Other Medical Services & Supplies
The Alberta School Employee Benefit Plan (ASEBP) provides coverage for a variety of medical services and supplies that complement your provincial health care insurance plan. Here are some things you should know about your Other Medical Services & Supplies coverage:
- Coverage for Other Medical Services & Supplies is the same for most ASEBP plans (differences and exceptions are outlined in the specific services and supplies)
- Some of the services and supplies included are also partially covered by your provincial health care insurance plan
- While all services and supplies must be medically necessary, a doctor's referral and/or prescription are not required for reimbursement, unless otherwise specified
- Non-emergency services received outside of Canada are only covered if the health care provider has the proper qualifications (i.e. licensed to practice)—which is the individual’s responsibility to ensure
- Medical supplies purchased outside of Canada are covered, unless otherwise specified
Note that the following is a comprehensive summary of the official, legally binding ASEBP insurance policies and plan documents, which are available through your employer or by contacting us.
What's covered?
Accidental Dental
You and your dependants each have a maximum of $1,000 per tooth for dental treatment due to accidental injury (both inside and outside of Canada).
Note that accidental dental claims do not affect your annual or lifetime dental coverage limits. If you receive dental treatment due to accidental injury, please have your dentist complete the “Dental Accident” section of the Dental Care Claim. If the form you’re using does not have a specific section for accidental dental information, please mark the claim “Dental Accident” to prevent expenses from being applied to your annual dental maximum. Please ensure your dentist identifies all injured teeth on the form along with the date and details of the accident.
If services exceed the $1,000 per tooth maximum and you’re inside of Canada, your claim can be submitted under your Dental Care benefits and will be applied to your annual or lifetime dental claim maximums. If services exceed the $1,000 per tooth maximum and you’re outside of Canada, your claim may be covered under your Travel Emergency benefits.
Requirement(s):
- Must be necessary for the treatment of either accidental dental injury due to an external blow to the mouth or damage caused from biting on a foreign object inserted in the mouth
- Treatment must be completed within two years of the accidental injury date
- Damage must not have existed prior to the accidental injury
Acupuncture
Every calendar year (January to December), you and your dependants can each use up to $700 for acupuncture services. Acupuncture treatments will be covered up to $65 a day per person. You can easily track your expenses and view your usage summary on My ASEBP or the My ASEBP Mobile App.
Requirement(s):
- Must be provided by an acupuncturist registered in the province of practice
Exclusion(s):
- No more than one treatment per day (per person)
Ambulance
You and your dependants each have 100 per cent coverage for professional ambulance services (ground and air)—regardless of whether or not you’re transported after treatment—at the rates negotiated between ASEBP and Alberta Health Services (AHS). Note that claiming practices may affect the time in which your claim is processed.
Requirement(s):
- Must be used for the emergency treatment and/or transport of a patient to the nearest hospital that can provide adequate medical treatment and when no other means of transportation is appropriate
- Ambulance services provided in a province other than Alberta are covered to the price negotiated within that province
- If you receive an invoice from the provider, call EMS Accounts Receivable at 1-855-919-6097 as you shouldn’t pay the provider directly because ASEBP has a direct billing agreement with ambulances
Exclusion(s):
- Trips that are:
- not an emergency
- to a treatment facility that is not active
- between active treatment facilities (the sending hospital is responsible for this fee)
- to or from a nursing home
- pre-arranged or pre-booked
- Additional fees (e.g. late payment charges, surcharges, escort charges, medications or other charges such as the Jaws of Life, etc.)
- Fire department response fees
Aerochambers
Every calendar year (January to December), you and your dependants each have a maximum of $40 towards the purchase of an aerochamber. Inhalers are covered separately.
Exclusion(s):
- Repairs
Allergy Testing Materials
Every calendar year (January to December), you and your dependants each have a maximum of $40 towards the purchase of allergy testing materials.
Exclusion(s):
- Food sensitivity testing (covered under Naturopathy benefit when ordered by a naturopathic doctor)
Blood Pressure Monitors
Based on a rolling three-year period, you and your dependants each have a maximum of $150 towards the purchase of a digital blood pressure monitor.
Requirement(s):
- You must submit a valid receipt (containing the required information) with your purchase.
Exclusion(s):
- Repairs
Canes, Cervical Collars, Crutches and Walkers (including Knee Walkers/Scooters), and Trusses (hernia belts)
Every calendar year (January to December), you and your dependants each have a combined maximum of $100 towards the purchase and/or rental of canes, cervical collars, crutches, walkers (including knee walkers/scooters), and trusses (hernia belts). Each category is covered up to a combined maximum of $40. Repair charges are excluded.
