendar years.

Hearing aids 

  • 70% reimbursement for the cost of hearing aids, up to a maximum of $400 per participant every 5 consecutive calendar years.
  • 6-month waiting period applies for the hearing aid benefit.

InConfidence

  • A confidential assistance program offering counselling and support through a comprehensive array of resources. This interactive tool can help participants maximise effectiveness in their work and personal lives in areas including emotional health, workplace issues, parental, financial needs and much more.

Managing Chronic Disease

  • Charges for the services rendered by an approved provider who is a certified specialist in chronic disease management. Coverage includes initial assessment, education relating to symptom management and development of action plans.

Massage therapy, naturopath, acupuncture

  • $20 per visit up to a maximum of 20 visits per calendar year for each practitioner. 
    Prescription required for massage.

Medical equipment

  • 70% of the rental cost of a wheelchair or hospital-type bed, or for purchase when there is a long-term need (as approved by Medavie Blue Cross).
  • If there is a long-term need for an insulin pump, Medavie Blue Cross, at its discretion, may approve the purchase.

Orthopedic shoes and moulded arch supports

  • 70% reimbursement for customized orthopedic shoes and shoe modification, adjustment supplies and/or moulded arch supports up to a combined maximum of $150 per participant in a calendar year.

Ostomy supplies

  • 70% reimbursement for essential ostomy supplies.

Other providers

  • 70% reimbursement for treatment by a licensed speech therapist, licensed clinical psychologist, registered chiropractor, osteopath, chiropodist or podiatrist.
  • Total maximum for each type of provider is $210 per participant in a calendar year. 

Oxygen equipment and oxygen

  • 70% reimbursement for rental costs for oxygen equipment and charges for gaseous oxygen (excluding liquid oxygen) when prescribed by a physician. 
    If the need for oxygen equipment is long term, Medavie Blue Cross, at its discretion, may approve the purchase.

Physiotherapy

  • 70% reimbursement for up to 15 physiotherapy treatments by a licensed physiotherapist outside of government funded hospitals, agencies or providers, up to a maximum of $350 per participant in a calendar year.

Private-duty nursing

  • 70% reimbursement for essential skilled nursing care in the participant’s residence.
  • Maximum $3,500 for each participant in 2 consecutive calendar years.

Prosthetic appliances

  • 70% reimbursement for the cost of artificial limbs, breasts, hair, eyes, crutches, canes, casts, and trusses when required due to sickness or accident.

Vision care

  • 70% reimbursement for the cost of eye exams, contact lenses, spectacle lenses and frames up to a maximum of $150 per participant in 2 consecutive calendar years.
  • 6-month waiting period applies for vision benefits.

Some restrictions may apply.

Options Plus

Accidental death and dismemberment benefit

Benefit in the event of accidental death of a participant or accidental loss as described in the policy.

  • $15,000 member, spouse or cohabitant.
  • $5,000 dependent child.
  • This benefit ends at age 65.  


Extended health benefits 

Accidental dental

  • 70% reimbursement for accidental injury to natural teeth up to a lifetime maximum of $7,000.

Ambulance or ambulance attendant

  • 70% reimbursement for emergency ambulance services up to $420 in a calendar year.
  • Allowance for an accompanying nurse if necessary up to a maximum of $280 in a calendar year.

Braces and splints

  • 70% reimbursement for cervical collars, splints and braces when prescribed by a physician for musculoskeletal deficiency.

Diabetic supplies

  • 70% reimbursement for any syringes, needles, swabs, blood and urine testing supplies.
  • 70% reimbursement for a blood glucose monitor up to a maximum of $70 every 5 consecutive calendar years.

Hearing aids

  • 70% reimbursement for the cost of hearing aids, up to a maximum of $500 per participant every 5 consecutive calendar years.
  • 6-month waiting period applies for the hearing aid benefit.

Massage therapy, naturopath, acupuncture

  • $20 per visit up to a maximum of 20 visits per calendar year for each practitioner
  • Prescription required for massage

Medical equipment

  • 70% of the rental cost of a wheelchair, hospital-type bed, or for purchase when there is a long-term need (as approved by Medavie Blue Cross).
  • If there is a long-term need for an insulin pump, Medavie Blue Cross, at its discretion, may approve the purchase.

