Hospital (Outside Canada) Provision

For:

• all employees with Comprehensive Coverage
• not available to pensioners

Coverage under this provision is mandatory for employees and members of the CF 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 Forces or a hospital of the armed forces of a foreign country. The co-payment and deductible amounts do not apply under this Provision.

Eligible Expenses

Eligible expenses are hospital charges for each day of hospitalisation in a general hospital, a hospital of the CF or the forces of a foreign country.

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 when prescribed by a physician;
8. use of diet counselling services when prescribed by a physician;
9. out-patient services provided by a hospital.

Exclusions

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 utilisation 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.