Casts, Medical Braces, and Splints
Based on a rolling 2-year period, you and your dependants each have a per person, combined maximum of $700 towards the purchase or rental of casts, medical braces, and splints.
Chiropractic
Every calendar year (January to December), you and your dependants can each use up to $700 for chiropractic services. Chiropractic treatments, including X-rays related to treatment and telephone and video call, will be covered up to $50 a day per person. You can easily track your expenses and view your usage summary on My ASEBP or the My ASEBP Mobile App.
Requirement(s):
- Must be provided by a chiropractor registered in the province of practice
Exclusion(s):
- No more than one treatment per day (per person)
Compression Garments and Support/Surgical Stockings
Every calendar year (January to December), you and your dependants each have a combined maximum of $250 towards the purchase of medically necessary compression garments (gloves, sleeves, support hosiery and surgical stockings).
Requirement(s):
- Support hosiery, gloves, sleeves and surgical stockings require a minimum gradient of 20-30mmHg
- Receipts must include pressure gradient
- Only gloves, sleeves, support hosiery and surgical stockings are covered
Diabetic: Glucose Monitoring Supplies
Every calendar year (January to December), you and your dependants each have a maximum of $6,000 towards the purchase of glucose monitoring supplies. This includes items such as OmniPods, cartridges, infusion sets, reservoirs, continuous glucose monitor receivers, transmitters, sensors, and flash glucose monitor sensors and readers. Insulin dependency is required.
Requirement(s):
- Insulin dependency is required for reimbursement.
Exclusion(s):
- Batteries
- Glucose control solution
- Dispensing fees for continuous glucose monitoring products (e.g., Dexcom, FreeStyle Libre)
Diabetic: Insulin Pumps
Based on a rolling four-year period, you and your dependants each have a maximum of $5,000 towards the purchase of insulin pumps. Insulin dependency is required.
Requirement(s):
- Insulin dependency is required for reimbursement.
Exclusion(s):
- Batteries
- Glucose control solution
Diabetic: Supplies
Every calendar year (January to December), you and your dependants each have a maximum of $1,000 towards the purchase of diabetic supplies. This includes items such as test strips, lancets, alcohol swabs, pen needles, syringes, lancing devices, and blood glucose meters. Insulin dependency is not required. Note: Not all diabetic supplies are eligible for coverage. Please contact a benefit specialist prior to purchasing to confirm eligibility.
Exclusion(s):
- Batteries
- Glucose control solution
Dressings, Bandages and Related Supplies
Every calendar year (January to December), you and your dependants each have a combined maximum of $600 towards the purchase of dressings, bandages and related supplies.
Requirement(s):
- Must be necessary as a result of a chronic medical condition
- Must be pre-approved by ASEBP prior to purchase (please contact us for pre-approval requirements)
Endovenous Laser, Radiofrequency Endovenous Ablation Therapy or Treatment with Medical Adhesives
You and your dependants each have a lifetime maximum of $4,000 to treat varicose veins by endovenous laser, radiofrequency endovenous ablation therapy or with medical adhesives (e.g. VenaSeal).
Requirement(s):
- Must be provided by a doctor or other licensed health care provider
Exclusion(s):
- Ultrasound-guided sclerotherapy treatment
Foot Orthotics
Every calendar year (January to December), you and your dependants each have a maximum of $200 towards the purchase of foot orthotics and/or arch supports, including repairs. Information about orthopedic shoes available below.
Requirement(s):
- Orthotics, including arch supports, must be custom made and individually fitted.
- A written order by a recognized healthcare professional.
- An assessment that analyzes the foot and body to design a suitable product.
- A fabrication form is required with claim submission.
Exclusion(s):
- Heel lifts
- Off-the-shelf products (e.g. Birkenstock, Blundstone, etc.)
Hairpieces and Wigs
Based on a rolling three-year period, you and your dependants each have a maximum of $600 towards the purchase of hairpieces or wigs.
Requirement(s):
- Only for hair loss due to radiation, chemotherapy or other serious medical conditions
- Must be pre-approved by ASEBP prior to purchase (please contact us for pre-approval requirements)
Hearing Supplies and Services
Based on a rolling three-year period, you and your dependants each have a maximum of $3,000 towards the following hearing-related supplies and services:
- Hearing tests (maximum of $70 on a rolling three-year period)
- Performed by an audiologist registered with a recognized association in their province or territory of residence, i.e. with the Alberta College of Speech-Language Pathologists and Audiologists
- Purchase, repair and/or replacement (not accident-related) of hearing aids and related supplies.
