Pre-determination of Benefits:
There are times in which you may be in a position which requires you to purchase an expensive item – i.e., a wheelchair, CPAP machine, prosthetic devices, etc. For items over $500, Canada Life may coordinate your claim directly with the service provider. For this to be accomplished, a pre-determination of benefits (pre-authorization) must be established.
This is a process that occurs before any services are performed, in which the provider outlines a proposed course of treatment and estimated costs. Canada Life will then specify the dollar amount and services that would be considered, if covered, by the CISVA Extended Healthcare plan. Canada Life requires the following information when submitting a pre-determination of benefits:
- letter from the doctor outlining diagnosis & prognosis, confirming necessity for the specified equipment;
- estimate from the service provider detailing the required equipment and applicable costs;
- a note from yourself (the employee) confirming and authorizing Canada Life to coordinate the claim directly with the service provider; therefore, reimbursing them directly;
- Extended Health claim form must be attached. Please indicate that this is a pre-determination which is why there will not be a purchase date on the invoice.
Take a photocopy for your own records and forward all originals to Canada Life for review.
Are special exams, e.g. MRI or CatScan or PetScan covered?
No. Canada life will not cover services or supplies that are covered by the government plan in the insured person’s home province.
Coverage is provided for wigs for permanent hair loss as a result of any injury or disease, or temporary hair loss as a result of medical treatment for any disease. Benefits are available following chemotherapy or radiation treatment or for total hair loss from Alopecia Totalis (please refer to the Medical services and equipment section of your benefit booklet for plan maximums). However, Canada Life will allow coverage of wigs for other medical conditions as well. Please refer to the following conditions that are covered:
- Alopecia Totalis
- Alopecia – areata, congenitalis, leprotica, medicamentosa, neurotica, scarring alopecia
- Cancer – chemotherapy
- Psuedopelade Broque – form of Alopecia Areata
Do I need to get travel insurance when I go outside of B.C. – or outside of Canada?
No, you don’t if you are an eligible employee within Benefit Class 1, 2, 4 or 8. Our Extended Healthcare plan provides 100% coverage for various emergency & unforeseen medical expenses up to $1 million for each insured person for all the eligible covered costs related to any medical emergency.
Yes, you do if you are an eligible employee within Benefit Class 3. Although the reimbursement level for these types of eligible expenses continues to be reimbursed at 100%, the benefit maximum is cut-back to a maximum of $10,000 per insured individual.
Yes, you do if you are an eligible employee within Benefit Class 5. Although the reimbursement level for these types of eligible expenses continues to be reimbursed at 100%, the benefit maximum is cut-back a maximum of $500,000 per insured individual.
Note: Each adult travelling should be carrying a Travel Assist booklet, which provides the toll-free telephone contact to direct payment to the medical provider anywhere in the world. The employee’s name, group policy number (No. 335645) and identification numbers are to be written on the back cover. A PDF copy of this booklet can be located within the Booklets section of the CISVA website.
Important: You must contact the Canada Life Out-of-Country department to verify any coverage that is in place for this benefit. Please call them directly from 6:00 am – 3:00 pm (Pacific Standard Time) at 1-800-957-9777.