Charges for dental treatment when natural teeth have been damaged by a direct, accidental blow to the mouth (but not by an object wittingly or unwittingly placed in the mouth) or a fractured or dislocated jaw requiring setting. This dental treatment must be rendered or reported and approved for payment by Saskatchewan Blue Cross within six (6) months of the Accident. Eligible Expenses will be limited to the current Dental Fee Guide for general practitioners in effect in Saskatchewan. Dental services in excess of $500 require pre-approval by Saskatchewan Blue Cross.

Charges for emergency ambulance services, including air ambulance within Saskatchewan, required to transport an Insured stretcher patient to the nearest Hospital equipped to provide necessary Treatment following a serious accidental Injury or sudden attack of a serious illness. The services must be provided by a licensed ambulance and must commence in Saskatchewan. Charges for emergency ambulance services that do not result in the transport of an Insured patient to a Hospital, payable at fifty percent (50%). Charges for ambulance services required to transport an Insured patient to their home residence, or another Hospital for continuing care, when ordered by the treating Hospital Physician as medically necessary following emergency Hospital Treatment, payable at fifty percent (50%). Documentation to support the order and medical necessity will be required. Charges for ambulance services that transport an Insured patient to and from Hospitals, Physician’s offices, laboratories or medical clinics for scheduled care are not covered.

Charges for the purchase or rental of a blood pressure monitor on the written authorization of a Physician, once in a five (5) year period.

Charges for the purchase of breast prostheses once in any twenty-four (24) month period.

Charges for poking devices, glucose meters, or other equipment approved by Saskatchewan Blue Cross used for the Treatment and control of diabetes, payable at eighty percent (80%) up to $500 per Insured in a five (5) year period.

Charges for needles, swabs, syringes, test strips and lancets, or other supplies approved by Saskatchewan Blue Cross in a quantity prescribed by a Physician and deemed reasonable by Saskatchewan Blue Cross.

Charges for diagnosis or treatment by a licensed or Saskatchewan Blue Cross approved chiropodist/podiatrist¹, chiropractor, massage therapist, naturopath, physiotherapist/athletic therapist², psychologist/counsellor/social worker³, or speech-language pathologist, except when performed in a Hospital, up to $400 per Insured per Policy year for each type of practitioner or combined group. A Physician referral may be required for the services of a registered massage therapist.

¹Chiropodists and podiatrists share a combined benefit maximum

²Physiotherapists and athletic therapists share a combined benefit maximum

³Psychologists, counsellors and social workers share a combined benefit maximum

Following a period of 12 months from the effective date of coverage, charges for hearing aids (excluding batteries) are eligible to a maximum of $800 per Policyholder and/or Spouse in a five (5) year period.

Dependent children are eligible for 2 hearing aids (one for each ear) to a maximum of $800 per hearing aid per Dependent child in a three (3) year period.

Hearing aids must be prescribed, tested and fitted by an otologist, clinical audiologist or board certified hearing instrument specialist.

Charges for a maximum of thirty (30) days per Insured per Policy year for Preferred Hospital Accommodation for acute care, when requested by the Policyholder or Insured, and for Drugs not covered by the Saskatchewan Drug Plan and dispensed to an Insured while an In-patient in the Hospital.

Charges for the purchase or rental of a wheelchair and/or hospital bed to a Lifetime Maximum of $500 per Insured.

Charges for the purchase or rental of a patient walker to a Lifetime Maximum of $300 per Insured.

Charges for the rental of equipment for the administration of oxygen on the written authorization of a Physician to a maximum of $500 per Insured per Policy year.

The combined Lifetime Maximum for all Medical Equipment is $1,500 per Insured.

Charges for the purchase of bathroom rails, bath seats, raised toilet seats or reachers on the written authorization of a Physician.

Charges for the purchase, repair or replacement of orthopaedic shoes and modification supplies (which may include scaphoid pads, torque heels, insoles, metatarsal pads and moulded arch supports) when prescribed by an orthopaedic surgeon, physiatrist, rheumatologist or chiropodist/podiatrist and custom built and supplied by a certified pedorthist, orthotist or chiropodist/podiatrist, payable at eighty percent (80%) up to $200 per Insured per Policy year.

Charges for ostomy supplies as recommended by a Physician for non-Hospital Treatment, which may or may not include skin barrier protectors, ostomy pouches, deodorizer, stoma paste, cleaning supplies, tubing, and tourniquets.

Services of a Private Duty Nurse where the services (excluding palliative and respite care) have been ordered by the attending Physician for an In-patient as well as in the home of the Insured (excluding nursing homes), for care consistent with the diagnosis and Treatment of the Medical Condition of the Insured, immediately following discharge from the Hospital. Saskatchewan Blue Cross will reimburse the Insured for eighty percent (80%) of the cost to a maximum of $5,000 per Insured per Policy year.

Prosthetic and medical appliances benefit details

Charges for the following appliances or supplies when prescribed by a Physician and required for medically necessary purposes on a daily basis: artificial eyes, limbs, crutches, canes, casts, splints, metal braces (excluding dental splints and braces), aerochambers, nebulizers, trusses, rib belts, sacroiliac corsets, embolic stockings, cervical collars.

Charges for the purchase of wigs when prescribed by a Physician and required as a result of a Medical Condition, up to $250 per Insured per Policy year.

Charges for the purchase of breast prostheses once in any twenty-four (24) month period.

Charges for one eye examination, including eye refractions, performed by a licensed optometrist or ophthalmologist up to $100 per Insured once in any twenty four (24) month period. Charges for prescription eyewear or laser eye surgery up to $150 per Insured in a twenty four (24) month period.

• Dental benefits are subject to a 3-month waiting period
• Basic dental services include procedures such as examinations, x-rays, tests, cleaning, fillings, root canals, oral surgery, denture repairs, etc.
• Major dental services include inlays, onlays, crowns, dentures, bridges, and some orthodontic services