Detailed Coverage Information

Not sure exactly what’s included in our PlanDirect plans? Read more about the coverage offered under each of our plans by category.

Coverage is for reasonable and customary expenses not covered by a government plan.

• Healthcare services and supplies
• Dentalcare services and supplies
• General limitations and exceptions
• Specific limitations and exceptions

Healthcare Services and Supplies

Prescription drugs – Basic, Comprehensive and Premier plans cover drugs that by law require a prescription by a physician or other person entitled by law to prescribe them.

Coverage is not provided for certain prescription drugs such as:

• Drugs for the treatment of erectile dysfunction
• Smoking cessation products
• Homeopathic preparations, proprietary or patent medicines
• Any drug that does not have a drug identification number as defined by the Food and Drugs Act, Canada

Hospital Accommodation – Value, Basic, Advantage and Comprehensive plans cover the difference in cost between semi-private and standard ward accommodation in hospital if the semi-private accommodation starts while you’re covered under the PlanDirect policy and the care is for acute, convalescent or palliative care.

The Premier Plan covers the difference in cost between private and standard ward accommodation in hospital if the private accommodation starts while insured under the PlanDirect policy and is for acute, convalescent or palliative care.

Nursing home care – All plans cover accommodation in a nursing home, if accommodation starts while insured under the PlanDirect Policy and is for acute, convalescent, chronic or palliative care. Coverage is for up to $50 per day, for 30 days per condition, per lifetime of the condition. Nursing home care must be approved by Great-West prior to commencement of care.

Ambulance service – All plans cover ambulance service including air ambulance, if provided by a licensed ambulance company for transportation to the nearest centre where essential treatment is available.

In-home nursing care – All plans cover in-home nursing care provided in a private residence by a graduate registered nurse, licensed practical nurse or registered nursing assistant.

Home health aid care – The Premier Plan covers home health aid care, if it’s prescribed by a physician, obtained through a licensed home health agency and provided on a part-time or intermittent basis.

• Medical supplies, Services, Aids & Appliances – All plans cover the following supplies, when prescribed by a physician. For supplies available on a rental basis, we cover the rental cost, or at our discretion, the cost of purchase.
• Diagnostic lab and X-ray services – We cover these services if they’re performed in your home province or territory.
• Breathing equipment – We cover oxygen and the equipment needed for its administration; intermittent positive pressure breathing machines; continuous positive airway pressure machines; apnea monitors for respiratory dysrhythmias; mist tents and nebulizers; chest percussors, drainage boards, sputum stands and tracheostoma tubes.
• Orthopedic equipment – We cover custom-made foot orthotics and custom-fitted orthopedic shoes; braces, casts, splints, cervical collars, external electrospinal stimulators for the correction of scoliosis, non-union bone stimulators and prone standers. Benefits for custom-made foot orthotics and custom-fitted orthopedic shoes are limited to a maximum for each insured person, per calendar year, of $100 for Value, Basic, Advantage and Comprehensive plans and $500 for the Premier plan.
• Prosthetic equipment – We cover external breast prostheses once per insured person per calendar year. We’ll pay for 2 surgical brassieres per insured person per calendar year. We also cover artificial eyes, standard artificial limbs, cleft palate obturators and internal breast prostheses to the amount payable for external breast prostheses.
• Mobility aids – We cover wheelchairs and power scooters when necessary to permit independent participation in daily living and repairs and rechargeable batteries for covered wheelchairs. This benefit is limited to $1,500 per insured person per lifetime.
• Diabetic equipment – We cover 1 blood-glucose monitoring machine per insured person every 4 years.
• Other medical supplies – We cover canes, walkers, crutches, parapodiums, hospital beds, bed rails, trapeze bars, head halters and traction apparatus, colostomy and ileostomy supplies, catheters and catheterization supplies, food substitutes that must be administered through a tube feed process and the tube feeding pumps and pump sets. Coverage of transcutaneous nerve stimulators for the control of chronic pain is limited to $700 per insured person per lifetime. We also cover custom-made pressure supports for lymphedema, up to 4 pairs of custom-made compression hose per insured person per calendar year, a lifetime maximum of $1,500 of extremity pumps for lymphedema or severe postphlebitic syndrome per insured person, custom-made burn garments, elevated toilets seats, shower chairs, bathtub rails and standard commodes, up to a lifetime maximum of $500 of wigs for cancer patients undergoing chemotherapy per insured person per lifetime, surgically implanted intraocular lenses, and 1 pair of eyeglasses or contact lenses following eye surgery.