Orthopedic shoes and moulded arch supports

  • 70% reimbursement for customized orthopedic shoes, shoe modification, adjustment supplies and/or moulded arch supports up to a combined maximum of $225 per participant in a calendar year.

Ostomy supplies

  • 70% reimbursement for essential ostomy supplies.

Other providers

  • 70% reimbursement for treatment by a licensed speech therapist, licensed clinical psychologist, registered chiropractor, osteopath, chiropodist or podiatrist.
  • Total maximum for each type of provider is $300 per participant in a calendar year.

Oxygen equipment and oxygen

  • 70% reimbursement for rental of oxygen equipment and charges for gaseous oxygen (excluding liquid oxygen) when prescribed by a physician.
  • If the need for oxygen equipment is long term, Medavie Blue Cross, at its discretion, may approve the purchase.

Physiotherapy 

  • 70% reimbursement for up to 20 physiotherapy treatments by a licensed physiotherapist outside of government funded hospitals, agencies or providers -  up to a maximum of $490 per participant in a calendar year.

Private-duty nursing

  • 70% reimbursement for essential skilled nursing care in the participant’s residence.
  • Maximum $5,600 for each participant in 2 consecutive calendar years.

Prosthetic appliances

  • 70% reimbursement for the cost of artificial limbs, breasts, hair, eyes, crutches, canes, casts and trusses when required due to illness or accident.

Vision care

  • 70% reimbursement for the cost of eye exams, contact lenses, spectacle lenses and frames up to a maximum of $300 per participant in 2 consecutive calendar years.
  • 6-month waiting period applies for vision benefits.

Note: Some restrictions may apply.

Hospital benefits (Semi-private accommodation)

  • 100% of the eligible expense for the difference between standard ward and semi-private room accommodation for inpatients in an active treatment hospital, up to a maximum of 90 days per calendar year.
  • If the hospital is unable to provide semi-private accommodation, Medavie Blue Cross will pay the member $30 per day for each day hospitalized.  8-month waiting period applies for hospital benefits related to pregnancy. 


Travel benefits

  • Provides 100% coverage in the event of an accident or unexpected or sudden illness occurring outside the province of residence.
  • Unlimited trips per year up to a maximum of 30 consecutive days for each trip. If travelling for more than 30 days, you must purchase additional travel coverage for the additional time.
  • Coverage is in excess of the amount paid by your provincial health care plan. Pre-existing condition limitations apply for each trip.
  • This benefit is optional at age 65.
  • Includes Worldwide Assistance.

Drug Benefits

(Optional)

Options

  • No overall maximum
  • 70% coverage
  • 30% co-payment per prescription (to a maximum participant cost of $50 per prescription)
  • 100% coverage after $4,500 in annual claims
  • Pay Direct drug card

*Contraceptives are not covered.

Options with Deductible

You can add an optional drug module with deductible to your Options plan.

Coverage Overview

  • No overall maximum 70% coverage, co-pay 30% up to a maximum of $50
  • 100% coverage when claims exceed $4,500

Additional Details

  • Coverage for eligible drug benefits is 70 per cent. The maximum a participant has to pay for a prescription is 30 per cent or $50, whichever is less. After drug benefits exceed $4,500 per person in a calendar year, coverage becomes 100 per cent for additional drug benefits.

Our Options Drug Module with a Deductible has a calendar year deductible of $500 per person, up to a maximum of $750 for a couple or family policy. This is a good option for those who want to lower their premiums but still maintain comprehensive drug coverage.

Options Plus

  • No overall maximum.
  • 80% coverage
  • 20% co-payment per prescription, to a maximum participant cost of $50 per prescription.
  • 100% coverage after $4,500 in annual claims.
  • Pay Direct drug card.
  • Most allergy serums, some over-the-counter medications and most oral and injectable contraceptives are included.


Dental Benefits

(Optional)

Whether it’s your regular checkup and cleaning or dental work, dental treatments can be expensive without a dental plan.

