Maximum Eligible Expenses

Benefits

Did You Know?

Prior to incurring expenses for nursing services, your physician must fill out a questionnaire so that Sun Life can determine if the services are eligible under the Plan.
Read more about Nursing Services

Extended Health Provision

Drug Benefit

Catastrophic drug coverage

Maximum Eligible Expense: Eligible drug expenses in excess of $3,000 out-of-pocket drug expense incurred in a given calendar year payable at 100%
PSHCP Pays: 100%

Eligible drugs

Maximum Eligible Expense: Reasonable and customary charges
PSHCP Pays: 80%

Erectile dysfunction drugs

Maximum Eligible Expense: $500 every calendar year on a combined basis
PSHCP Pays: 80%

Smoking cessation aids

Maximum Eligible Expense: $1,000 in a lifetime
PSHCP Pays: 80%

Vision Care Benefit

Eye examinations

Maximum Eligible Expense: One examination every two calendar years commencing every odd year
PSHCP Pays: 80%

Eyeglasses/contact lenses (purchase and repairs)

Maximum Eligible Expense: $275 every two calendar years commencing every odd year. No limit if required as a result of surgery or accident and purchased within six months of the event
PSHCP Pays: 80%

Laser eye surgery

Maximum Eligible Expense: $1,000 per lifetime. Surgery must be performed on or after October 1, 2014 to be eligible
PSHCP Pays: 80%

Medical Practitioners Benefit

Chiropractor

Maximum Eligible Expense: $500 in a calendar year
PSHCP pays: 80%

Electrologist (or electrology treatment performed by a physician)

Maximum Eligible Expense: $20 per visit
PSHCP pays: 80%

Massage Therapist

Maximum Eligible Expense: $300 in a calendar year
PSHCP pays: 80%

Naturopath

Maximum Eligible Expense: $300 in a calendar year
PSHCP pays: 80%

Nurse (nursing services)

Maximum Eligible Expense: $15,000 in a calendar year
PSHCP pays: 80%

Osteopath

Maximum Eligible Expense: $300 in a calendar year
PSHCP pays: 80%

Physiotherapist

Maximum Eligible Expense: Up to $500 and over $1,000 in a calendar year
PSHCP pays: 80%

Podiatrist or chiropodist

Maximum Eligible Expense: $300 in a calendar year
PSHCP pays: 80%

Psychologist, or social worker (when no psychologist practices in that isolated post)

Maximum Eligible Expense: $2,000 in a calendar year

In 2014: $1,000 for expenses incurred between January 1 and September 30. $1,000 for expenses incurred between October 1 and December 31
PSHCP pays: 80%

Speech language pathologist

Maximum Eligible Expense: $500 in a calendar year
PSHCP pays: 80%

Miscellaneous Expense Benefit

Hearing aids (purchase/repairs)

Maximum Eligible Expense: $1,000 less any eligible hearing aid expenses claimed during the previous 60 months

No limit if required as a result of surgery or accident and purchased within 6 months of the event
PSHCP pays: 80%

Insulin jet injector device

Maximum Eligible Expense: $760 during a 36-month period
PSHCP Pays: 80%

Orthopaedic brassieres

Maximum Eligible Expense: $200 in a calendar year
PSHCP pays: 80%

Orthopaedic shoes

Maximum Eligible Expense: $150 in a calendar year
PSHCP pays: 80%

Servicing fees, repairs and replacement parts for CPAP and BiPAP machines

Maximum Eligible Expense: $300 per calendar year

Does not include expenses for cleaning supplies or warranties

Purchases must be made on or after October 1, 2014, to be eligible.
PSHCP pays: 80%

Wigs

Maximum Eligible Expense: $1,000 in a 60-month period
PSHCP pays: 80%

Out-of-Province Benefit

Emergency benefit while travelling / Emergency travel assistance services

Maximum Eligible Expense: $500,000 per period of travel (not exceeding 40 consecutive days)
PSHCP Pays: 100%

Referral benefit

Maximum Eligible Expense: $25,000 per illness or injury
PSHCP pays: 80%

Hospital Provision

Level I

Maximum Eligible Expense: $60 per day
PSHCP pays: 100%

Level II

Maximum Eligible Expense: $140 per day
PSHCP pays: 100%

Level III

Maximum Eligible Expense: $220 per day
PSHCP pays: 100%

Basic Health Care Provision

Basic Health Care Provision

Maximum Eligible Expense: Three times (3x) the amount otherwise payable under the current fee schedule of the Health Insurance Act 1972 of Ontario
PSHCP pays: 100%