- Damages caused by an accident: You and your dependants each have a lifetime maximum of $3,000 ($1,500 for MyRetiree Core Plan) for expenses resulting from accident-related damages
- Batteries for cochlear implants
Exclusion(s):
- Batteries for hearing aids
- Cochlear implant devices
- Online and over-the-counter (OTC) hearing aids
Home Nursing Care
You and your dependants each have a lifetime maximum of 4,000 hours for home nursing care (e.g., private-duty professional nursing services provided in the home) within Canada.
Registered nurses and graduate nurses will be covered up to $42 per hour; registered licensed practical nurses will be covered up to $27 per hour.
Requirement(s):
- Must be provided by a registered nurse, graduate nurse or registered licensed practical nurse
- Must be deemed as an appropriate service or course of treatment by your doctor or other licensed health care provider (e.g. occupational therapist)
- Must be pre-approved by ASEBP prior to service (please contact us for pre-approval requirements)
Exclusion(s):
- Homemaker, homecare services and custodial care (e.g. assistance for bathing, house cleaning, meal prep, etc.)
Hospital Beds
You and your dependants each have a lifetime maximum of $3,000 towards the purchase or rental of a hospital bed. Hospital beds allow for variable angles of incline and easily raised or lowered to assist the patient and caregivers. Hospital beds are meant for single occupancy, and allow for additional options such as IV hooks, safety rails and overbed tables.
Requirement(s):
- Must be necessary as a result of a chronic medical condition
- Must be pre-approved by ASEBP prior to purchase (please contact us for pre-approval requirements)
Exclusion(s):
- Beds (including adjustable beds) that do not qualify as “hospital beds”
Hospital Rooms
You and your dependants are each covered 100 per cent up to the Government of Alberta’s daily rate for a semi-private hospital room within Canada.
Requirement(s):
- Service must be from an institution regarded as an accredited hospital. To be recognized as a hospital, the institution must:
- be accredited as a hospital by the Canadian Council on Hospital Accreditation,
- be approved for resident in-patient care under a provincial hospital services program,
- be primarily engaged in the in-patient medical care and treatment of sick and injured persons,
- provide medical, diagnostic and major surgical facilities, and
- provide 24-hour-a-day nursing service.
Exclusion(s):
- Services from an institution not regarded as an accredited hospital, including:
- an institution which is primarily a home for the aged, rest home or nursing home,
- a facility solely dedicated to addiction treatment,
- a facility that operates under the Mental Health Act, and
- an institution operating primarily as a school or furnishing custodial care (e.g. auxiliary hospital, palliative care or respite room).
Ileostomy, Colostomy and Urinary Incontinence Supplies
Every calendar year (from January to December), you and your dependants each have a maximum of $1,000 towards the purchase of ileostomy, colostomy and urinary incontinence supplies.
Requirement(s):
- The expense must qualify for Alberta Aids to Daily Living (AADL) coverage
Exclusion(s):
- Tubing
- Skin care products
Intravenous Supplies
Every calendar year (January to December), you and your dependants each have a maximum of $150 towards the purchase of intravenous supplies (e.g. hep-locks, IV solutions, IV tubing, needles and swabs).
Joint Injectable Materials
Plans 1, 2, 3, and 5 cover up to $1,000 per person per calendar year (January to December) for the cost of joint injectable materials (used to cushion or lubricate a joint, such as Duralane and Synvisc), which can be dispensed by and administered in a physician’s office.
Please contact us for eligibility details on specific types of injectable materials.
Requirements
- Note that joint injectable drugs (not materials), i.e., steroids such as prednisone or cortisone, may be available for coverage under your ASEBP drug benefits.
- Drugs administered in a physician’s office MUST be dispensed by a licensed pharmacist.
Massage Therapy
Every calendar year (January to December), you and your dependants can each use up to $700 for massage therapy services. Massage therapy treatments will be covered up to $75 a day per person.
You can easily track your expenses and view your usage summary on My ASEBP or the My ASEBP Mobile App.
