Claimants: Additional Information : Uninsured Medical Expenses

Uninsured Treatments and Medications

• Compensation for Uninsured Treatments and Medications
• Approval Criteria
• Receipts
• If Treatment and Medication Costs Incurred Outside of Canada
• Subsequent Claims for Compensation
• HCV Medication List
• Alternative Medications List
• Disease Level 6 Treatments and Medications List
• How to File a Claim
• Appeals

Compensation for Uninsured Treatments and Medications (top)

To the extent that costs that you may claim are NOT Costs of Care and/or costs to cover Loss of Services in the Home, an Approved HCV Infected Person may be reimbursed for his or her costs for generally accepted treatments and medications which were incurred due to the HCV infection and which were/are not recoverable under any public or private health care plan.

Approval Criteria (top)

Section 4.06 of Schedule A (Transfused Plan) and section 4.06 of Schedule B (Hemophiliac Plan) of the 1986-1990 Hepatitis C Settlement Agreement coupled with the Court Approved Protocol "Uninsured Medical Expenses and Out-of-Pockets Expenses" provide that the Administrator may pay compensation for costs incurred for uninsured treatments and medications for the HCV Infected Person if ALL of the criteria listed below are met:

Receipts (top)

If receipts cannot be provided in the course of your first application, the Administrator will nevertheless process your claim for reimbursement. The Administrator will however require the following documentation:

If Treatment and Medication Costs Incurred Outside of Canada (top)

Section 4.06 of Schedule A (Transfused Plan) and section 4.06 of Schedule B (Hemophiliac Plan) provide that the Administrator will pay compensation equal to the amount payable if the costs had been incurred in the Province or Territory where the HCV Infected Person resides.

Subsequent Claims for Compensation by the Same Claimant (top)

After completing your initial claim for uninsured treatments and medications, you are entitled to claim again. Subsequent claims will be processed only after the Approved HCV Infected Person has incurred costs amounting to $250.00 or more. The Administrator will require a valid receipt for every expense claim.

HCV Medication List (top)

A number of treatments and medications may be eligible for reimbursement but only if they were purchased on the recommendation of one of the medical specialists listed below:

The Court Approved Protocol "Uninsured Medical Expenses and Out-of-Pocket Expenses" provides that the Administrator must compile lists of generally accepted medications and treatments, which are recommended/prescribed for persons who have Hepatitis C. These lists, which are prepared by the Administrator in consultation with HCV medical specialists, shall be updated from time to time.

Please consult the HCV Medication List if you would like to know which medications, to date, have been approved by the Administrator.

Alternative Treatments and Medications (top)

Alternative treatments or medicines costs may be eligible but only if they were incurred on the recommendation of one of the medical specialists listed below:

Please consult the HCV Alternative Medicines and Treatments List if you would like to know which alternative treatments and medications have been approved, to date, by the Administrator.

Disease Level 6 Medications (top)

A number of treatments and medications associated with Disease Level 6 may be eligible for reimbursement but only if they were incurred on the recommendation of one of the medical specialists listed below:

The Court Approved Protocol "Uninsured Medical Expenses and Out-of-Pocket Expenses" provides that the Administrator must compile lists of generally accepted medications and treatments, which are recommended/prescribed for persons who have Hepatitis C. A list of treatments and medications for the seven (7) medical conditions associated with disease level 6, which is prepared by the Administrator in consultation with HCV medical specialists, shall be updated from time to time.

Please consult the HCV Medication List for Conditions Associated with Disease Level 6 if you would like to know which medications have been approved, to date, by the Administrator.

How to File a Claim (top)

If your claim meets the approval criteria outlined in this section and the treatments or medications that you have paid for are due to your HCV infection, please complete the following claim forms and return them to the Administrator.

Complete, sign and date the GEN 3 Form. Be sure to attach all original receipts and indicate your claim ID number on all receipts.

Appeals (top)

The Administrator may determine that your claim for uninsured treatments and/or medications must be rejected. If you disagree with the Administrator's determination, you must submit a letter to the Centre explaining your objections to the Administrator's decision. The Administrator will then mail a letter about this determination to you and further advise that you have the opportunity to appeal its decision by completing and returning a Request for Review Form. This will entitle you to submit your argument and evidence to an independent arbitrator or referee for final determination.