Paramedical services – All plans cover out-of-hospital treatment, after provincial benefits have been paid, for reasonable and customary charges for each of the following practitioners:

• Licensed chiropractor for muscle and bone disorders; licensed osteopath; licensed naturopath; and licensed podiatrist for foot disorders; to a maximum for each of these practitioners of:

• $250 per insured person per calendar year (Value, Basic, Advantage and Comprehensive Plans)
• $365 per insured person per calendar year (Premier Plan)

• Licensed physiotherapist for movement disorders to:

• $250 per insured person per calendar year (Value, Basic, Advantage and Comprehensive Plans)
• $425 per insured person per calendar year (Premier Plan)

• Registered psychologist and social worker combined, to:

• $320 per insured person per calendar year (Value, Basic, Advantage and Comprehensive Plans)
• $425 per insured person per calendar year (Premier Plan)

• Qualified speech therapist for speech impairments to:

• $270 per insured person per calendar year (Value, Basic, Advantage and Comprehensive Plans)
• $365 per insured person per calendar year (Premier Plan)

• Qualified massage therapist to:

• $250 per insured person per calendar year (Advantage and Comprehensive Plans)
• $365 per insured person per calendar year (Premier Plan)

Hearing aids – Value, Advantage, Comprehensive and Premier plans cover hearing aids, including batteries, tubing and ear molds provided at the time the hearing aid is purchased.

Visioncare – All plans cover:

• Eye exams when performed by a licensed ophthalmologist or optometrist
• Advantage, Comprehensive and Premier plans cover:
• Glasses and contact lenses required to correct vision when provided by a licensed ophthalmologist, optometrist or optician
• Laser eye surgery when performed by a licensed ophthalmologist

Dental accident treatment* – All plans cover treatment from accidental injury to sound, natural teeth. The accident must occur while you are covered under the PlanDirect policy. Treatment must begin within 60 days after the injury and be performed by a dentist, oral surgeon or denturist.

*Note: The Value and Basic plans cover Dental Accident Treatment under Healthcare Services and Supplies, but they do not cover Dentalcare Services and Supplies not related to the accident.

Dentalcare Services and Supplies

We provide coverage for reasonable and customary expenses based on the current fee guide in effect in your home province or territory on the date the expense is incurred.

Routine Dental Services and Supplies

Advantage, Comprehensive and Premier plans cover:

Level 1

• Diagnostic services – We cover 1 complete oral examination per insured person every 3 years; oral pathology, periodontal, surgical, prosthodontic and endodontic examinations; 2 limited oral and periodontal examinations per year per insured person, or 1 examination every 9 months with the Premier Plan; specific and emergency examinations; 1 complete series of intra-oral radiographs per insured person every 3 years; intra-oral radiographs to a maximum of 15 films and 1 panoramic radiograph per insured person every 3 years when not provided in the same year as a complete series; sialography; extra-oral radiographs other than panoramic and sialography; radiopaque dyes used to demonstrate lesions; interpretation of radiographs or models from another source; microbiological, histological, cytological and pulp vitality tests and laboratory services.
• Preventative services – We cover prophylaxis and topical application of fluoride twice per insured person per year, or once every 9 months with the Premier Plan; pit and fissure sealants on bicuspids and permanent molars once per insured person every 5 years; space maintainers and maintenance of space maintainers; appliances for the control of harmful habits; finishing restorations; interproximal disking and recontouring of teeth.
• Minor restorative services – We cover caries, trauma and pain control; amalgam and tooth-coloured posts for fillings; retentive pins and prefabricated posts for fillings and prefabricated crowns for primary teeth.
• Denture maintenance – 1 denture reline, rebase and resilient liner in relined or rebased dentures per insured person every 3 years
• Oral surgery – We cover removal of teeth; surgical exposure of teeth; minor alveoplasty, gingivoplasty and stomatoplasty for remodeling and recontouring oral tissues; surgical incisions; surgical excision of tumors, cysts, and granulomas; treatment of fractures, including related bone grafts to the jaw; treatment of maxillofacial deformities, including related bone grafts to the jaw and cheiloplasty and palatal obturators.
• Adjunctive services – We cover minor remedies for relief of dental pain, therapeutic injections and anesthesia required in relation to covered services.

