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Health and Health Plus

The calendar year for Health and Health Plus is January 1 to December 31 . Your plan will automatically renew each year. You have 180 days after the end of the calendar year (December 31) to submit your claim expenses that were incurred during that calendar year.

Co-insurance for Health Insurance refers to the portion that is paid by the insurance company. For example, a 90% co-insurance means the insurer pays 90% and you pay 10%.

Contact us

To learn more about OMA Insurance programs call

1-800-268-7215
(Monday – Friday 8:45am – 5pm ET)

Or speak to an advisor

Benefit Health Health Plus
Co-insurance

Per insured person: 50% of the first $350 of eligible expenses, 90% thereafter.

This applies to in-province hospital expenses, ambulance services, nursing, pregnancy and family support benefits, medical equipment and services, paramedical services and hearing aids.

Per insured person: 90% of eligible expenses.

This applies to prescription drugs, ambulance services, nursing, pregnancy and family support benefits and paramedical services.

Prescription drugs

Per insured person: 50% of the first $650 of eligible expenses, 90% thereafter

  • Eligible expenses for the dispensing fee are limited to 50% up to $10 for each prescription or refill. Increased to 90% after out-of-pocket prescription maximum is reached
  • Generic drugs (or brand name drugs when no generic equivalent is available) listed in federal or provincial drug schedules that have a Drug Identification Number (DIN) and require a prescription
  • $1,000,000 lifetime maximum per insured. Once lifetime maximum is reached, annual $25,000 maximum reinstated
  • Injectable drugs, vitamins and allergy serums
  • Vaccines, whether or not they require a prescription
  • Assisted conception drugs up to $7,000 lifetime maximum
  • Diabetic supplies

Per insured person: 90% of eligible expenses

  • Eligible expenses for the dispensing fee are limited to 90% up to $11 for each prescription or refill
  • Generic drugs (or brand name drugs when no generic equivalent is available) listed in federal or provincial drug schedules that have a Drug Identification Number (DIN) and require a prescription
  • $1,000,000 lifetime maximum per insured. Once lifetime maximum is reached, annual $25,000 maximum reinstated
  • Injectable drugs, vitamins and allergy serums
  • Vaccines, whether or not they require a prescription
  • Assisted conception drugs up to $7,000 lifetime maximum
  • Diabetic supplies
Paramedical services

Do not require a physician's order.

  • Physiotherapist: maximum $1,000 per insured person, per calendar year
  • $350 per insured person, per calendar year for each practitioner of these practitioners:
    • Massage therapists, naturopaths, Doctors of Osteopathy and osteotherapists, acupuncturists, podiatrists or chiropodists, kinesiologists or kinotherapists, speech therapists, chiropractors
    • Maximum of one x-ray for each practitioner, in a calendar year for Doctors of Osteopathy, podiatrists or chiropodists, chiropractors

Do not require a physician's order.

