Healthcare Plan Benefits

Healthcare Coverage

All eligible healthcare expenses are paid based on “Reasonable and Customary” charges or expenses, which refers to the amount usually charged for specific medical procedures or services in the area where the procedures or services are provided.

You will be reimbursed 100% for the following eligible expenses in Manitoba, subject to their maximum:

Ambulance Benefits

Payment of reasonable and customary charges for ambulance services provided within Manitoba, and payment of up to $250 per trip for ambulance services provided elsewhere. This includes not only local ambulance services to and from the hospital but also long-distance ambulance trips for which additional mileage charges are made.

There are no limits on the amount payable within the province or on the number of trips covered.

All “emergency” ambulance trips are covered, and “non-emergency” trips are covered on the prior recommendation of an attending physician if the patient is non-ambulatory and cannot be transported by any means other than ambulance.

Air ambulance allowances will be paid up to the amount equivalent to the cost of the same trip if the services had been provided by ground.

Medical Transfer Service (“Stretcher Service”)

Charges for “non-emergency” transport by a participating medical transfer service are covered to a lifetime maximum of $250 per person.

Hospital Benefits

You will receive full payment for the charge of a semi-private room in a hospital in Manitoba if the hospital does not normally provide the semi-private room without charge to any patient. Reimbursement towards the cost of semi-private room charges for stays in a hospital outside of Manitoba will be based on Manitoba rates.

Hostel Accommodation

If you require diagnostic testing or treatment on the recommendation of a physician, at a Manitoba hospital located more than 60 kilometres from your home; and if you are placed in a recognized medical hostel associated with the hospital, Manitoba Blue Cross will pay the Reasonable and Customary daily charge for such hostel accommodation.

Exclusions and Limitations

The ambulance and hospital expenses are limited to the Reasonable and Customary charges or expenses, which is the amount usually charged for specific medical procedures or services in the area where the procedures or services are provided.

If you are hospitalized prior to the effective date of your coverage, you will not be entitled to benefits until the first of the month following 30 days after your discharge from the hospital.

HEB Manitoba and Manitoba Blue Cross are not responsible for the availability or provision of any of the services or supplies described on this website.

See also General Exclusions section. 

You will be reimbursed 80% for the following eligible expenses not covered by Manitoba Health, subject to their maximum:

Accidental Dental Treatment

Expenses for dental treatment resulting from accidental injury to the jaw or natural teeth. The treatment must begin within 90 days of the accident.

Cardiac Rehabilitation

A lifetime maximum of $300 if you are diagnosed with cardiac disease requiring recognized cardiac rehabilitation program services when prescribed by the attending physician.

Foot Orthotics

Expenses for foot orthotics to a maximum of $250 per person per calendar year.

Medical Appliances

Charges for rental, purchase or repair of:

  • A wheelchair, hospital bed, oxygen equipment or respirator when prescribed by the attending physician to a lifetime maximum of $1,000 per item per person.
  • Walkers when prescribed by the attending physician.
  • Other medical equipment when prescribed by the attending physician to a lifetime maximum of $250 per person.

Orthopedic Shoes and Modifications to Orthopedic Shoes

Charges for orthopedic shoes custom made from a mould, or stock shoes which are modified (excluding orthotics or insoles, removable or permanently-affixed) to accommodate, relieve or remedy a mechanical foot defect or abnormality. Payment is limited to one pair per person per calendar year.

Charges for orthopedic shoe modifications (excluding orthotics or insoles, removable or permanently-affixed) to accommodate, relieve or remedy a mechanical foot defect or abnormality.

Boots, sandals or sport-specific footwear are not eligible.

