Common use of PROSTHETIC APPLIANCES Clause in Contracts

PROSTHETIC APPLIANCES. Purchase of the following items when authorized in writing by the patient's attending physician: standard type artificial limb or eye, repairs to prosthetic appliances, xxxxx socks, surgical stockings up to a maximum of $400 per calendar year, splints, trusses, casts, cervical collars, braces (excluding dental braces), catheters, urinary kits, external breast prostheses (following mastectomies), surgical brassieres, incontinence supplies, ostomy supplies (where a surgical stoma exists), tracheotomy supplies and corrective prosthetic lenses and frames (once only for persons who lack an organic lens or after cataract surgery). Lymphedema sleeves/compression sleeves with a mean compression factor of 20mmHG, up to a maximum of 2 sleeves per body part or limb per calendar year. Wigs and hairpieces for patients with temporary hair loss, up to a maximum of $1,500 per lifetime. Custom- made orthopedic boots or shoes, adjustments to stock item footwear and custom molded foot orthoses (orthotics) are subject to a combined maximum of $500 per Employee per calendar year and $750 per 2 calendar years for spouse and dependent children. 7. HEARING AIDS - Payment will be made towards the purchase of a hearing aid when prescribed by a licensed physician or hearing specialist. Eligible charges include the cost of repairs and batteries. Refer to your Summary of Benefits for the amount and frequency of payment. Benefits are not payable for ear examinations or tests. 8. VISION - Payment will be made towards the purchase of new or replacement eyeglasses, inclusive of eye test, contact lenses or elective laser vision correction procedures for you or an eligible dependent, when prescribed by your doctor, ophthalmologist or optometrist. Charges to repair existing frames or lenses are also covered. Refer to your Summary of Benefits for the amount and frequency of payment. Benefits are not payable for the cost of industrial safety glasses, or expenses covered by the Workers' Compensation Board or any government plan. 9. DURABLE MEDICAL EQUIPMENT - Purchase or rental of the following items when authorized in writing by the attending physician: hospital bed or hospital bed repairs, crutches, cane, walker, apnea monitor, aerochambers, compressors, nebulizers, CPAP machines, oxygen set, respirator (a device to provide artificial respiration), standard- type wheelchair and wheelchair repairs. Diabetic Equipment: pen injectors, kidney checking devices, bloodletting devices, insulin infusion set (excluding infusion pump) and blood glucose monitoring machines. 10. MEDICAL SERVICES AND SUPPLIES - Bandages or surgical dressings, blood transfusions, plasma, radium and radioactive isotope treatments when authorized in writing by the patient's attending physician. 11. AMBULANCE - Licensed ground and air ambulance services (the difference between the government agency allowance and the customary charge). 12. PARAMEDICAL SERVICES - Services of the following registered/certified practitioners up to the maximums shown on the "Summary of Benefits" pages: a) Clinical Psychologist; b) Registered Massage Therapist - when the patient's attending physician authorizes in writing that such treatment is necessary; c) Speech Pathologists - when the patient's attending physician or dentist authorizes in writing that such treatment is necessary; d) Chiropractor - benefits are payable only after the annual maximum allowance under your provincial health plan has been paid. 13. EMERGENCY TREATMENT - OUT OF PROVINCE - Payment will be made for the following reasonable and customary charges incurred for emergency treatment which occurs during the first 60 days while traveling or temporarily residing outside your province of residence, and which are in excess of the provincial health plan allowance:

PROSTHETIC APPLIANCES. Purchase of the following items when authorized in writing by the patient's attending physician: standard type artificial limb or eye, repairs to prosthetic appliances, xxxxx socks, surgical stockings up to a maximum of $400 per calendar year, splints, trusses, casts, cervical collars, braces (excluding dental braces), catheters, urinary kits, external breast prostheses (following mastectomies), surgical brassieres, incontinence supplies, ostomy supplies (where a surgical stoma exists), tracheotomy supplies and corrective prosthetic lenses and frames (once only for persons who lack an organic lens or after cataract surgery). Lymphedema sleeves/compression sleeves with a mean compression factor of 20mmHG, up to a maximum of 2 sleeves per body part or limb per calendar year. Wigs and hairpieces for patients with temporary hair loss, up to a maximum of $1,500 per lifetime. Custom- Custom-made orthopedic boots or shoes, adjustments to t o stock item footwear and custom molded foot orthoses (orthotics) are subject to a combined maximum of $500 per Employee employee per calendar year and $750 per 2 calendar years for spouse and dependent children. The purchase of a cystistat kit will be considered an eligible expense when a pre-authorization is completed by the attending physician, outlining the diagnosis and recommended course of treatment. The patient will be re-evaluated after the eighth treatment and additional preauthorization must be obtained if further treatment is required. This benefit is limited to one course of treatment. 7. HEARING AIDS - Payment will be made towards the purchase of a hearing aid when prescribed by a licensed physician or hearing specialist. Eligible charges include the cost of repairs and batteries. Refer to your Summary of Benefits for the amount and frequency of payment. Benefits are not payable for ear examinations or tests. 8. VISION - Payment will be made towards the purchase of new or replacement eyeglasses, inclusive of eye test, contact lenses or elective laser vision correction procedures for you or an eligible dependent, when prescribed by your doctor, ophthalmologist or optometrist. Charges to repair existing frames or lenses are also covered. Refer to your Summary of Benefits for the amount and frequency of payment. Benefits are not payable for the cost of industrial safety glasses, or expenses covered by the Workers' Compensation Board or any government plan. 9. DURABLE MEDICAL EQUIPMENT - Purchase or rental of the following items when authorized in writing by the attending physician: hospital bed or hospital bed repairs, crutches, cane, walker, apnea monitor, aerochambers, compressors, nebulizers, CPAP machines, oxygen set, respirator (a device to provide artificial respiration), standard- standard-type wheelchair and wheelchair repairs. Diabetic Equipment: pen injectors, kidney checking devices, bloodletting devices, insulin infusion set (excluding infusion pump) and blood glucose monitoring machines. 10. MEDICAL SERVICES AND SUPPLIES - Bandages or surgical dressings, blood transfusions, plasma, radium and radioactive isotope treatments when authorized in writing by the patient's attending physician. 11. AMBULANCE - Licensed ground and air ambulance services (the difference between the government agency allowance and the customary charge). 12. PARAMEDICAL SERVICES - Services of the following registered/certified practitioners up to the maximums shown on the "Summary of Benefits" pages: a) Clinical Psychologist; b) Registered Massage Therapist Xxxxxxxx - when the patient's attending physician authorizes in writing that such treatment is necessary; c) Speech Pathologists - when the patient's attending physician or dentist authorizes in writing that such treatment t reatment is necessary; d) Chiropractor - benefits are payable only after the annual maximum allowance under your provincial health plan has been paid. 13. EMERGENCY TREATMENT - OUT OF PROVINCE - Payment will be made for the following reasonable and customary charges incurred for emergency treatment which occurs during the first 60 days while traveling or temporarily residing outside your province of residence, and which are in excess of the provincial health plan allowance:

