Health

a prescription from a physician or nurse practitioner that includes the patient's condition
the type of service provided
the name of the provider of service
the provider's professional title
area of treatment

Please note:

A new prescription is required every 36 months.
A prescription isn't needed if patient is undergoing gender affirmation procedures.

Claims must include the following:

the type of service provided
the name of the provider of service
the provider's professional designation

Claims must include the following:

the type of service provided
the name of the provider of service
the provider's professional designation

Claims must include the following:

the type of service provided
the name of the provider of service
the provider's professional designation

Claims must include the following:

the type of service provided
the name of the provider of service
the provider's professional designation

Claims must include the following:

the type of service provided
the name of the provider of service
the provider's professional designation

Claims must include the following:

the type of service provided
the name of the provider of service
the provider's professional designation

Claims must include the following:

the type of service provided
the name of the provider of service
the provider's professional designation

Claims must include the following:

the type of service provided
the name of the provider of service
the provider's professional designation

Claims must include the following:

the type of service provided
the name of the provider of service
the provider's professional designation

Claims must include a receipt that shows the following:

the type of service provided
the provider details (name, address, phone number)
the provider's professional designation

In-home nursing claim requirements

For in-home nursing (except for drawing of blood, midwifery or foot care): Request for Nursing Care Health Assessment form completed in full. We recommend that you submit the form to Canada Life for an estimate/predetermination so that you know what will be covered before you incur any expenses.
For in-home nursing that is for blood work, foot care and midwifery, claims must include a prescription from a physician or nurse practitioner ordering the work/care. A new prescription is required every 12 months.

Receipt requirements

All nursing claim receipts must include:

name and designation of nurse
nurse's registration number if not from an agency/association
dates of service
number of hours
cost per hour
total cost
nurse's signature

Service type	Claim requirements
Breathing equipment and supplies	Claims and predeterminations must include: Request for Coverage for Positive Airway Pressure Machine Assessment form, completed and signed by the patient's attending physician, sleep specialist, respirologist or nurse practitioner copy of the Sleep Study invoice or quote for BPAP, VPAP or AVS machines: additional supporting documentation (i.e., doctor's notes, or sleep study review notes) confirmation/denial of provincial/territorial plan coverage where coverage is offered provincially/territorially Exception: we do not require a completed form for patients where the provincial/territorial plan has paid a portion of the machine.
Miscellaneous breathing supplies	Claims must include a prescription from a physician or nurse practitioner.
Compressor	Claims must include a prescription from a physician or nurse practitioner.
Nebulizer	Claims must include a prescription from a physician or nurse practitioner.
Oximeter	Claims must include a prescription from a physician or nurse practitioner that includes the patient's condition.
Apnea monitor	Claims must include a prescription from a physician or nurse practitioner.
Spirometer	Claims must include a prescription from a physician or nurse practitioner that includes the patient's condition.
Saturometer	Claims must include a prescription from a physician or nurse practitioner that includes the patient's condition.
Oxygen	Claims must include a prescription from a physician or nurse practitioner that includes the patient's condition.
Oxygen equipment and supplies	Claims must include a prescription from a physician or nurse practitioner that includes the patient's condition.

Service type	Claim requirements
Brace	Claims must include the following: prescription from a physician or nurse practitioner that includes the patient's condition an indication of the type of brace, material it is constructed with and the specific limb or body part
Orthotics	Claims must include the following: a prescription from a physician, podiatrist, chiropodist or nurse practitioner that includes the patient's condition a detailed description of the type of orthotics provided the date of full payment for the orthotics the date the orthotics were dispensed, and who they were dispensed by (must be dispensed by podiatrist, chiropodist, pedorthist, orthotist, chiropractor, certified orthotist (CO), or Technologue professionel (TP) in Quebec) details of the casting technique used for the patient a copy of a detailed biomechanical examination A new prescription is required every 36 months.
Off-the-shelf orthotics	Claims must include a prescription from a physician, podiatrist, chiropodist or nurse practitioner that includes the patient's condition. A new prescription is required every 36 months.
Orthopedic shoes, including modifications and repairs	Claims must include the following: a prescription from a physician, podiatrist, chiropodist or nurse practitioner that includes the patient's condition. the technique/process that was used for casting confirmation that the cast used to fabricate the footwear is unique to the patient confirmation that the footwear was fabricated from raw materials or documentation that shows the shoes are an integral part of a brace A new prescription is required every 12 months.
Modifications to orthopedic shoes	Off-the-shelf (non-custom-made) shoes are not covered, but modifications to these shoes are eligible. Claims or estimates for modifications to shoes must include a prescription from a physician, podiatrist or chiropodist or nurse practitioner that includes the patient's condition. A new prescription is required every 12 months.
Shoe or boot splint	Claims must include a prescription from a physician or nurse practitioner. A new prescription is required every 12 months.
Repairs or adjustments to orthopedic shoes	Claims must include a prescription from a physician or nurse practitioner. A new prescription is required every 12 months.
Cast	Claims must include a prescription from a physician or nurse practitioner.
Splint	Claims must include a prescription from a physician or nurse practitioner.
Abdominal support or truss	Claims must include a prescription from a physician or nurse practitioner that includes the patient's condition.
Cryo Cuff	Claims must include a prescription from a physician or nurse practitioner that includes the patient's condition.

