Page 4 - Impact XM Canada Benefits Guide 2023

Medical Coverage

Here are some important plan provisions you should keep in mind while using your plan:

Reimbursement
Co-Pays & Maximums
Level
In-Canada Prescription 80% Included, $2 per

Drugs prescription
80% $25,000 for a maximum of
Home Nursing Care
12 months per condition

Hearing Aids 80% $500 Every 5 Years

Custom-fitted 80%

orthopedic $500 each calendar year
shoes and foot orthotics

Myoelectric Arms 80% $10,000 per prosthesis

External breast 80%
1 Every 12 months
prosthesis

Surgical brassieres 80% 2 Every 12 months

Mechanical or hydraulic 80% $2,000 per lifter every 5

patient lifters years

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