Supplementary Health Coverage

Prescription Drugs
Paramedical and Health Professionals
Hearing Aids
Medical Supplies and Equipment
Private Duty Nursing
Cardiac Rehabilitation
Accidental Dental Treatment
Eye Examinations
Vision Care

Prescription Drugs – 80% coverage

– you may fill prescriptions using the Blue Net drug card system. You just give your pharmacist your drug card and the pharmacist goes online with Blue Cross. You will be told how much you have to pay (typically your 20% share) and Blue Cross pays the balance to the pharmacy. The card system eliminates the need to file paper claims

Formulary Drugs – charges 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 sold 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. Pharmacare deductibles are:

Adjusted family income     Deductible
$50,001 – $75,000 5.27%
$75,001 + 6.60%

Non-Formulary Drugs – charges for drugs or medicines not listed in the current edition of the applicable Provincial Drug Plan Formulary or Blue Cross Formulary, and sold 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 shall be $1000 per family.

Blue Cross requires all plan participants to register with the Provincial Pharmacare Program.  Proof of Pharmacare Registration will be requested by Blue Cross. (www.gov.mb.ca/health/pharmacare/apply.html)

Paramedical and Health Professionals – 80% coverage

Note: some maximums and limitations apply

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 certified Foot Care Nurse

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

Clinical Psychology – maximum $750 per person per calendar year when referred by a physician

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

Hearing Aids – 80% coverage

Note: maximum of $1500 per person in a five consecutive year period

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

Medical Supplies and Equipment – 80% coverage

Note: some maximums and limitations apply; written prescription of a physician required

Foot Orthotics – charges for the cost of foot orthotics when prescribed by the attending physician, occupational therapist, physiotherapist or podiatrist, to a maximum of $300 per person per calendar year

Prosthetic Appliances and Miscellany – artificial limbs and eyes, crutches, splints, casts, trusses, braces, lumbar-sacro supports, corsets, traction equipment, knee braces, cervical collars, and surgical elastic stockings

Orthopedic Shoes – orthopedic shoes custom made from a mould, stock shoes which are modified, or orthopedic shoe modifications (excluding orthotics, covered above, or insoles, removeable or permanently affixed) to accommodate, relieve or remedy a mechanical foot defect or abnormality, to a maximum of $300 per person per calendar year

Breast Prosthesis – breast prosthesis and surgical bras (maximum $400 per calendar year per single prosthesis or bra, or $800 per calendar year per double prosthesis or bra)

Wigs – wigs or hairpieces necessitated by illness or accidental injury (lifetime maximum of $1,000 per person)

Rental or Purchase of Medical Equipment – lifetime maximum of $250 per person

Iron Lung, Wheelchair, Hospital-type Bed or Respirator – lifetime maximum of $1,000 per person for purchase or rental

Private Duty Nursing – 80% coverage

Note: to a maximum of $3,000 per person per calendar year

  • charges for private duty nursing in a hospital by a professional nurse (not an employee of the hospital) when recommended by a physician
  • charges for in-home nursing visits by a professional nurse (not a relative) during the 12 months following discharge from a hospital for services consistent with in-patient treatment

Cardiac Rehabilitation – 80% Coverage

Note: to a lifetime maximum of $300 per person

  • for patients diagnosed with cardiac disease requiring the services of a recognized cardiac rehabilitation program, when prescribed by the attending physician

Accidental Dental Treatment – 80% coverage

  • when required as a result of accidental injury where natural teeth have been damaged or broken or a dislocated jaw requires setting
  • treatment must commence within 90 days of the accident

Eye Examinations – 80% coverage

  • charges for the cost of one eye examination per person every 24 months, provided that no portion of the cost is eligible for payment under any legislated plan (limited to usual customary and reasonable charges – some providers may charge more than customary and reasonable charges)

Vision Care

  • 100% coverage for charges for prescription eye glasses or contact or laser eye surgery up to $300 per person, in any consecutive 24 months.