You are eligible to apply for coverage for Extended Health if you are:

• under age 70 as of the effective date of coverage,
• and a Doctors Manitoba member.

Enrollment is available at any time within one year of becoming a regular Doctors Manitoba member. If a member does not enroll with that first eligibility window, then are eligible to enroll:

• within 6 months of losing alternate extended health coverage, or,
• during an open enrollment period
  

Your coverage also applies to the following eligible dependents (family rates apply):

Your Spouse, who is:

• the person you are legally married to, or
• the person you have continuously resided with for at least one year in a conjugal relationship.

Your Dependent children, which are your:

• unmarried children under age 21 (or under age 25 if enrolled as a full time student in an accredited college or university in Canada) who are principally dependent on you for support and maintenance, or
• children of any age with a physical or mental infirmity, provided they were insured prior to age 21, or age 25 if in full-time attendance at a specialized school, college or university.

You must enrol according to your true family status.

No medical exam is required. Pre-existing conditions are covered, with the exception of the Travel portion of the policy.

Coverage begins on the date Doctors Manitoba receives your application, unless you enrol during a re-opening period, where coverage will be in effect as of the date stated during that re-opening.

Once enrolled in the plan, you are not required to re-enrol. Your coverage will renew automatically and you will be invoiced each year.

If you withdraw from the plan you may not rejoin the plan at a later date. This protects the viability of the plan by preventing people from enrolling only at periods when they know they require extensive coverage.

Coverage at a Glance

The Doctors Manitoba Extended Health plan covers:

• 100% of the cost for ambulance and semi-private hospital accommodation. See Ambulance and Semi-Private Hospital Coverage (below) for details.
• 100% of the Reasonable and Customary charges for prescription eye glasses / contact lenses, subject to maximums
• 80% of the reasonable and customary charges for the following expenses, subject to maximums:
  • prescription drugs
  • private duty nursing
  • assisted care
  • cardiac rehabilitation
  • accidental dental
  • medical products and equipment
  • paramedical services
  • hearing aids.
  See Supplementary Health Coverage for details of eligible expenses.

• Emergency travel coverage for trips of up to 60 days for you and your dependants. See Travel Coverage for details of eligible expenses. An exclusion applies for pre-existing conditions.

Ambulance

Emergency Ground or Air Ambulance Service – 100% coverage of reasonable and customary charges for transportation by ambulance from where the accident or sickness occurs to the nearest hospital where appropriate treatment can be provided

Non-Emergency Ambulance Service – 100% coverage of reasonable and customary charges for transportation (upon recommendation by a physician) by ambulance to the nearest hospital where appropriate treatment can be provided, (e.g., from hospital to hospital, or from hospital to home)

Medical Transfer Service – lifetime maximum of $250 per person for ​“non-emergency” transportation by a participating medical transfer service

Out-of-Province Ambulance – maximum of $250 (Canadian funds) per person

Emergency Evacuation – when a regular ambulance service cannot be used, coverage for emergency evacuation from a mountain, body of water or other remote location by a commercial operator licensed to convey passengers to the nearest qualified medical facility capable of providing appropriate treatment, to a maximum benefit payment of $5,000 per subscriber

Semi-Private Hospital Coverage

Semi-Private Hospital Accommodation – coverage for the difference in cost between standard ward and semi-private rates for in-patient hospital accommodation in Canada

Hostel Accommodation – 100% coverage for reasonable and customary per diem charges for hostel accommodation if you or your dependents require diagnostic testing or treatment at a Manitoba hospital located more than 60 km from home when recommended by a medical practitioner

Prescription Drugs – 80% coverage

We make filling your covered prescriptions simple, using the Blue Net drug card system. Simply hand your pharmacist your drug card and the pharmacist will submit the claim directly to Blue Cross on your behalf. You will only need to pay a small portion of the cost (typically your 20% share) and Blue Cross will reimburse the balance directly to the pharmacy. The card system eliminates the need to file paper claims.

Blue Cross requires all plan participants to register with the Manitoba Pharmacare Program and to provide proof of registration.

Prescription drugs coverage reimburses drugs listed in the Manitoba Formulary.

Formulary Drugs – charges are covered for drugs or medicines listed in the current edition of the Manitoba Drug Benefits and Interchangeability Formulary as issued by the Government of Manitoba, and dispensed based on the written prescription of a physician.

The plan pays up to the Manitoba Pharmacare deductible. Pharmacare pays 100% of the cost exceeding this amount. Use the province’s Pharmacare Deductible Estimator tool to determine your family’s pharmacare deductible.

Non-Formulary Drugs – charges are covered for drugs or medicines not listed in the current edition of the applicable Provincial Drug Plan Formulary or Blue Cross Formulary, and dispensed on the written prescription of a physician. The non-formulary plan does not cover the following prescription drug expenses:

• proprietary drugs
• “over the counter” drugs
• smoking cessation products
• fertility drugs

The annual maximum amount payable for non-formulary drugs is $1,000 per family.