Options

Basic dental

  • No overall annual or lifetime maximum for basic dental benefits
  • 60% reimbursement for basic dental services.
  • Includes examination, cleaning, X-rays, fillings, extractions, root canals, denture adjustments and repairs and surgical procedures. 
  • Six month waiting period applies for basic dental benefits.


Options Plus

Basic dental

  • No overall annual or lifetime maximum for basic dental benefits.
  • 70% reimbursement for basic dental services.
  • Includes examination, cleaning, X-rays, fillings, extractions, root canals, denture services (denture reline and rebase) and surgical procedures.
  • 6-month waiting period applies for basic dental benefits.

Periodontal services

  • 50% reimbursement up to a maximum of $1,000 per participant in a calendar year.
  • Periodontal services include non-surgical services such as displacement dressings, surgical services, additional scaling and root planing, periodontal appliances and re-evaluation.
  • TMJ appliances are excluded.
  • A 24-month waiting period applies for periodontal services.

Critical Care Module

(Optional)

When you or a family member is faced with an unexpected, traumatic illness, finances should not add to the stress of the situation. Critical Care is a living benefit that provides financial support when you and your family need it the most.

Benefit features:

If you or a dependent become ill with a critical condition meeting the degree of severity specified in the policy, and survive the 30 day benefit survival period, Medavie Blue Cross will pay the applicable amount once per lifetime in its entirety (certain limitations apply). 

Options

This benefit provides $10,000 for a member, spouse or cohabitant and $5,000 for a dependent child.

Covered conditions*

  • Severe heart attack
  • Severe stroke
  • Life-threatening cancer
  • Heart transplant
  • Kidney failure or transplant
  • Liver failure or transplant
  • Lung failure or transplant

*Not all details are specified. No benefit will be paid for a covered condition if symptoms or sickness commenced within the participant’s first 90 days of continuous coverage and result in medical treatment, consultation, care or service (including diagnostic measures) leading to the diagnosis of a covered condition. This benefit ends at age 65.

Accidental death and dismemberment

Benefit features:

In the event of accidental death of a participant or accidental loss as described in the policy.

  • $10,000 member, spouse or cohabitant.
  • $5,000 dependent. 
  • This benefit ends at age 65.


Options Plus

This benefit provides $25,000 for a member, spouse or cohabitant; and $10,000 for a dependent child.

Covered conditions*:

  • Severe stroke
  • Severe heart attack
  • Senile dementia
  • Parkinson’s disease
  • Paralysis
  • Multiple sclerosis
  • Motor neuron disease
  • Lung failure or transplant
  • Loss of speech
  • Liver failure or transplant
  • Life-threatening cancer
  • Kidney failure or transplant
  • Heart transplant
  • Deafness
  • Coma
  • Burns
  • Blindness
  • Alzheimer’s disease

*No benefit will be paid for a covered condition if symptoms or sickness commenced within the participant’s first 90 days of continuous coverage and result in medical treatment, consultation, care or service (including diagnostic measures) leading to the diagnosis of a covered condition. This benefit ends at age 65.

Accidental death and dismemberment benefit

  • Provided in the event of accidental death of a participant or accidental loss as described in the policy.
  • $25,000 member, spouse or cohabitant.
  • $10,000 dependent child.
  • This benefit ends at age 65

Hospital cash benefit

  • Payable for member, spouse or cohabitant and dependent children.
  • Provides $100 per day for up to 100 consecutive days per calendar year when a participant under the age of 65 is confined to an active treatment hospital as an inpatient.
  • If a participant is 65 years of age or older, the benefit is $100 per day payable for up to 30 consecutive days of hospitalization per calendar year. When a participant is hospitalized, the Hospital Cash benefit begins:
    • On the first day of hospitalization due to an accident
    • On the fourth day of hospitalization due to sickness
    • On the eight day of hospitalization due to pregnancy

Assured Access

Add Assured Access to your personal health plan. Assured Access allows you to put your coverage on hold, should you acquire group health benefits and to reactivate your health plan later without needing to be medically underwritten again. Assured Access can be purchased while applying for a personal health plan or, with additional medical underwriting, when acquiring group health benefits. Assured Access protects tomorrow's insurability today.

Find out more about Assured Access

Still not sure which plan is right for you?