PROSTHETIC APPLIANCES. Purchase of the following items when authorized in writing by the patient's attending physician: standard type artificial limb or eye, repairs to prosthetic appliances, xxxxx socks, surgical stockings up to a maximum of $400 per calendar year, splints, trusses, casts, cervical collars, braces (excluding dental braces), catheters, urinary kits, external breast prostheses (following mastectomies), surgical brassieres, incontinence supplies, ostomy supplies (where a surgical stoma exists), tracheotomy supplies and corrective prosthetic lenses and frames (once only for persons who lack an organic lens or after cataract surgery). Lymphedema sleeves/compression sleeves with a mean compression factor of 20mmHG, up to a maximum of 2 sleeves per body part or limb per calendar year. Wigs and hairpieces for patients with temporary hair loss, up to a maximum of $1,500 per lifetime. Custom- Custom-made orthopedic boots or shoes, adjustments to t o stock item footwear and custom molded foot orthoses (orthotics) are subject to a combined maximum of $500 per Employee employee per calendar year and $750 per 2 calendar years for spouse and dependent children. The purchase of a cystistat kit will be considered an eligible expense when a pre-authorization is completed by the attending physician, outlining the diagnosis and recommended course of treatment. The patient will be re-evaluated after the eighth treatment and additional preauthorization must be obtained if further treatment is required. This benefit is limited to one course of treatment. 7. HEARING AIDS - Payment will be made towards the purchase of a hearing aid when prescribed by a licensed physician or hearing specialist. Eligible charges include the cost of repairs and batteries. Refer to your Summary of Benefits for the amount and frequency of payment. Benefits are not payable for ear examinations or tests. 8. VISION - Payment will be made towards the purchase of new or replacement eyeglasses, inclusive of eye test, contact lenses or elective laser vision correction procedures for you or an eligible dependent, when prescribed by your doctor, ophthalmologist or optometrist. Charges to repair existing frames or lenses are also covered. Refer to your Summary of Benefits for the amount and frequency of payment. Benefits are not payable for the cost of industrial safety glasses, or expenses covered by the Workers' Compensation Board or any government plan. 9. DURABLE MEDICAL EQUIPMENT - Purchase or rental of the following items when authorized in writing by the attending physician: hospital bed or hospital bed repairs, crutches, cane, walker, apnea monitor, aerochambers, compressors, nebulizers, CPAP machines, oxygen set, respirator (a device to provide artificial respiration), standard- standard-type wheelchair and wheelchair repairs. Diabetic Equipment: pen injectors, kidney checking devices, bloodletting devices, insulin infusion set (excluding infusion pump) and blood glucose monitoring machines. 10. MEDICAL SERVICES AND SUPPLIES - Bandages or surgical dressings, blood transfusions, plasma, radium and radioactive isotope treatments when authorized in writing by the patient's attending physician. 11. AMBULANCE - Licensed ground and air ambulance services (the difference between the government agency allowance and the customary charge). 12. PARAMEDICAL SERVICES - Services of the following registered/certified practitioners up to the maximums shown on the "Summary of Benefits" pages: a) Clinical Psychologist; b) Registered Massage Therapist Masseurs - when the patient's attending physician authorizes in writing that such treatment is necessary; c) Speech Pathologists - when the patient's attending physician or dentist authorizes in writing that such treatment t reatment is necessary; d) Chiropractor - benefits are payable only after the annual maximum allowance under your provincial health plan has been paid. 13. EMERGENCY TREATMENT - OUT OF PROVINCE - Payment will be made for the following reasonable and customary charges incurred for emergency treatment which occurs during the first 60 days while traveling or temporarily residing outside your province of residence, and which are in excess of the provincial health plan allowance: