Catastrophic drug coverage is an option available on Manulife Coverme’s Flexcare health, drug and dental plans. We strongly recommend that you select this option. This coverage is also known as ’stop loss coverage’.

Most health and dental plans have a cap or a maximum on the drug coverage. For example, Manulife’s DrugPlus basic plan has a maximum reimbursement of $5000. The basic plan provides no coverage for annual drug costs exceeding that amount. Almost all drug plans from all companies have some sort of cap in place. What happens if you have drug costs that exceed that amount?

Catastrophic drug coverage (also called stop-loss insurance) fills that gap. The catastrophic drug option provides no coverage for annual drug costs less than $4500 – though your base drug plan will provide coverage to some extent for that amount. However, it covers 100% of drug costs that exceed $4500 per year. You can think of it as a drug plan with a really high deducatible – no coverage for the first $4500 and then 100% coverage above that.

Specifically, for basic ‘Health and Dental’ plans and Drug only plans, the Catastrophic option covers:

• 100% generic and brand name prescription drugs when annual claims exceed $4500 per person per anniversary year.
• In the event of an accident that requires a hospital stay of at least 24 hours, the Catastrophic option provides unlimited chiropractor and physiotherapist
  coverage for 1 year following the accident. (paid at reasonable and customary levels, and coordinated with any other health plan coverage you have).

Enhanced ‘Health and Dental’ plans and Drug only plans provide maximum benefit payable per year of $10,000 so the catastrophic coverage starts at $10,200 instead of $4500. (i.e. the underlying coverage pays benefits of $10,000, the catastrophic option provides coverage after $10,200 and above).