Paramedical and Health Professionals – 80% coverage

Paramedical Practitioners – maximum $750 per person, per practitioner, per calendar year for diagnosis and treatment (excluding X‑rays) of chiropractors, osteopaths, naturopaths, audiologists, speech therapists and licensed massage therapists

Physiotherapy and Podiatry – maximum $750 per person, per practitioner, per calendar year for diagnosis and treatment, excluding X‑rays. Includes treatment by a certified Foot Care Nurse

Nutrition Counseling – maximum $750 per person, per calendar year for the services of a registered dietician when prescribed by a physician

Clinical Psychology – maximum $750 per person, per calendar year when referred by a physician (psychotherapist, clinical therapist, psychologist, social worker, and marriage & family therapist).

Athletic/​Occupational Therapy – combined maximum of $300 per person, per calendar year when prescribed by a physician

Note: some maximums and limitations apply. You do not require a note from your physician to access these benefits, except where noted.

Hearing Aids – 80% coverage

Coverage is provided to a maximum of $1,500 per person in a five-year consecutive period.

• Coverage must be prescribed by an Otologist or Clinical Audiologist
• No coverage for charges for batteries or recharging devices

Vision Care – 100% coverage

Coverage is provided for up to $300 per person, in any consecutive 24 months, for:

• charges for prescription eyeglasses or contacts or laser eye surgery

Members age 65 and over must first submit their receipts to Manitoba Health for reimbursement under Manitoba’s provincial Seniors Eyeglass Program.

*Travel Coverage for COVID-19

The group travel coverage under the Doctors Manitoba group does not have a Travel Advisory restriction that would limit coverage for COVID related claims.

The intent of the Travel Health coverage is to provide emergency medical coverage for unexpected medical conditions.

If a member is travelling without prior symptoms of COVID-19, we would not specifically exclude assessment for COVID-19 related Travel Claims if all other plan requirements are met.

It is also recommended that members follow up with the guidelines provided by each provincial/​federal government regarding any requirements for isolation upon arriving in a new Province/​State and/​or returning home once the trip is completed.

Introduction

Nobody wants to get injured or become ill while travelling, but it’s important to be prepared for the unexpected. Doctors Manitoba wants to help you feel at ease when you travel and know you’re protected from sudden costs, so this plan includes coverage for emergency medical expenses while travelling out-of-province or out-of-country.

• There is no maximum trip duration if your trip is outside of your home province but still within Canada.
• If any portion of your trip includes travel outside of Canada, then the entire trip is subject to a trip maximum of 60 days for you and your dependents.
  • If you are travelling for longer than 60 days. Individual Blue Cross travel medical insurance should be purchased as a top-up 
    
• A trip begins when you leave home. A new trip begins when you have returned to your home province for 24 hours or more.
• A lifetime maximum of $5,000,000 per person will apply.

Limited Coverage for Pre-existing Conditions

An exclusion applies for pre-existing conditions. This means:

• If you are retired or age 65 and over, you consulted a physician for an illness or medical condition, were hospitalized, received treatment, were prescribed treatment or new medication or were given a change in prescribed medication during the 90 days prior to your trip’s departure date.
• If you are under age 65, you have a medical condition for which it was reasonable to expect treatment or hospitalization during the trip.

What’s Covered

The following are eligible expenses under the travel medical benefit. Coverage or reimbursement is based on reasonable and customary charges for services provided by a legally qualified medical practitioner licensed in the jurisdiction where the service is performed. Exclusions and limitations may apply.

Hospital – in-patient and out-patient charges for services and supplies provided by a licensed hospital

Medical and Surgical – does not include charges for services associated with general examinations for ​“check-up” purposes or for cosmetic purposes

Ambulance – transportation from the place of illness or accident to the nearest hospital capable of providing appropriate treatment

Air Transportation – by stretcher after receiving treatment at a hospital as an in-patient, provided the trip is directly to the patient’s home city in Canada

Dental Charges (maximum $3,000 per person per accident) – for service to natural teeth when necessitated by a direct accidental blow to the mouth only:

• treatment must be rendered within 180 days of the accident
• charges for out-of-province treatment for the emergency relief of dental pain, to a maximum of $300.

Blood and Blood Plasma – if not available free of charge

Return Air Travel – additional cost, if any, for the most direct economy airfare from the place where you or a dependent is hospitalized as an in-patient, to the patient’s home city in Canada.

• A letter of support from the attending physician is required
• Coverage also applies to one relative or friend who is covered by a Blue Cross Travel Health Plan and is traveling with the patient at the time of illness or injury

Private Duty Nursing – charges for a graduate professional nurse registered in the place where the service is rendered. Services must be recommended by the attending physician. The nurse must not be a relative of the patient.

