Reimbursement for the services of a licensed dental practitioner for dental care when required by a direct blow to the mouth and not by an object consciously or unconsciously placed in the mouth. The accident must occur while the coverage is in force. You must notify GSC immediately following the accident and the treatment must commence within the timeframe indicated in your benefit booklet.
A hearing aid is a small electronic device that can be worn in or behind the ear. It consists of three basic parts: a microphone, amplifier and speaker. A hearing aid may be required if an audio specialist has determined that you have a loss of hearing acuity. To determine specific benefit coverage based on your individual plan design, contact our customer service center.
Custom shoes are prescribed when your needs cannot be accommodated by regular (or modified) orthopedic footwear due to the severity of your foot condition. This includes structural deformities resulting from congenital systemic disease, arthritic disease, traumatic foot injury, asymmetry or aging, or postsurgical amputations.
The construction of custom shoes requires a high degree of specialized expertise from the provider. You must go to an authorized provider who will assess your condition, create a cast of your feet, and have the custom footwear manufactured from scratch using raw materials.
Information about GSC’s orthotics and orthopedic shoe policy can be found in our FAQ and Glossary.
A professional land or air ambulance to the nearest hospital equipped to provide the required treatment, when medically required as a result of an injury, illness or acute physical disability.
A home care benefit provides coverage for the services of a Registered Nurse, or a Registered Practical Nurse on some plans, in the home. These services are only a benefit when medically necessary and only when the services required cannot be performed by someone with lesser qualifications. Various plans may have the added benefit of a Personal Support Worker. Pre-approval with GSC is required for this benefit.
- Private – we define private hospital accommodation as a private room with one bed in a public general hospital.
- Semi-Private – we define semi-private hospital accommodation as a room with no more than two beds, sharing one bathroom.
- Ward – we define ward hospital accommodation as a room with three or more beds in a public general hospital.
Upon discharge, remember to ask to see a copy of the accommodation charges to verify that they are charging you for exactly
what you received. Your hospital may send a claim through directly to
GSC as semi-private, without even verifying the room type that you
actually received. If your doctor requests a private or semi-private
room (preferred accommodation) for you for medical reasons, neither you
nor GSC should be billed for these room charges. Your Provincial Health
Insurance Plan will cover this benefit. GSC will only pay for
preferred accommodation (a private or semi-private room) upon patient
choice and provided the patient has signed a request for such
accommodation. You should also not be charged for ward accommodations
(three or more beds in a room), ICU (Intensive Care Unit) beds, CCU
(Critical Care Unit) beds, or outpatient beds for day surgery. When a
mother and her newborn occupy the same room, only one claim should be
Medical items required due to medical necessity to assist with mobility, or to help correct a medical condition may be eligible through a benefit plan. Items that are not primarily medical in nature or that are for comfort and convenience are not eligible. A physician’s authorization may be required for various medical items, and specific medical items may require pre-approval. GSC does not reimburse claims for used medical equipment.
The following is a list of some of the more common paramedical practitioners (health care professionals) and their related health professional services. A physician’s authorization may be required on the initial claim. GSC requires that a paramedical practitioner be licensed in the province in which they are practicing.
Acupuncturist – Acupuncture is an all-natural form of Chinese medicine which involves inserting needles into a patient’s skin at specific areas of the body, to concentrate on the points in need of healing. Acupuncture is used to improve a patient’s mood or energy levels, relieve pain, and restore function of the affected areas.
Chiropodist – Chiropodists assess and treat disorders of the foot including deformities, skin lesions, corns, calluses and warts, and nail conditions.
Chiropractor – Chiropractors are medical professionals trained to diagnose and treat conditions related to the spine, and other body joints, by manipulating and correcting the alignment of the spinal column. They primarily treat disorders related to the back, and neck and head pain. Chiropractors also counsel patients on corrective exercises and nutrition.
Dietitian – Dietitians are certified health professionals who can provide advice on nutrition, food, and healthy eating choices. The term nutritionist is not interchangeable with dietitian – although all dietitians are nutritionists, not all nutritionists are certified dietitians.
Massage Therapist – A massage therapist manipulates the soft tissues of the body in an effort to relieve muscle tension and discomfort. Registered massage therapists (RMT) use their in-depth knowledge of anatomy, physiology, and pathology to adjust the soft tissue in a scientific manner to break the pain cycle and bring about results. Massage therapy can help give patients relief from muscle spasms, tension in the neck and back, tired hands and feet, headaches, sports injuries, etc.
Naturopath – Naturopathic medicine combines modern scientific health knowledge with traditional and natural remedies. The naturopathic philosophy is to treat the underlying cause of the disease. Symptoms are viewed as warning signals of malfunctions within the body and poor lifestyle habits. Many people visit a naturopath on a regular basis to find out how to maintain good health. Naturopaths help manage patient concerns on a variety of health issues, from allergies and digestive problems to depression and more serious illnesses. Supplements and remedies are not eligible benefits under any GSC plan.