Requirement(s):
- Service provided by a massage therapist registered with a massage therapy association in the province or territory of practice
- Provider must have a minimum of 2,200 hours of massage therapy training with a recognized institution
Exclusion(s):
- No more than one treatment per day (per person)
- Services provided by massage therapy students—even if they’re registered with a professional college or association
Naturopathy
Every calendar year (January to December), you and your dependants each have a maximum of $200 for naturopathy services including telephone and video call sessions. Naturopathy treatments (including food sensitivity testing) will be covered up to $20 a day per person.
Requirement(s):
- Must be provided by a naturopathic practitioner registered in the province of practice or a member of the Canadian Naturopathic Association (for those provinces where there is no licensing body)
Exclusion(s):
- No more than one treatment per day (per person)
- Naturopathic medicines
Orthopedic Shoes
Based on a rolling 2-year period, you and your dependants each have a maximum of $1,500 towards the purchase of orthopedic shoes, including repairs. Information about foot orthotics found above.
Requirement(s):
- A written order from a recognized healthcare professional.
- An assessment that analyzes your foot and body to determine the most suitable product. Claims must include this assessment.
- Must be constructed from raw materials.
Exclusion(s):
- Off-the-shelf products (e.g. Birkenstock, Blundstone, etc.)
Oxygen and Supplies Required for Its Use
Every calendar year (January to December), you and your dependants each have a maximum of $1,000 towards the purchase, repair, rental and/or shipment of oxygen and supplies required for its use.
Phototherapy Light
You and your dependants each have a lifetime maximum of $300 towards the purchase of one phototherapy light.
Requirement(s):
- Must be required to treat seasonal affective disorder, and a physician's letter/prescription stating the diagnosis must be included with the claim submission. As of March 1, 2024, a Physician Written Order completed by a Nurse Practitioner will be accepted.
Exclusion(s):
- Red light therapy/devices
- Batteries
- Repairs
- Replacement bulbs
Physical Rehabilitation Equipment
You and your dependants each have a lifetime maximum of $300 towards the purchase or rental of the medically necessary physical rehabilitation equipment listed below:
- Passive Motion machine
- Electrospinal stimulators
- Bio feedback (Myotrac) system
- Neuromuscular stimulators
- TENS machines
Note: for TENS machines and neuromuscular stimulators, you and your dependants each have a $150 maximum every 3 years up to a lifetime maximum of $300.
Requirement(s):
- A physician's letter/prescription stating the diagnosis must be included with the claim submission. As of March 1, 2024, a Physician Written Order completed by a Nurse Practitioner will be accepted. Note: letters/prescriptions from physiotherapists and chiropractors do not qualify.
Exclusion(s):
- Repairs
- Handheld massage guns or percussion massage devices
Physiotherapy
Every calendar year (January to December), you and your dependants can each use up to $700 for physiotherapy services. Physiotherapy treatments, including telephone and video call sessions, will be covered up to $75 a day per person.
You can easily track your expenses and view your usage summary on My ASEBP or on the My ASEBP Mobile App.
Requirement(s):
- Must be provided by a physiotherapist registered in the province of practice
Exclusion(s):
- No more than one treatment per day (per person)
Podiatry
Every calendar year (January to December), you and your dependants each have a maximum of $700 for podiatric services. Podiatry treatments, including X-rays related to treatment, will be covered up to $50 a day per person. The $50 per treatment limitation does not apply to podiatric surgery.
Requirement(s):
- Must be provided by a podiatrist
Exclusion(s):
- No more than one service per day (treatment, related x-rays, or surgery) per person
- Facility fees
Prosthetics
Breast Prostheses
Every calendar year (January to December), you and your dependants each have a maximum of $400 per breast towards the purchase of breast prostheses, including an additional $200 maximum per year for mastectomy bras.
Exclusion(s):
- Repairs
Eye Prostheses
Based on a rolling 3-year period, you and your dependants each have a maximum of $2,110 towards the purchase and/or repair of eye prostheses.
Larynx Prostheses
Based on a rolling 3-year period, you and your dependants each have a maximum of $2,000 towards the purchase and/or repair of larynx prostheses.
Limb Prostheses
Based on a rolling 3-year period, you and your dependants each have a combined maximum of $15,000 per limb towards the purchase, repair and/or replacement of prosthetic limbs, myoelectric limbs and stockings.
Exclusion(s):
- Adults are restricted to no more than one replacement per limb on a rolling three-year period. Dependants under the age of 18 are still subject to the $15,000 per limb maximum, but are covered for more than one prosthesis per limb.