Diagnostic Services and Physiotherapy – when provided in a hospital

Drugs and Medicines – purchased on the prescription of a licensed physician. Vitamins, vitamin preparations, patent or proprietary drugs or ​“over the counter” drugs are not considered eligible expenses

Additional Board and Lodging Expenses – for a traveling companion also covered by a Blue Cross Travel Health Plan who remains with you or your covered dependent during hospitalization as an in-patient, beyond the original duration of the trip

Chiropractic and Podiatry Services – a letter from the attending practitioner certifying services were for acute care must be submitted with the claim

Vehicle Return (maximum $ 4,000) – to return a private or rental vehicle to your place of residence or nearest rental agency if you are totally disabled and unable to drive the vehicle

Hospital Allowance (up to $40 per day, to a maximum of $1,000) – for each day of hospitalization as an in-patient

Glasses or Contact Lenses (maximum $100) – for repair or replacement as a result of an accident which also resulted in injury which required treatment by a physician

Loss of life (maximum $7,500) – to transport a deceased person covered by this plan to the home city in Canada (including costs of preparation and standard transportation container), or up to $5,000 for cremation or burial at place of death

Family Transportation – to the bedside of a covered person confined as an in-patient for at least 3 days, when recommended in writing by the attending physician. This includes:

• direct round trip economy fare for a family member to travel to identify a deceased covered person prior to release of the body, if required by law
• charges for commercial accommodation and meals, to a combined maximum of $500, for persons travelling to the bedside or travelling to identify a deceased family member
• additional cost of return economy airfare for an escort to accompany your children (up to 18 years of age) to their province of residence in the event you have been evacuated to Canada for medical reasons
• additional cost of returning your pet to your home city in Canada, up to a maximum of $500, in the event you are confined to hospital for at least 3 days outside your province of residence
• charges for emergency veterinary care due to unexpected injury of your accompanying pet, to a maximum of $200.

Travel Exclusions and Limitations

The following are not eligible:

• persons on sabbatical, paid and non-paid leave of absence, employee exchange or other such similar absence in excess of 90 days
• persons travelling outside Canada for full-time educational purposes
• persons travelling outside their province of residence for the purpose of obtaining medical treatment
• persons travelling against medical advice
• charges associated with the required confinement due to childbirth and delivery, if any portion of travel outside your province of residence falls after the 31^st week of gestation
• charges for a medical condition or emergency that occurs or recurs after Blue Cross or the International Travel Assistance provider recommends returning home following emergency treatment, and you choose not to return
• expenses resulting from non-compliance with any prescribed medical therapy or medical treatment (as determined by Blue Cross) or failure to carry out a physician’s or health care provider’s instructions
• treatment for a medical condition for which it was reasonable to expect treatment or hospitalization during the trip.

International Travel Assist – Provides 24-hour worldwide assistance if you have a medical emergency

You, the hospital or attending physicians should contact International Travel Assistance when:

• it is difficult to locate medical care
• you need to verify insurance coverage
• you or your dependent is hospitalized, or when treatment is provided
• treatment is complicated by language problems
• a medical evacuation may be necessary.

Be sure to take your Blue Cross I.D. card with you when you travel.

Definitions

Change in prescribed medication – means the medication dosage or frequency has been reduced, increased, stopped and/​or medication has been prescribed. It does not mean:

• a change from a brand name medication to a generic of the same dosage
• the routine adjustment of Coumadin, Warfarin, insulin or oral medication to control diabetes (as long as they are not newly prescribed or stopped) when there has been no change in your medical condition.

Treatment – means a medical or diagnostic procedure prescribed, performed or recommended, including but not limited to prescribed medication, investigative testing and surgery. Treatment does not include a change in prescribed medication for a medical condition which has been stable and controlled or a medical examination in which a physician observes no change in a previously identified condition for the 90-day period prior to the departure date.

Stable and controlled – means the medical condition is not worsening and there has been no change in prescribed medication for the condition or its usage or dosage, nor any other treatment prescribed, recommended or received for the 90-day period prior to the departure date.

Purchasing Additional Travel Coverage

If you or your dependents are planning to travel for longer than 60 days, additional days should be purchased as a top-up. Please contact Manitoba Blue Cross directly to purchase this added coverage.

The following are not covered under Extended Health:

• services not listed in the What’s Covered section
• services or supplies which are paid by Medicare, Pharmacare or similar government plan
• any portion of a charge for services in excess of the reasonable and customary charge for treatment of an illness of similar nature or severity, in the locality where the service is provided
• illness or injury resulting from:
  • war, insurrection or the hostile action of the armed forces of any country
  • participation in a riot or civil commotion, or in the commission or attempted commission of a criminal offense
  • any cause for which indemnity or compensation is provided under Workers’ Compensation or similar legislation
• dependent children attending college outside of Canada
• services related to the treatment of Temporo-Mandibular Joint dysfunction
• charges for completing claim forms or for missed appointments
• charges for services provided prior to the effective date of coverage
• expenses for services and supplies rendered or prescribed by a person who is ordinarily a resident in your home or who is a close relative of yours.