Hospitals
Your asrTrust plan does not cover upgrades to semi-private or private rooms in a standard hospital. However, it does provide some coverage in a rehabilitation hospital setting or chronic care / alternative level of care hospital setting.
Rehabilitation hospital setting: For patients who require additional care after first being treated in a traditional hospital.
Chronic care / alternative level of care hospital setting: For patients who have long-term illnesses or disabilities and need specialized services or technology that are not available at home or in a long-term care (LTC) facility.
It’s a good idea to keep your GreenShield benefit card in your wallet or available on your phone. This can help if you are admitted to a hospital, so the admissions team is clear on what you are covered for and what you are not.
What is covered?
Semi-private room in rehabilitation hospital accommodations
- Up to $200 per day
Semi-private room for chronic care hospital accommodations
- Up to $30 per day
Semi-private room for alternate level of care hospital accommodations
- Up to $30 per day
Co-payment coverage for a standard (ward) room only in a chronic care hospital or alternate level of care hospital setting
- Up to $60 per day towards the co-payment
Example: Semi-private room in rehabilitation hospital setting
Allan broke his hip and had surgery in a traditional hospital. After his surgery, he was admitted to a rehabilitation hospital for his post-surgery treatment.
Allan asked to be upgraded to a semi-private room at the rehabilitation hospital, which cost $250 per day.
Since Allan will be $50 out of pocket, he has two choices:
- Pay the remaining $50 out of pocket; OR
- Use his Health Care Spending Account (HCSA) to help cover his cost—in full or in part.
If a hospital voluntarily moves you to a semi-private room and you did NOT request it, they cannot charge you the additional fees.
Example: Standard ward chronic care
Allan had a serious case of pneumonia and needed to be on a mechanical ventilator for an extended period. Since the LTC facility he lives in didn’t have a ventilator, he was admitted to a chronic care ward room in the hospital.
Patients receiving chronic care can be required to make a co-payment, which is a fee determined by your provincial Ministry of Health for accommodation and meals.
For a chronic care co-payment to apply, a doctor must determine that the patient requires complex continuing care and would essentially become a permanent resident in a hospital or other institution.
In Allan’s situation, when he had pneumonia and needed to go on a ventilator, his physician could not determine a discharge date and instead determined that Allan would become a permanent resident of the hospital. As a result, Allan was charged a co-payment for his chronic care standard hospital accommodations. However, he received up to $60 per day from his asrTrust health plan to help cover the cost of the co-payment.
Example: Semi-private chronic care
When Allan had pneumonia and needed to go on a ventilator, he requested to be upgraded to a semi-private room, which cost $100 per day.
Since Allan will be $70 out of pocket, he has two choices:
- Pay the remaining $70 out of pocket; OR
- Use his Health Care Spending Account (HCSA) to help cover his cost—in full or in part.