Psychology and Counselling
Psychological and counselling services are intended to support positive mental health and well-being, and for the treatment of mental, nervous or emotional conditions, such as stress, anxiety or trauma.
Every calendar year (January to December), you and your dependants each have a per person combined maximum of $1,200 for psychological and counselling services, including assessment fees. Sessions, including telephone and video call sessions, will be covered up to $180 per psychology session (administered by a psychologist or other noted eligible provider) and $120 per counselling session (administered by an eligible counsellor). Assessments will be covered to a maximum of $300 per assessment.
Group/family psychology and counselling are available for the covered member and their eligible dependants, and is prorated based on the number of individuals attending the session(s).
Requirement(s):
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Services must be provided by a:
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Registered psychologist, a person holding a Master of Social Work degree, or a provisional psychologist (under the supervision of a registered psychologist), or
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Certified counsellor.
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Providers must be certified and registered (in good standing) with a recognized association in their province, territory, or state of practice. For instance, an Alberta psychologist must be registered with one of the following associations:
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Counsellors must be registered with one of the following associations:
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Association of Cooperative Counselling Therapists of Canada (ACCT)
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Professional Association of Christian Counsellors and Psychotherapists (PACCP)
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Canadian Addictions Counsellors Certification Federation: provider must be certified and registered as one of the following:
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Associate Addictions Counsellor
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Canadian Certified Addiction Counsellor
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Canadian Indigenous Addiction Counsellor
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Canadian Clinical Supervisor - Addiction Counsellor
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International Certified Alcohol and Drug Counsellor
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Receipts for claim submissions must include:
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the provider's name, address, and credentials (note: in cases of provisional psychologists, the name of the supervising psychologist must also be included),
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the amount being charged for each session,
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the amount being charged per assessment (if applicable) as a separate line item, and
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each patient's name if more than one person is attending a session.
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Important Note:
If you see ASEBP listed as a benefit provider on a third-party website (such as Psychology Today), it is your responsibility to confirm whether the provider is eligible under your ASEBP benefits. To verify coverage, click on the "My ASEBP Login" button located at the top right of the webpage. Once logged in, navigate to the Providers tab and look under Psychologist/Counsellor for eligible providers. You can also check eligibility using the My ASEBP mobile app, or contact ASEBP directly for assistance.
Exclusion(s):
- No more than one service (session or assessment) per day (per person).
- Subscription-based online psychology/counselling services.
- Employer-provided psychology or counselling sessions or seminars.
Respiratory Equipment
Based on a rolling 5-year period, you and your dependants each have a per person, combined maximum of $1,800 toward the purchase or rental of respiratory equipment (e.g. continuous positive airway pressure (CPAP) machines, sleep apnea dental appliances, nebulizers, peak flow meters, etc.).
You can easily track your expenses and view your usage summary on My ASEBP or the My ASEBP Mobile App.
Requirement(s):
- For equipment used to treat sleep apnea (e.g. CPAP machines or sleep dental appliances), a sleep study indicating the following is required:
- Anyone 18 and older must have a combined apnea-hypopnea index (AHI) of 15 or greater
- Dependants under 18 must have a combined AHI of 1 or greater
- Sleep apnea dental appliances must be purchased—not repaired or rented
Exclusion(s):
- Batteries
- Air purifiers
- Chargers or charging cords
- Sleep studies, testing and dental examination fees
- Cleaning supplies
- Replacement filters
Respiratory Equipment Accessories and Repairs
Every calendar year (January to December), you and your dependants have a maximum of $200 per person toward the purchase or rental of eligible respiratory equipment accessories (e.g. tubes, masks, etc.) and repairs. A sleep study isn't required to access this coverage.
Exclusion(s):
- Accessories for, or repairs to, ineligible respiratory equipment
- Batteries
- Chargers or charging cords
- Cleaning supplies
Sclerotherapy
For sclerotherapy details, please see Drugs. It’s important to note that ultrasound-guided sclerotherapy treatment is not covered.
Ultraviolet Light
You and your dependants each have a lifetime maximum of $300 towards the purchase of one ultraviolet light.
Requirement(s):
- Must be required to treat psoriasis, and a physician's letter/prescription stating the diagnosis must be included with the claim submission. As of March 1, 2024, a Physician Written Order completed by a Nurse Practitioner will be accepted.
Exclusion(s):
- Batteries
- Repairs
- Replacement bulbs
Wheelchairs or Motorized Scooters
Based on a rolling 4-year period, you and your dependants each have a combined maximum of $4,000 toward the purchase, repair, replacement and/or rental of wheelchairs or motorized scooters.