Service type	Claim requirements
Artificial limbs/eyes, repairs and supplies	Claims must include: Request for Artificial limbs Assessment form completed in full confirmation or denial of provincial/territorial plan coverage where coverage is offered provincially
Cleft palate obturator and supplies	Claims must include a prescription from a physician or nurse practitioner.
Breast prosthesis	Claims must include the following: a prescription from a physician or nurse practitioner that includes the patient's condition confirmation or denial of provincial plan coverage where coverage is offered provincially
Surgical and orthopaedic bras	Claims must include the following: a prescription from a physician or nurse practitioner that includes the patient's condition confirmation or denial of provincial/territorial plan coverage where coverage is offered provincially
Penile prosthesis	Claims must include a prescription from a physician or nurse practitioner.

Service type	Claim requirements
Canes	Claims must include a prescription from a physician or nurse practitioner.
Walkers	Claims must include a prescription from a physician or nurse practitioner.
Crutches	Claims must include a prescription from a physician or nurse practitioner.
Patient lifters	Claims must include a Request for Durable Equipment Health Assessment form completed in full.
Wheelchairs, rentals, repairs and supplies	Claims for purchase or rental must include the following: Request for Durable Equipment Assessment form completed in full confirmation or denial of provincial/territorial plan coverage where coverage is offered provincially/territorially Claims for repairs or a cushion must include a prescription from a physician or nurse practitioner.
Electric wheelchair	Claims for purchase or rental must include the following: Request for Durable Equipment Assessment form completed in full confirmation or denial of provincial/territorial plan coverage where coverage is offered provincially/territorially Claims for repairs or a cushion must include a prescription from a physician or nurse practitioner.
Scooter	Claims must include the following: Request for Durable Equipment Assessment form completed in full confirmation or denial of provincial/territorial plan coverage where coverage is offered provincially/territorial
Geriatric chair	Claims must include a Request for Durable Equipment Assessment form completed in full.
Other chair	Claims must include a prescription from a physician or nurse practitioner.

Service type	Claim requirements
Hearing aids including batteries	Claims must include the following: a prescription from a physician, audiologist or nurse practitioner (not required for replacement hearing aids or for hearing aids associated with cochlear implants) confirmation or denial of provincial/territorial plan coverage where coverage is offered provincially/territorially
Hearing aid (right) after surgery or accident	Claims must include the following: a prescription from a physician, audiologist or nurse practitioner (not required for replacement hearing aids or for hearing aids associated with cochlear implants) confirmation or denial of provincial plan coverage where coverage is offered provincially/territorially the date of the surgery or accident with supporting documentation
Hearing aid batteries	Claims must include a prescription from a physician, audiologist or nurse practitioner.

Service type

Claim requirements

Hearing aids including batteries

Claims must include the following:

a prescription from a physician, audiologist or nurse practitioner (not required for replacement hearing aids or for hearing aids associated with cochlear implants)
confirmation or denial of provincial/territorial plan coverage where coverage is offered provincially/territorially

Hearing aid (right) after surgery or accident

Claims must include the following:

a prescription from a physician, audiologist or nurse practitioner (not required for replacement hearing aids or for hearing aids associated with cochlear implants)
confirmation or denial of provincial plan coverage where coverage is offered provincially/territorially
the date of the surgery or accident with supporting documentation

Hearing aid batteries

Claims must include a prescription from a physician, audiologist or nurse practitioner.

