Eligible Expenses

An eligible expense is any medical or dental service, product, or treatment that qualifies for reimbursement under the terms of your insurance plan. To be eligible, the service must meet several criteria: it must be medically necessary, performed by a licensed or approved provider, and fall within the plan’s specific limits and exclusions.

Insurers define eligibility to ensure benefits are paid only for valid, health-related needs rather than elective or cosmetic procedures. Examples of eligible expenses include prescription drugs, physiotherapy, dental cleanings, and vision exams. Some services, such as cosmetic surgery or over-the-counter supplements, are usually not eligible unless specifically listed in your policy.

Example:

A dental cleaning performed by a licensed hygienist is an eligible expense, while teeth whitening for cosmetic reasons is not.

What to Watch For:

Always verify whether your provider is licensed and recognized by your insurer. Even if a service is medically necessary, it may be ineligible if performed by an unapproved practitioner or outside Canada.