Requirement(s):
- Must be pre-approved by ASEBP prior to purchase (please contact us for pre-approval requirements)
- Repairs and components do not require ASEBP pre-approval
Exclusion(s):
- Knee scooters/walkers
Resources
What's not covered?
Only expenses specifically listed as covered may be reimbursed and are subject to any limitations, maximums or exclusions as indicated. Here are a number of items not covered under the plan. Note that this list is not exhaustive.
- Magnetic Resonance Imaging (MRI)
- Check-ups (including screening, routine physical examinations and research studies) not necessary for treatment
- X-rays (unless related to chiropractic or podiatry treatments)
- Speech therapy
- Beds (including adjustable beds) that do not qualify as “hospital beds”
- Surgical implants (e.g. breast, testicular, cochlear)
- Medical services and supplies (including hospital confinement) provided in association with cosmetic surgery or procedures
- Expenses that are not considered medically necessary for the care of the patient’s injury or illness
- Treatment that is experimental, educational or for the purpose of research
- Extra billing charges by your doctor or other licensed health care provider (e.g. missed appointment fees, fees to complete medical forms, late fees, etc.)
- Additional costs for medical supplies purchased from providers inside and outside Canada (e.g. shipping, duty)—unless related to oxygen and supplies required for its use
- Accessories and repairs (e.g. charging cords, batteries, replacement filters, etc.)
- Treatment and/or supplies provided free of charge
- Services or supplies that should be free-of-charge under legislation (e.g. charges made by doctors which are in excess of fees allowed by Health Canada)
- Expenses covered through a government program, whether or not you or your dependants choose to participate in the program
- Expenses acquired because of active participation in a war or act of war (declared or not)
- Expenses incurred while on active duty in any military or peacekeeping force
- Services that are self-performed or supplies that are self-prescribed by a covered member or dependant that is a health care provider (e.g. a doctor writes him/herself a prescription)
- Dental services other than those described under the Accidental Dental benefit
- All expenses incurred as a result of conduct that would constitute an indictable offence within Canada
Additional Information
Best Practices for Ambulance Claims
In order to direct-bill ASEBP for ambulance services you must provide AHS with your ASEBP ID number during pick-up and transport. If you’ve provided AHS with your ID number and receive an invoice from AHS, please contact them to bill ASEBP directly instead.
If you do not provide your ID number during pick-up and transport and pay AHS for the service directly, you must request a refund from AHS and have them bill ASEBP directly using your ID number in order to be reimbursed. If you do not request a refund and you submit the claim to ASEBP for reimbursement, ASEBP will only reimburse at the rates negotiated between ASEBP and AHS.
Prorated
Benefit coverage that is prorated refers to a maximum being divided proportionally.
Examples:
Coverage for group/family counselling is prorated based on both the length of the session and the number of patients attending. Please note that covered members and their dependants are not charged for other individuals in attendance. Examples of prorated group sessions are included below:
- Scenario 1: An ASEBP covered member solely attends one psychology session. The cost of the session is $220 and the maximum allowable amount for psychology is $180 per person per session. Therefore, the covered member is eligible up to $180 for the session.
- Scenario 2: An ASEBP covered member, together with a second person who is not a dependant or covered member, attend one group psychology session. The cost of the session is $220 and the maximum allowable amount for psychology is $180 per person per session. Therefore, the covered member is eligible up to $110 for session.
- Scenario 3: A covered member and their dependants attend one psychology counselling group session together. The cost of the session is $260 and the maximum allowable amount for counselling is $120 per person per session. Therefore, each member is subject eligible up to $120 for the session to a maximum reimbursement of up to $90 (50 per cent of $180) for the session. This amount is determined by dividing the total cost of the session amongst the number of patients attending (two). As the prorated amount exceeds the per person maximum of $120, the covered member and dependant are both eligible up to the per person maximum of $120 for the counselling treatment.
Rolling Period
Your plan maximum is based on a rolling-year period (e.g. two years for a rolling two-year period, three years for a rolling three-year period, etc.) by service date (the date you received the treatment, service or product being claimed—not the date it was paid for)—not calendar year.
Example:
- If you make a respiratory claim (which has a rolling five-year period) for $100 on May 15, 2015, that $100 will be added back to your respiratory coverage balance on May 15, 2020.
You can easily track your expenses and view your usage summary on My ASEBP or the My ASEBP Mobile App.