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Medical Equipment And Devices

With prior approval, the rental of the following medical equipment, appliances, supplies and prosthetic devices prescribed by a physician or surgeon. If, due to extended illness or disability, it is shown that the need for these items will be long-term, the Trustees, at their sole discretion, may approve the purchase of the items. Once the original purchase is approved, the rental or purchase of another piece of similar equipment will be limited to once every five calendar years except wheelchair cushions which are eligible once every three calendar years. Eligible equipment and devices are as follows:

  • standard manual wheelchairs (but excluding electric wheelchairs except for quadriplegics), wheelchair cushions and inserts, including charges for repairs to a wheelchair;
  • standard hospital beds including mattress and bed rails (excludes electric hospital beds), trapeze bars and traction apparatus;
  • neuromuscular stimulation device, that is a transcutaneous nerve stimulator, or a TENS machine;
  • intermittent or continuous positive pressure breathing machine or apnea monitors for respiratory disrhythmias, provided there is coverage under the Assistive Devices Program (ADP) for Ontario residents, up to a lifetime maximum of $1,500;
  • aerosol equipment, mist tents and nebulizers for cystic fibrosis, acute emphysema, chronic obstructive bronchitis or asthma;
  • non-union bone stimulator or electromagnetic therapeutic device worn over casted or non-casted fracture site to stimulate healing;
  • oxygen and equipment necessary for its administration up to a lifetime maximum of $1,500;
  • enuretic devices head halters;
  • colostomy and ileostomy apparatus and catheters pacemakers;
  • iron lung.

Prostheses and remedial prosthetic appliances:

  • artificial limbs limited to one for each limb per lifetime including repairs and possible replacement if required due to pathological or physiological change to the residual limb but excluding myoelectrical limbs, stump socks and shoulder harnesses;
  • breasts post-mastectomy limited to a left and a right prosthesis every calendar year;
  • artificial nose limited to one per lifetime artificial larynx limited to one per lifetime;
  • artificial eyes limited to one left and one right prosthesis per lifetime;
  • Replacement due to pathological or physiological change is covered, as are repairs and/or adjustments to a max of $300 per calendar year.
  • Mobility aids including repairs or adjustments if applicable, for canes and crutches limited to a combined maximum of two per lifetime, trusses limited to one truss every five calendar years, one cervical collar a calendar year, braces with rigid supports (excluding lumbar supports) limited to one per lifetime, walkers, casts and splints.
  • Treatment or diagnostic services of a optometrist or ophthalmologist for surgery, eye injury or disease, including prosthetic lenses and frames, up to a lifetime maximum benefit of $1,000.
  • Visual training and remedial eye exercises by a licensed optometrist or ophthalmologist, up to a lifetime maximum benefit of $500.
  • Wigs if hair loss is due to an underlying pathology or its treatment (i.e., chemotherapy) subject to a lifetime maximum of $1,500. Hair prosthetics, replacement therapy and/or other procedures for physiological hair loss are not eligible (i.e., male pattern baldness).
  • Equipment and supplies used for treatment and control of diabetes including insulin pump (to a maximum of $5,000 in a five calendar year period), Glucometer, pressurized insulin injector, blood glucose monitoring and insulin dosing systems, or other approved equipment that performs similar functions, once in any five calendar year period up to $5,000. The Plan covers the portion net of any ADP funding.
  • Essential incontinence supplies subject to proof of medical need from the attending physician, to a calendar year maximum of $600.
  • Compression garments, including elastic support garments and gradient compression garments (custom made) to a maximum of 6 pairs per calendar year. Every claim must include a clear diagnosis by the physician or specialist confirming ongoing medical need.
  • Lift chairs subject to evidence of medical need from a physician to a maximum of $500 per lifetime. One stair lift per lifetime may be covered at 50% with evidence of medical need from a physician.
  • One PSA test in a twelve month period for screening purposes (OHIP covers the cost if the test is for diagnosing or monitoring purposes).
  • PUVA therapy for the treatment of psoriasis and other skin diseases, when recommended and administered by a dermatologist and using psoralen and high-intensity ultraviolet light (UV lights).
  • Sleeves for lymphedema following mastectomy limited to two per calendar year,
  • Surgical brassieres limited to two per calendar year. Spacing devices.
  • Allergy testing materials to a maximum of $50 per calendar year.
  • Burn pressure garments to a maximum of $500 a calendar year.