Paramedical Practitioners

Expenses for the following practitioners’ services to a maximum of $450 per service per person per calendar year:

  • Acupuncturist.
  • Athletic therapist, when prescribed by a physician.
  • Audiologist, including audiological assessment, communications assessment, site of lesion assessment, and audiological review.
  • Certified foot care nurse and/or podiatrist (combined).
  • Chiropractor, including diagnostic x-ray examinations.
  • Clinical psychologist, when prescribed by a physician.
  • Licensed massage therapist.
  • Naturopath.
  • Nutritional counsellor, when prescribed by a physician.
  • Physiotherapist and/or occupational therapist (combined), excluding diagnostic x-ray examinations. Occupational therapist must be prescribed by a physician.
  • Osteopath.
  • Speech therapist.

Prosthetic and Remedial Equipment

Upon the written prescription of the attending physician, expenses for the purchase or repair of the following, subject to their maximum:

  • Artificial limbs and eyes, compression garments, splints, casts, canes, crutches, trusses, braces, lumbar-sacro supports, corsets, traction equipment, and cervical collars.
  • Breast prostheses and surgical bras to a maximum of $100 per single mastectomy and $200 per double mastectomy per person per calendar year.
  • Wigs or hairpieces to a lifetime maximum of $1,000 per person.

You will be reimbursed 90% for the following eligible expenses not covered by Manitoba Health, subject to their maximum:

Private Duty Nursing

Expenses for private duty nursing by a professional registered nurse (not a relative) either in the hospital or home, when prescribed by the attending physician, to a maximum of $3,000 per person per calendar year. Visits to the home must be within 12 months following discharge from the hospital and the service must be consistent with the treatment for the condition for which the patient was hospitalized.

You will be reimbursed 100% for the following eligible expenses not covered by Manitoba Health, subject to their maximum:

Assisted Care Benefit

Expenses for assisted care services when prescribed by a physician during the year following discharge from a hospital where the patient was hospitalized as an in-patient. Services must be provided by persons regularly employed as a healthcare aide, home care worker or homemaker. Payment is limited to $30 per day to a maximum of 14 days per illness or injury.

Hearing Aids

Expenses for purchase or repair of hearing aids when prescribed by an otologist or clinical audiologist to a maximum of $450 per person every five years.

Expenses for regular maintenance, batteries or recharging devices are not eligible.

Specialist Referral

Mileage expenses for residents of rural Manitoba who have been referred by a physician to a medical specialist practicing in a major urban centre in the province. Payment of $0.30 per kilometre for distances of more than 150 kilometres, up to a combined maximum of $200 for you and your eligible family members per calendar year.

Tutorial

Expenses for tutorial services incurred within six months of the date of accident or illness that are required when, within 90 days of the illness or injury, the student is totally disabled for a period of more than 30 days. Payment is limited to a maximum of $10 per hour up to a maximum of $1,000 per illness or injury.

Prescription Drugs

You and your eligible family members will be reimbursed 80% of eligible expenses to a combined maximum of $650 per calendar year for the following:

Expenses for prescription drugs or medicines (including serums, injectables, and insulin) that are prescribed by a physician and dispensed by a licensed pharmacist. To be eligible, these drugs or medicines must be listed in the most current edition of the applicable Provincial Drug Plan Benefits List, or where there is no provincial drug plan benefits list, in a drug plan benefits list developed by Manitoba Blue Cross. Benefits payable will be integrated with those available from any provincial government drug plan.

Coverage for you and your eligible family members is 80% of eligible expenses to a combined annual maximum of $650.

For example, if your family spends $900 in one year on prescription drugs, the Healthcare Plan would pay $650 and you would pay the remaining $250.

Expenses​                                                $900
Less Maximum (reimbursed to you)  $650
You would pay                                       $250

Exclusions and Limitations

The Healthcare Plan will not pay for the following:

  • Any drugs or medicines in excess of a 100-day supply.
  • Orthodontic services.
  • Dental implants.

See also General Exclusions section.

© 2017 HEB Manitoba

 

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HEB Manitoba is a name notation registered by the Healthcare Employees’ Pension Plan – Manitoba and the Healthcare Employees’ Benefits Plan – Manitoba and under which each of their respective undertakings is carried out.

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