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Expenses Not Covered By The Plan
  • Services or supplies which are neither medically necessary nor proven effective, or not listed as covered expenses.
  • Charges for rest cures, convalescent and custodial care, rehabilitation services in a hospital for the chronically ill or a chronic care unit of a general hospital, or charges incurred by the participant when, in the opinion of MBC, proper treatment should be in a chronic care unit of an institution for the chronically ill.
  • Doctors’ services, hospital room and board charges, except for emergency out of country coverage.
  • Plastic surgery except to correct deformities resulting from illness or injury or such congenital defects as to interfere with function.
  • Charges for missed appointments or for the completion of forms.
  • Service performed by an unqualified practitioner.
  • Elective services outside an individual’s province of residence when that provincial government health care programs have not accepted liability for items normally covered in the province of residence.
  • Blood pressure monitors, hearing and pregnancy tests.
  • Medications restricted under federal or provincial legislation that are prescribed and/or dispensed despite such regulations.
  • Charges for health care planning assessments including, but not limited to, physiotherapy assessments.
  • Any health care services and supplies administered in a hospital or by any agency or provider controlled by a hospital or by any agency or provider funded, in whole or in part, by government of any level.
  • Vaporizers, humidifiers, services provided in a health spa, etc.
  • Routine medical examinations or general check-ups and diagnostic tests, even if required for use by a third party.
  • Injury or illness sustained while working for pay or profit or resulting from a motor vehicle accident, or expenses that would be paid by workers compensation statute or any other legislation.
  • Treatment for cosmetic purposes or for a condition not detrimental to one’s health.
  • Routine eye tests or examinations requested by an employer, school or government and non-prescription sunglasses or safety glasses.
  • Services required as a result of committing or attempting to commit a criminal act.
  • Services and supplies that are no longer covered under a Provincial Government plan because of changes to that plan that are effective after May 1, 1996.
  • Any services and supplies normally available without cost, or at nominal cost, under any government statute whether or not they continue to be eligible under a government program.
  • Registration charges or non-residents surcharges in any hospital.
  • Services in connection with an injury or disease resulting from riot, insurrection or war whether war be declared or not. This includes any condition caused directly or indirectly by any armed forces.
  • Treatment received from a medical department maintained, or paid for directly or indirectly, by an employer, a mutual benefit association, or similar group.
  • Services and supplies received while not ordinarily resident in Canada.
  • Delivery, transportation and parking charges.
  • Services and supplies received from social workers, dieticians, homeopaths, herbalists, Christian scientist and psychiatrists.
  • Services and supplies received during a period of hospital confinement which began before coverage under this Plan started.
  • Shiatsu and acupuncture.
  • Synvisc and other synovial fluid replacements. Lumbar supports and Myoelectric limbs.
  • Treatment that is experimental in nature or investigative health care.
  • Charges which normally would not be made if an individual was not covered by Plan.
  • Expenses resulting from any suicide attempt or self-inflicted injury, whether sane or not.
  • Mileage and/or delivery charges to or from a hospital or a health care professional.
  • Any tax charged on an otherwise eligible expense.
  • Any health care services and supplies which are not provided by a provider approved by the Trustees on the advice of Medavie Blue Cross.

Note:

It is illegal for the Plan to pay for any doctor’s services if those services are performed in the Province of Ontario. These services are covered by the Provincial Government Plans. It is also illegal for the Plan to pay the difference between the doctor’s charge and the government payment.

The Plan will not pay for services that are normally covered by the Provincial Government Plans even if coverage under the Provincial Plans is lost due to permanent residence out of Canada.