Limitations and Exclusions to Prescription Drug Benefits
No benefits are paid for:
1) over-the-counter products, or medicines available without a prescription;
2) fertility drugs;
3) anti-smoking remedies (e.g. nicorette gum, patches or similar prescribed remedies);
4) injectable vitamins that are non-prescription;
5) patented medicines and G.P. products;
6) first-aid and surgical supplies;
7) atomizers, vaporizers;
8) salt and sugar substitutes;
9) infant formula, dietary foods and aids;
10) contact lens care products;
11) diagnostic aids and laboratory tests;
12) contraceptives, other than oral and the IUD Mirena;
13) lozenges, mouthwash, toothpastes and cosmetics;
14) oral vitamins;
15) items deemed cosmetic, even if a prescription is legally required;
16) male baldness treatments;
17) drugs which in whole or in part a government health plan prohibits from being paid, except to the extent that it permits excess reimbursement;
18) drugs which the Insured Person received without charge;
19) drugs which are experimental in nature;
20) drugs, hormones, products and injections for the treatment of obesity;
21) erectile dysfunction drugs;
22) Accutane or other acne preparations containing the same medicinal ingredient as Accutane;
23) anabolic steroids; or
24) sclerosing agents.
Limitations and Exclusions to Extended Health Benefits
No benefit is payable for:
1) expenses as a result of any injury or sickness caused by declared or undeclared war or any act thereof;
2) expenses of any kind which would not normally be charged to you if the policy were not in effect;
3) expenses incurred from any injury or sickness sustained as a result of employment when you are covered or eligible to receive benefits under the applicable Workplace Safety and Insurance Board's legislation or similar law;
4) expenses as a result of suicide or any attempt thereat or intentionally self-inflicted injury, while sane or insane;
5) cosmetic medical or surgical care, other than due to an accidental bodily injury sustained while you are insured under this benefit;
6) medical treatment which is experimental or investigational in nature;
7) periodic health examinations, broken appointments, physician's costs for traveling or providing telephone advice, third party examinations, completion of forms or medical reports, travel for health purposes;
8) services, treatment or supplies not included in this benefit;
9) expenses incurred from any injury or sickness as the result of active full-time service in the armed forces of any country;
10) expenses incurred by you if you are not covered under any Federal or Provincial Hospital or Medical Plan or its equivalent;
11) expenses which are not medically required;
12) services or supplies associated with exercise, weight loss, physical fitness or sports, environmental or atmospheric control in the home or workplace;
13) expenses which are prohibited by law from being covered by a private insurance plan; or
14) services, treatments or supplies which the Insured Person received without charge.
15) Services or supplies received outside of Canada;
16) any other exclusion identified in the policy contract.
Limitations and Exclusions to Dental Benefits
No benefit is payable for:
1) Services not included in the list of defined eligible services (e.g. temporary fillings);
2) Completion of claim forms, advice by phone, or charges for missed or cancelled appointments;
3) Cosmetic surgery or treatment when classified as such by the Company;
4) Any dental treatment not yet approved by the Canadian Dental Association or which is clearly experimental in nature.
5) implants and any dental service associated with implants;
6) replacement of fixed bridge pontics, retainers, abutments, crowns, or removable complete or partial dentures unless:
(a) made necessary by the extraction of a natural tooth while insured hereunder,
(b) the crown is at least five years old,
(c) the existing appliance is at least five years old and cannot be made serviceable, or
(d) the existing appliance is temporary and is replaced with a permanent bridge pontic or denture within 12 months of the date on which the temporary appliance was installed;
7) services not included in the list of defined eligible services;
8) cosmetic surgery or treatment when classified as such by Canada Life;
9) expenses recoverable from other benefit sections of this policy;
10) expenses which are provided for by any Federal, Provincial, or Municipal government plan, or which would have been provided for if the Insured Person had applied for coverage under such plan;
11) expenses of any kind which would not normally be charged to the Insured Person if the insurance provide by this policy were not in effect;
12) completion of claim forms, advice by phone, or charges for missed or cancelled appointments;
13) replacement of lost, misplaced or stolen appliances or dentures;
14) initial crowns, bridges, retainers, abutments or complete or partial dentures required to replace a tooth or teeth missing prior to coverage becoming effective;
15) nutritional counseling, oral hygiene and dental plaque control programs;
16) any dental treatment which is not yet approved by the Canadian Dental Association or which is clearly experimental in nature;
17) Services or supplies received outside of Canada;
18) any other exclusion identified in the policy contract.