The PetSmart Extended Health Care Benefits plan covers services and supplies typically not covered under your provincial health care plan, such as:
- prescription drugs
- hospital
- out-of-country emergency
- out-of-country referral
- professional services
- medical supplies
- private duty nursing
- accidental dental
- vision care
Your weekly costs for coverage, by province.
Prescription Drugs
Reimbursement at 90% and dispensing fee cap of $12.00
Mandatory Generic Drug Program
This plan feature helps manage the costs associated with prescription drugs. Since you share in the cost of your prescription, switching to generics may help you save some money! “Generic” is the term used to describe a drug product that is equivalent to a brand-name drug.
Pharmaceutical manufacturers can produce and sell generic drugs after the patent on the brand-name drug has expired. The generic drug must use the same active ingredients as the brand-name drug, and Health Canada monitors this to ensure they are equally safe and effective.
With mandatory generic substitution, your prescription will be filled with a generic drug, when available, even if the physician indicates a brand name in the prescription. If the drug you are prescribed is a brand name and there is no alternative drug, then the plan will continue to allow the brand-name medication at the same reimbursement level.
In rare instances, an individual may not be able to tolerate the generic drug, or it may be therapeutically ineffective. When this happens, you can work with your physician and submit an appeal with medical evidence to Manulife for consideration of a brand-name drug.
Hospital
The plan pays 100% of the cost of a semi-private hospital room.
Out-of-Country Emergency
If you become sick or injured while traveling outside Canada, 100% of your emergency health care costs are covered. The maximum lifetime coverage is $1 million.
Out-of-Country Referral
If your doctor sends you outside of Canada for treatment of an illness or injury, the plan pays 50% of the costs for the treatment. The maximum coverage is $3,000 every three calendar years.
Professional Services
After any eligible expenses have been paid by your Provincial Health Plan, the plan pays 80% of the cost up to a combined $1,000.00 maximum per calendar year per family member for the following services:
- Acupuncturist
- Chiropractor
- Masseur
- Naturopath
- Osteopath
- Physiotherapist
- Podiatrist
- Psychologist
- Social Worker
- Speech Therapist
Medical Supplies
|
Item |
Benefit Amount |
|---|---|
|
Orthopedic shoes |
$150 each calendar year |
|
Orthotics |
$500 every 3 calendar years |
|
Hearing aids |
$500 every 5 calendar years |
Private-Duty Nursing
The plan pays 80% of the cost with a maximum of $10,000 each calendar year.
Accident-Related Dental Services
If you need dental work as a result of an accident, the plan pays 100% of the cost. There is no maximum coverage.
Fertility Benefits
Fertility Treatment
Who’s eligible? The coverage for fertility treatments is offered to support the needs of the different members of your family (you and your covered dependents).
For questions about your individual eligibility, please contact Manulife at 1-800-268-6195.
The Plan covers:
- Fertility treatments and medical procedures delivered by a Canadian fertility clinic
- The cost of eligible non-drug fertility expenses based on the list from the Canada Revenue Agency (CRA) Medical Expense Tax Credit (METC), up to a maximum of $15,000 per person, per lifetime.
Examples of covered services include:
-
- Administration fees
- Physician and Nurse’s fees (including injection fees)
- Counselling services provided by the fertility clinic
- Diagnostic services (blood work, lab tests, ultrasounds)
- Genetic testing (diagnosis/screening, embryo biopsy)
- Egg/Sperm/Embryo freezing, storage, transfer, and thawing costs
- Procedure costs for:
- Assisted hatching
- Egg/sperm retrieval
- Sperm analysis, function tests, and preparation
- Embryo culturing
- Embryo transfer
- ICSI, IVF, IUI, GIFT, and ZIFT
Fertility Drug Coverage
Fertility drug coverage includes prescribed medications to support the fertility process and procedures. The Plan covers up to 90% with a $10,000 lifetime maximum.
Gender Affirmation Treatment
To be eligible for the gender affirmation treatment expenses outlined in this section, the insured/covered person must go through the provincial process, where provincial coverage exists.
The purpose of this coverage is related to masculinization or femininization, not elective cosmetic enhancement. All eligible services must be Medically Necessary and ordered by a Physician involved in the transitioning treatment.
IMPORTANT: Before incurring an expense, the covered/insured person must contact Manulife Financial to predetermine the eligibility of their claim. A covered/An insured person must provide the Administrator/Manulife Financial with one of the following:
- Proof of approval from the province that has accepted coverage under their gender affirmation program, where provincial coverage exists, OR
- Proof of completing a recognized program at a specialized gender identity treatment centre (such as the CAMH Gender Identity Clinic), OR
- Proof that they have met the clinical eligibility for gender affirming surgery as determined by the World Professional Association for Transgender Health (WPATH) Standards of Care (SoC) criteria and have been assessed by a Physician, specialist, nurse practitioner (NP) and/or a health care professional (HCP) trained in the WPATH SoC.
Members electing to not follow WPATH identity treatment guidelines or provincial process (where provincial coverage exists), will NOT be eligible for treatment expenses outlined in this section.
Manulife Financial is responsible for determining a covered/insured person’s eligibility for coverage under the gender affirmation benefits and reserves the right to request details of the services, along with provincial approval with respect to the assessment/approval for coverage under the provincial gender affirmation program. The Administrator/Manulife Financial will assess all medical expenses based on the terms of this plan/policy and considering WPATH’s standards of care for Gender Identity Dysphoria.
Vision Care
Glasses or contacts
The Plan pays:
- up to 100% with a maximum of $250 every 12 months if under 18.
- up to 100% with a maximum of $250 every 25 months if over 18.
Eye exams
The Plan pays:
- 100% of the cost of one eye exam per year (not included in the overall vision maximum).
- a maximum of $250 every 24 months if over the age of 18e