Hospital Accommodation Benefit

A semi-private room can make a hospital stay much more comfortable, but like many other healthcare costs, the portion you are required to pay out of your pocket has been increasing. Without coverage for semi-private accommodation in hospital, your costs can add up quickly.

This benefit pays all or a portion of the difference between a standard ward rate, which may be eligible for payment under your provincial plan, and the cost of semi-private accommodation.

Coverage levels

• Scales 1 to 4: This is an optional benefit that provides up to $175 per day for up to 60 days each year.
• Guaranteed Acceptance Plan (GAP): Coverage is included in the plan, for a maximum of $175 per day for up to 30 days each year.

Detailed coverage information

Sonata Health covers:

• Semi-private accommodation in a hospital in Canada if:

• The stay starts while you’re covered under the policy
• The care you receive is acute care, convalescent care, or palliative care

• The difference between the standard ward rate for the hospital accommodation and the government-authorized allowance under your provincial plan for hospital accommodation in Canada, but outside your home province or territory
• The hospital facility fee related to dental surgery
• Charges by a hospital for services on an outpatient basis, incurred outside your home province or territory but in Canada when not covered by your provincial plan

Hospital means an institution that meets the following criteria:

• Is legally termed a hospital
• Is open at all times
• Offers in-patient accommodation
• Has a staff of one or more physicians available at all times
• Continuously provides 24-hour nursing by graduate registered nurses

We cover accommodation in a nursing home if your situation meets the following criteria:

• The stay starts while you’re covered under the policy
• The care you receive is acute care, convalescent care, or palliative care
• We have approved the accommodation prior to commencement of care

Nursing home means an institution or part of an institution that meets the following criteria:

• Offers in-patient accommodation
• Has a staff of one or more physicians available at all times
• Continuously provides 24-hour medical care by or under the supervision of professional nurses

Nursing home does not include a facility established primarily as a residence for senior citizens or that provides personal rather than medical care.

For nursing home accommodation, benefits payable are limited to the government-authorized co-payment under your provincial plan for a maximum of 60 days in a calendar year for Scales 1 to 4, or 30 days for the Guaranteed Acceptance Plan (GAP).

If you need more information, talk to your financial security advisor, or contact us and we’ll put you in touch with a financial security advisor in your area.