To be considered under the PSHCP’s Miscellaneous Expenses Benefit, expenses must be reasonable and customary charges and prescribed by a physician unless otherwise specified. Eligible expenses include the rental or purchase (at Sun Life’s discretion) of cost-effective durable equipment that meet all of the following criteria:
- Manufactured specifically for medical use
- For use in the patient’s private residence
- Approved by the Administrator for cost effectiveness and clinical value
- Designated as medically necessary
- Used either for care or treatment of a medical condition.
Examples of eligible expenses include:
- Orthopaedic shoes, which are an integral part of a brace or are specially constructed for the patient, including modifications to such shoes, provided the shoes or modification is prescribed in writing by a physician or podiatrist, limited to a maximum total eligible expense in any one calendar year as specified in the Summary of Maximum Eligible Expenses of the Plan Directive; the prescription is valid for one year
- Hearing aids and repairs to them, excluding batteries, limited to the maximum eligible expense equal to the lesser of:
- cost less the cost of all eligible hearing aid claims made in the previous 5 years,
- the maximum specified in the Summary of Maximum Eligible Expenses.
- Devices for physical movement including:
- Walkers — limited to one every five years and a maximum eligible expense equal to cost less all eligible walker repair expenses incurred during the previous five years.
- Wheelchairs — limited to one every five years and a maximum eligible expense equal to cost less all eligible wheelchair repairs incurred during the previous five years.
- Hospital beds — limited to one in a lifetime and a maximum eligible expense equal to cost less all eligible hospital bed repairs incurred prior to purchase.
Examples of expenses that are not eligible include:
- Expenses for items purchased primarily for athletic use
- Bathroom safety equipment
- A modification to the patient’s home (bar, ramp, mat, elevator, etc.)
- An accessory to an eligible device
For more information on the Miscellaneous Expense Benefit please see page 23 of the Plan Information Booklet. If you are unsure of whether or not your claim is eligible for reimbursement, please contact the PSHCP Call Centre at 1-888-757-7427 (toll-free) or 618-247-5100 (in the National Capital Region).