Level 2

• Endodontic services – We cover procedures described in the endodontic section of the Canadian Dental Association Uniform System of Coding and List of Services. Root canal therapy on permanent teeth is limited to 1 course of treatment per tooth.
• Periodontal services – We cover procedures described in the periodontal section of the Canadian Dental Association Uniform System of Coding and List of Services. Both scaling and root planing are limited to combined maximum of 6 15-minute time units per insured person per year. Both occlusal adjustment and equilibration are limited to a combined maximum of 6 15-minute time units per insured person per year.

Major Dental Services and Supplies

Premier Plan covers:

• Crowns and onlays – We cover metal, plastic, porcelain and ceramic crowns, onlays, posts, cores, pins and copings related to covered crowns. Coverage for crowns on molars is limited to the cost of metal crowns.
• Dentures – We cover dentures, including overdentures, when required to replace 1 or more teeth extracted while the PlanDirect policy is in force.
• Denture-related surgery – We cover the following denture-related surgical services for remodeling and recontouring oral tissues: Remodeling, excisions, removal, reduction or augmentation of the alveolar bone, remodeling of the flooring of the mouth, vestibuloplasty, reconstruction of the alveolar ridge, extensions of mucous folds and related surgical grafts.
• Appliance maintenance – We cover 1 denture remake per insured person every 3 years and 1 denture adjustment per insured person per year, denture repairs and additions, tissue conditioning and resetting of denture teeth.

General Limitations and Exceptions

We will not pay benefits under a PlanDirect plan for the following:

• Expenses for drugs (Value and Advantage plans)
• Services and supplies associated with the diagnosis or treatment of infertility or contraception (except oral contraceptives, which are covered under the Basic, Comprehensive and Premier plans)
• Dentalcare services and supplies associated with congenital defects or developmental malformations in people 19 years of age or over, temporomandibular joint disorders, vertical dimension correction, myofacial pain or orthodontic treatment (Advantage, Comprehensive and Premier plans)
• Expenses that private insurers are not permitted to cover by law
• Services and supplies that the insured is entitled to without charge by law, or for which a charge is made only because the insured has insurance coverage
• Services and supplies that do not represent reasonable medical treatment or reasonable dental treatment
• Services and supplies associated with treatment performed for cosmetic purposes only
• Services and supplies associated with chronic care except those used for Nursing Home accommodation
• Services or supplies associated with items covered under your policy, unless specifically listed as a covered healthcare or dentalcare service or supply
• Services or supplies received outside of Canada, except:

• If Great-West would have paid benefits for the same services and supplies, if they had been received in the insured’s home province or territory; or
• As provided by the Emergency Travel Medical Rider, if inforce

• Expenses arising from war, declared or undeclared, insurrection, acts of terrorism, voluntary participation in a riot or civil unrest
• Expenses arising from committing or attempting to commit an assault, battery or criminal offense, whether or not the insured was charged with a criminal offense
• Expenses incurred as a result of or a loss resulting from or associated with a self-inflicted injury or attempted suicide, while sane or insane

We also will not cover services or supplies received out-of-province in Canada, unless the following conditions apply:

• You’re covered by the Government Plan providing Medicare coverage in your home province or territory
• We would have paid benefits for the same services or supplies if they had been received in your home province

Benefits payable under PlanDirect for healthcare and dentalcare services and supplies eligible under any government plan are limited to any deductible and co-insurance amounts the insured is required to pay under the government plan. A government plan means a plan that provides drug, health, dental or vision coverage and is legislated, funded or administered by a government.

Specific Limitations and Exceptions

The above are the general limitations and exceptions that apply to PlanDirect. PlanDirect also contains specific limitations and exceptions that apply to specific coverage. For example, we don’t cover air-fluidized beds or for special wheelchair features primarily for participation in sports.

These are examples only and further specific limitations and exceptions apply. Please read your policy carefully when you receive it, as it contains important definitions, limitations and exceptions.

To compare the coverage offered under each PlanDirect plan, view our Coverage at a Glance chart.

For more information about PlanDirect plans and optional benefits, contact your financial security advisor. If you don’t have one, contact us and we’ll help you find an advisor in your area.