  • Physiotherapist: maximum $1,000 per insured person, per calendar year
  • $500 per insured person, per calendar year for each practitioner of these practitioners:
    • Massage therapists, naturopaths, Doctors of Osteopathy and osteotherapists, acupuncturists, podiatrists or chiropodists, kinesiologists or kinotherapists, speech therapists, chiropractors, audiologists, occupational therapists, dietitians
    • Maximum of one x-ray for each practitioner, in a calendar year for Doctors of Osteopathy, podiatrists or chiropodists, chiropractors
Mental health support
  • $10,000 per calendar year, per insured person for mental health services provided by an approved provider, either in person or online
Medical services
  • Up to a combined maximum of $5,000 per insured person, per calendar year for:
    • Laboratory tests, ultrasounds, and other medical imaging services, excluding MRI (magnetic resonance imaging) and CT (computed tomography) scans rendered outside of a hospital, except if the insured person’s provincial plan prohibits payment of these expenses
    • Oxygen, plasma, and blood transfusions
    • Radiotherapy or coagulotherapy
    • Artificial limbs and eyes
    • Colostomy and ileostomy supplies
    • Insulin pumps
    • Continuous glucose sensors and continuous glucose transmitters prescribed by a diabetologist or a specialist
    • Cosmetic surgery required because of an accident that occurs while coverage is in force. Treatment must be started within 12 months of the accident and completed within 36 months of the accident
  • Pharmacogenomics: limited to one test, lifetime maximum $500 per insured person
  • Wigs: lifetime maximum $500 per insured person, physician’s order not required.
  • Breast prostheses: maximum $500 per insured person every 2 calendar years
  • Surgical bras: maximum 2 per insured person every calendar year
  • Stump socks: maximum 5 pairs per insured person every calendar year
  • Compression stockings: maximum 2 pairs per insured person every calendar year
  • Custom-made orthotic inserts for shoes, orthopaedic shoes or modifications to orthopaedic shoes prescribed by a physician, podiatrist, or chiropodist: maximum $400 per insured person every 2 calendar years
  • Glucometers prescribed by a diabetologist or specialist: maximum $250 per insured person every 5 calendar years
  • Up to a combined maximum of $5,000 per insured person, per calendar year for:
    • Laboratory tests, ultrasounds, and other medical imaging services, excluding MRI (magnetic resonance imaging) and CT (computed tomography) scans rendered outside of a hospital, except if the insured person’s provincial plan prohibits payment of these expenses
    • Oxygen, plasma, and blood transfusions
    • Radiotherapy or coagulotherapy
    • Artificial limbs and eyes
    • Colostomy and ileostomy supplies
    • Insulin pumps
    • Continuous glucose sensors and continuous glucose transmitters prescribed by a diabetologist or a specialist
    • Cosmetic surgery required because of an accident that occurs while coverage is in force. Treatment must be started within 12 months of the accident and completed within 36 months of the accident
  • Pharmacogenomics: limited to one test, lifetime maximum $500 per insured person
  • Contact lenses or intraocular lenses following cataract surgery: lifetime maximum of one lens per eye
  • Wigs: lifetime maximum $500 per insured person, physician’s order not required.
  • Breast prostheses: maximum $500 per insured person every 2 calendar years
  • Surgical bras: maximum 2 per insured person every calendar year
  • Stump socks: maximum 5 pairs per insured person every calendar year
  • Compression stockings: maximum 2 pairs per insured person every calendar year
  • Custom-made orthotic inserts for shoes, orthopaedic shoes or modifications to orthopaedic shoes prescribed by a physician, podiatrist, or chiropodist: maximum $300 per insured person every calendar
  • Glucometers prescribed by a diabetologist or specialist: maximum $250 per insured person every 5 calendar years
Medical equipment
  • Wheelchairs: $5,000 lifetime maximum, and expenses are limited to the use of a manual wheelchair except if the insured’s medical condition warrants the use of an electric wheelchair
  • Hospital beds: $5,000 lifetime maximum
  • $5,000 maximum per calendar year for rental or purchase of cast, splints, trusses, braces, or crutches as a result of illness or injury
  • Wheelchairs: $5,000 per insured person every 5 calendar years, and expenses are limited to the use of a manual wheelchair except if the insured’s medical condition warrants the use of an electric wheelchair
  • Hospital beds: no lifetime maximum
  • 100% of the approved cost for rental or purchase of cast, splints, trusses, braces, or crutches as a result of illness or injury
Private duty nursing
  • Licensed, certified or registered nurse or nursing assistant who is not a relative of the patient or a resident in the insured’s home
  • Prescribed by a physician and rendered outside the hospital
  • $25,000 every three consecutive calendar years, if age 65 or under
  • $5,000 per calendar year if over age 65
Pregnancy and family support benefits
  • Lactation consultant: maximum $125 per hour for up to 2 hours per birth
  • Birthing coach: $1,000 maximum per pregnancy
Ambulance services

Unlimited ground and air ambulance from:

  • The place where the injury or illness occurs to the nearest hospital able to provide adequate treatment
  • One hospital to another hospital
  • A hospital to your residence
Hearing aids
  • $500 per insured person, every 4 calendar years, including repairs and moulds
  • $1,000 per insured person, every 4 calendar years, including repairs and moulds
Hospitalization

Hospital

  • Room and board charges between standard ward and semi-private rate

Convalescent hospital

  • Room and board charges if admitted within 24 hours following a period as an in-patient in a hospital (180 day maximum)

Rehabilitative facility

  • Room and board charges between standard ward and semi-private or private rate up to $200 per day to a maximum of $14,000 per lifetime

Hospital

  • Room and board charges between standard ward and semi-private rate plus up to $100 per day for private room accommodation

Convalescent hospital

  • Room and board charges if admitted within 24 hours following a period as an in-patient in a hospital (180 day maximum)

Rehabilitative facility

  • Room and board charges between standard ward and semi-private or private rate up to $200 per day to a maximum of $14,000 per lifetime
Emergency out-of-province/country travel medical
  • 100% of the cost of emergency services while outside your home province
  • Coverage for pre-existing medical conditions with no exclusions
  • Lifetime maximum of $2,000,000 per insured person
  • Coverage for the first 90 days of travel if under age 70
  • Coverage for the first 30 days of travel if age 70 or over 
  • Need more coverage to protect your entire trip? You can
    use the Emergency Medical Top-Up Plan. Learn more about the Top-Up Plan.
Vision care Not included

For any insured person, in two calendar years, this can include:

  • $50 maximum per insured person every two calendar years for ophthalmologist or licensed optometrist services
  • $300 per insured person under age 18 in a 12-month period or for any other covered person in any 24-month period. This can include:
    • Contact lenses, eye glasses or laser eye correction surgery (laser eye correction surgery must be performed by an ophthalmologist)
    • Requires prescription by an ophthalmologist or licensed optometrist
    • Prescription sunglasses, magnifying glasses or safety glasses for the correction of vision
    • For coverage following cataract surgery, refer to medical services above
Accidental dental
  • Expenses incurred within three years of accident
  • Maximum $10,000 for any one dental accident