Service type	Claim requirements
Diabetic infusion pump	Claims must include a prescription from a physician or nurse practitioner.
Diabetic infusion pump and supplies	Claims must include a pharmacy's official prescription receipt OR Any other kind of receipt (e.g., handwritten receipt from pharmacy, receipt from medical supply store) that includes: the patient's name a copy of the prescription the supply name and quantity the date of service
Blood glucose monitor	Claims must include a prescription from a physician or nurse practitioner.
Flash glucose monitor	Claims must include a prescription from a physician or nurse practitioner.
Continuous glucose monitor	Claims must include a prescription from a physician or nurse practitioner that includes the patient's condition. Please note coverage is only available for the treatment of type 1 diabetes.
Glucose monitor and supplies	Claims must include a prescription from a physician, nurse practitioner or other qualified health professional permitted in your province or territory that includes the patient's condition.
Insulin jet injector	Claims must include a prescription from a physician or nurse practitioner that includes the patient's condition.

Service type	Claim requirements
Bandages and surgical dressings	Initial claims must include a prescription from a physician, nurse practitioner or other qualified health professional permitted in your province or territory that includes the patient's condition. Please note coverage is only available for the treatment of an open wound or ulcer. A new prescription may be required if additional bandages or surgical dressings are needed beyond the initial approval period.
Catheters and supplies	Initial claims must include a prescription from a physician, nurse practitioner or other qualified health professional permitted in your province or territory that includes the patient's condition. Please note that coverage is only available for incontinent patients or for paraplegic or quadriplegic patients.
Needles and syringes	Claims received for needles and syringes must include the following: The name or DIN of the drug being administered A prescription from a physician, nurse practitioner or other qualified health professional permitted in your province/territory A new prescription is required every 3 years.
Viscosupplementation/synovial fluid/synvsic	Claims must include a prescription from a physician, nurse practitioner or other qualified health professional permitted in your province or territory.
Hospital beds	Claims must include a Request for Durable Equipment Assessment form completed in full.
Therapeutic mattress	Claims must include a Request for Durable Equipment Assessment form completed in full.
TENS machine	Claims must include the following: a prescription from a physician or nurse practitioner that includes the patient's condition and how long the patient has suffered from chronic pain confirmation that the machine was used in a facility to test its effectiveness for the patient
Pressure supports for lymphedema	Claims must include the following: a prescription from a physician or nurse practitioner that includes the patient's condition a description of the pressure supports as custom-made or including a compression factor
Extremity pumps	Claims must include a prescription from a physician or nurse practitioner that includes the patient's condition.
Compression hose (20-30 mmHg)	Claims must include the following: a prescription from a physician or nurse practitioner that includes the patient's condition brand name, model number and compression range of the hose
Compression hose (30-40 mmHg)	Claims must include the following: a prescription from a physician or nurse practitioner that includes the patient's condition brand name, model number and compression range of the hose
Compression hose (>40 mmHg)	Claims must include the following: a prescription from a physician or nurse practitioner that includes the patient's condition brand name, model number and compression range of the hose
Custom-made compression hose	Claims must include the following: a prescription from a physician or nurse practitioner that includes the patient's condition brand name or manufacturer's name the style name of the custom hose copy of the lab order form confirmation of the compression range
Burn garments	Claims must include a prescription from a physician or nurse practitioner.
Wigs	Claims must include a prescription from a physician or nurse practitioner that includes the patient's condition.
Enuresis monitor	Claims must include a prescription from a physician or nurse practitioner that includes the patient's condition.
Blood pressure monitor	Claims must include a prescription from a physician or nurse practitioner that includes the patient's condition.
Traction kit	Claims must include a prescription from a physician or nurse practitioner.
Coagulation monitor	Claims must include a prescription from a physician or nurse practitioner that includes the patient's condition.
Heart monitor	Claims must include a prescription from a physician or nurse practitioner that includes the patient's condition.

Requirements for ambulance claim:

services must be provided by a licensed ambulance company
pickup and drop-off locations are limited to nearest hospital equipped to provide the required treatment.

Claims must include the Gender Affirmation Procedure Application form, completed and signed by the patient's health care provider.

Claims must include the following:

the date the accident happened
a description of how the accident happened
the tooth/teeth that were injured, including a description of the damage incurred
the condition of the tooth/teeth before the accident
the treatment required to restore the tooth/teeth
the date treatment began, and the expected time frame involved in completing this treatment
pre-accident and post-accident X-rays of the tooth/teeth if available

Claims must include the following:

the procedure codes of the dental services performed
tooth number(s), if applicable
the explanation of benefits statement from your dental plan, if applicable