The Extended Health Care (EHC) Plan covers many medical expenses not eligible under government plans, such as vision care, hearing aids, practitioners and drug coverage, which is often a family’s single largest health care expense.
Covered expenses:
Prescription Drugs (100% co-insurance):
- Generic drugs that legally require a prescription and are dispensed by a pharmacist are eligible. If no generic drug/interchangeable drug is available, the prescription will be reimbursed based on the brand-name drug.
-
The calendar year maximum is $2,500, with a lifetime maximum of $60,000 per insured.
-
Coverage for vaccines (approved by Health Canada, not provincially funded)
The plan does not cover:
-
Fertility drugs, treatment for erectile dysfunction, smoking cessation aids, or anabolic steroids;
- Drugs that can be purchased without a physician’s prescription (some exceptions may apply).
Benefits at 80% co-insurance:
- Vision Care
- Prescription eyewear (lenses, frames, and contact lenses) and laser eye surgery to a maximum of $225, and one eye exam, every two calendar years (one year for dependent children).
- Professional Services
- Services of a licensed physiotherapist, chiropractor, chiropodist, osteopath, speech therapist, podiatrist, or registered massage therapist as recommended by a physician to a maximum of $500 per calendar year per practitioner.
- In addition, $50 for one X-ray per calendar year per practitioner is covered.
- Private Duty Nursing
- In-home nursing care by a registered nurse or nursing assistant, licensed practical nurse, or certifi ed nursing assistant is covered when recommended by a physician for a calendar year maximum of $10,000; $5,000 if over age 65.
- Aids and Appliances
- Purchase, rental or repair of medically necessary items including: hospital beds, braces, wheelchairs, prosthetic appliances, diabetic supplies, respiratory equipment, TENS machines, and orthotics.
- Ambulance
- Emergency ground ambulance to and from the nearest medical facility.
- Dental Care for Accidents
- Dental treatment required as a result of an accidental blow to the mouth.
- Hearing Aids
- Purchase or repair of hearing aids to a maximum of $600 every three calendar years.
- Professional Counselling Services
- Treatment for depression, substance abuse, family/work concerns, bereavement, and child/elder care issues through the ONA Member Assistance Plan – MAP.
Optional Hospital:
The Optional Hospital benefit can be added to, and is only available with, the EHC coverage.
- Coverage begins on the first day of hospitalization, and pays 100% of the cost of a semi-private room for a maximum of 60 consecutive days in a calendar year.
- The lifetime maximum is $30,000 per insured.
- Coverage includes a Convalescent Home Care benefit at 80% reimbursement up to a maximum of $75 per day, for a maximum of 30 days following an active, acute care hospital stay for a minimum of 24 hours, and a maximum of three days following non-elective day surgery.
EHC Plan – 60-day open enrollment:
If you are losing coverage, you can enroll in the EHC Plan without providing medical evidence (subject to being actively at work) within 60 days of:
- the first day you became an ONA Member;
- the day you lost coverage due to a change from full-time to part-time status;
- the day you lost coverage under your (or your spouse’s) employer benefit program, or any other group plan; or
- the day you lost coverage due to retirement.
Note: Retired Members can enroll without providing medical evidence within 60 days of losing retiree or spousal coverage.
Additional information on plans and application form:
Application Form for Extended Health & Dental Plans
