9 Hospital (Outside Canada) Provision (For All Employees with Comprehensive Coverage, Excluding Pensioners)

9.1  General

9.1.1 Coverage under this provision is mandatory for employees and members of the CAF and RCMP residing outside Canada who are not eligible to be covered under a provincial/territorial health insurance plan. Its purpose is to provide hospital coverage protection equivalent, as far as possible, to that available to individuals resident in Canada and covered under a provincial/territorial health or hospital plan. This provision provides reimbursement for reasonable and customary charges for hospital confinement in a general hospital, a hospital of the Canadian Armed Forces or a hospital of the armed forces of a foreign country. The co-payment does not apply under this provision.

9.2  Eligible Expenses

9.2.1 Eligible expenses are hospital charges for each day of hospitalization in a general hospital, a hospital of the CAF or the forces of a foreign country.

9.2.2 Eligible charges may include those for:

1. standard ward accommodation;
2. necessary nursing services when provided by the hospital;
3. laboratory, radiological and other diagnostic procedures;
4. drugs, prescribed and administered in hospital by any attending physician;
5. use of operating and delivery rooms, anaesthetic and surgical supplies;
6. services rendered by any person paid by the hospital;
7. use of speech therapy facilities;
8. use of diet counselling services;
9. out-patient services provided by a hospital.

Exclusions

9.2.3 No benefit is payable for:

1. expenses incurred under any of the conditions listed under General Exclusions and Limitations in the Plan Provisions;
2. co-insurance charges or similar charges for hospital care which are in excess of charges payable by a provincial or territorial government health or hospital insurance plan and which are not charges made for utilization of semi-private or private accommodation, except that co-insurance charges for a chronic care hospital for a patient who is confined to a chronic care hospital, and has made at least one claim for such charges before September 1, 1992 and makes a further claim for the same period of confinement, are eligible;
3. a person insured under a non-government group hospital insurance plan administered in a foreign country that provides hospital expense benefits similar to those provided under the Health Insurance Act, 1972 of Ontario, as amended from time to time.