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Part of Coverage and benefits

Coverage for Seniors Program

Premium-free coverage for prescriptions drugs and other health-related services not covered under the 草榴社区 Health Care Insurance Plan.

Overview

The Government of 草榴社区 provides seniors with premium-free coverage for prescriptions drugs and other health-related services not covered under the 草榴社区 Health Care Insurance Plan (AHCIP).

  • 草榴社区 Blue Cross administers the Coverage for Seniors program and claims.
  • AHCIP manages eligibility and registration.

The Coverage for Seniors program does not include travel insurance.

If you are planning to travel outside of the province or country, you are advised to purchase travel insurance to cover emergency hospital and medical expenses.

Eligibility

To be eligible for Coverage for Seniors, you need to have active AHCIP coverage and have had your age validated.

When AHCIP records indicate an 草榴社区n will be turning 65, a package is mailed to the address on their AHCIP file that includes information about programs and services for seniors.

  • If your age has not been validated, this package will be mailed up to 6 months prior to your 65th birthday and include a letter asking you to submit a proof-of-age document.
  • If your age has been validated, the package is mailed up to 3 months before your 65th birthday and Coverage for Seniors is automatically added to your AHCIP account on the first of the month following your 65th birthday, or on the first if your birthday is on the first.
  • If you did not receive the package, we may not have your current address on file. You can download a Proof-of-Age Declaration form or contact the AHCIP office.

Acceptable proof-of-age documents include:

  • 草榴社区 driver’s licence
  • 草榴社区 identification (ID) card
  • birth certificate
  • old-age pension entitlement form
  • passport or immigration record
  • Canadian citizenship certificate

Your proof-of-age document and declaration can be submitted by one of the following:

Benefits provided

  • Prescription drugs

    Prescription drugs listed in the 草榴社区 Drug Benefit List are covered. The co-payment is 30% to a maximum of $25. A co-payment is the portion of the prescription cost you pay to your pharmacy when you have your prescription filled. For most prescriptions, you will not pay more than $25 for each prescription.

    There are a few cases when you might have to pay more than the $25 co-payment maximum:

    • If your drug is not listed in the 草榴社区 Drug Benefit List, or
    • If you want a more expensive brand of drug than the least cost alternative or generic product, or
    • If the brand of drug you want costs more than the maximum cost set by the 草榴社区 government for that drug.

    To avoid surprises, ask your pharmacist about the cost of your prescription before it is filled.

  • Diabetes supplies

    Plan members with diabetes will receive coverage for diabetes supplies purchased from a licensed pharmacy, up to a maximum of $2,400 per eligible person depending on the method of diabetes management. (Read the Coverage Maximums for Diabetes Supplies fact sheet). This benefit will be for each benefit year, that is, July 1 to June 30. Eligible diabetes supplies include test strips, needles, syringes, and lancets.

    There is no co-pay for eligible diabetes supplies.

    If you are a low-income senior, learn about Special Needs Assistance for Seniors, if you have reached your diabetes supplies limit for the benefit year.

  • Ambulance services

    Seniors, age 65 and over, enrolled in the Coverage for Seniors program do not receive a bill for ambulance services. AHCIP pays the complete cost of ambulance services.

    Ambulance services are covered to the maximum rate established by the 草榴社区 government for treatment, and transportation to and from a general, active treatment hospital in the event of illness or injury.

    Transportation must be provided in a ground vehicle approved under the Emergency Health Services Act and regulations. It does not include interfacility transfer by ambulance.

  • Clinical psychological services

    Coverage for clinical psychological services are up to $60 per visit, to a maximum of $300 per family each benefit year for treatment of mental or emotional illness by a registered chartered psychologist.

  • Home nursing care

    Coverage for home nursing care is up to $200 per family each benefit year for nursing care provided in the patient's home by written order of a physician. Home nursing care must be provided by a registered nurse or licensed practical nurse who is not a relative of the patient.

  • Chiropractic services

    Coverage for chiropractic services is up to $25 per visit to a maximum of $200 per person each benefit year.

What is not covered

The following are not covered under the Coverage for Seniors program:

  • claims for benefit expenses incurred prior to the effective date of coverage
  • claims for benefit expenses received by 草榴社区 Blue Cross more than 12 months after the service was provided
  • services covered by the AHCIP
  • charges for drugs supplied directly and charged for by a physician, with the exception of allergy serums
  • registration, admission or user fees charged by a hospital
  • drug products not listed in the 草榴社区 Drug Benefit List – ask your pharmacist or physician if your prescribed medication is on this list
  • semi-private or private hospital room
  • travel insurance for emergency hospital and medical expenses outside of the province or country

Contact

Connect with 草榴社区 Blue Cross.

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