Osteopath – An osteopath treats diseases by manipulation of the bones. Osteopathy is based on the theory that the body will produce the remedies necessary to protect itself as long as the bones are aligned properly and do not press on the nerves. Osteopaths treat patients using a combination of gentle stretching, massage, and mobilizing joints to ease symptoms. Commonly, patients visit an osteopath to seek relief from back pain, stiff joints, headaches, arthritis, fatigue, or digestive issues.
Physiotherapist – Physiotherapists use a combination of comprehensive knowledge of how the body works and practical clinical skills to diagnose and treat injuries and illness. They work towards maximizing patient strength, mobility and well-being. A physiotherapist prescribes customized exercises as well as educates patients on essential steps to recovery.
Podiatrist – Podiatry is a specialized medical field that centres around the study and care of the foot and ankle. A podiatrist focuses on preventing, diagnosing, and treating conditions of this area by medical, surgical, or other means.
Psychologist – Psychology is the scientific study of the human mind and its functions. Psychologists provide counseling and psychotherapy for patients seeking treatment for life adjustment problems, behavioural issues, emotional disorders, or mental illness. They provide treatment for individuals of all ages as well as for families or groups.
Speech Therapist – Speech therapists work to prevent, identify, and treat communication and swallowing disorders as well as counsel patients and their families on their conditions. Speech therapists assess each patient’s individual needs and implement custom speech and language programs in an effort to help develop effective communication.
Orthopedic footwear accommodates, controls, or supports the therapeutic needs of a foot deformity or abnormality in the leg, knee, or ankle, and must be manufactured by recognized and reputable orthopedic footwear manufacturers. The footwear may be modified or adjusted to fit your feet.
Orthopedic footwear may be prescribed for bone deformities, neurological conditions such as multiple sclerosis, osteoarthritis, and foot complications caused by diabetes.
If you are prescribed orthopedic footwear, you must go to an authorized provider trained to assess, design, modify, and fit orthopedic footwear.
Information about GSC’s orthotics and orthopedic shoe policy can be found in our FAQ and Glossary.
A custom orthotic is a removable foot-care device worn inside a shoe and made from a three-dimensional cast impression of your foot. It must be constructed from raw materials based on your individual specifications. Orthotics are intended to support, align, prevent and/or accommodate foot abnormalities and improve how the foot functions.
Orthotics are prescribed to treat diagnosed medical conditions such as structural weaknesses or deformities, traumatic injuries, overuse syndromes, and complications from diseases such as diabetes.
If you are prescribed custom orthotics, you must buy them from an authorized provider trained to assess, design, manufacture, and fit orthotics. Information about GSC’s orthotics and orthopedic shoe policy can be found in our FAQ and Glossary.
What happens at an orthotics assessment?
Here’s what to expect:
Medical history: A complete investigation of your medical history, including symptoms, previous injuries, lifestyle (occupation, activities), and footwear.
Biomechanical examination: A complete hands-on evaluation of your lower limb, including foot structure, alignment, strength, range of motion, and identification of any abnormalities.
Gait analysis: You are observed while walking to identify any accommodations required or abnormalities affecting your ability to walk.
Orthotic evaluation: Determines your treatment options and explains how the treatment will address your specific needs.
Casting: A three-dimensional cast or mold of your foot is necessary to make a truly custom-made orthotic. The provider makes the cast based on the contour and structure of your foot. Casting techniques include foam box casting, plaster of paris slipper casting, contact digitizing, and laser screening.
Manufacturing: The orthotics must be constructed completely from raw materials and fabricated directly from the cast. Usually it takes at least a week between your assessment and fitting appointments.
Dispensing: The orthotic should be fit to your foot and your footwear, and you should be evaluated while walking with the orthotic. The provider typically schedules a follow-up fitting appointment within two to six weeks.
Education: You should receive instructions about the appropriate break-in routine, orthotic longevity, and footwear fit and features.
This is the “reasonable” reimbursement amount determined by GSC for a medical item or service. GSC establishes reasonable and customary pricing for all covered health services and major medical equipment. We determine our reasonable and customary pricing based on reviewing rendered amounts, manufacturers’ pricing and provincial and association pricing. In all cases, we reimburse the lesser of either the submitted or the allowed unit cost per device or service, as determined by our reasonable and customary pricing policy. Our reasonable and customary pricing policies are reviewed on an annual basis.
Here are some services and products you might come across if you have vision benefits:
Prescription eyeglasses or contact lenses
Replacement parts to prescription eye glasses
Medically necessary contact lenses when the visual acuity cannot be corrected to at least 20/40 in the better eye with conventional eyeglasses
Plano sunglasses prescribed by a medical practitioner for the treatment of ophthalmic diseases or conditions
Some plans also allow reimbursement toward laser eye surgery in lieu of vision benefits (at the same benefit level). Laser vision correction is used to correct common vision problems, such as myopia (near sightedness), hyperopia (far-sightedness) and astigmatism (distorted vision when looking at objects in the distance).