Ostomy Supply Reimbursement in Yukon

Yukon Health Care Insurance Plan (YHCIP)

UNDER CONSTRUCTION

Yukon Health Care Insurance Plan (YHCIP) has the following strategies to help with the funding of ostomy supplies:

Yukon seniors have access to Pharmacare and extended health care benefit program to help pay for medical, dental and vision needs. The Pharmacare and extended healthcare benefits program assist registered seniors with the cost of prescription drugs, dental care, eye care, medical-surgical supplies and equipment. This includes most Ostomy Supplies.
You must be 65 or between 60 and 64 and married to someone 65 or over.
Contact number: 867-667- 5403
Website: https://yukon.ca/en/health-and-wellness/care-services/apply-extended-heath-care-benefits-and-pharmacare-seniors

This program provides financial help to Yukon residents experiencing functional disabilities and/or chronic diseases considered serious. The program covers durable medical equipment, prescription drugs, and medical supplies, including Ostomy supplies.
There is a pre-defined list of eligible diseases and conditions. This can be found in the “Health Act and Health Care Insurance Plan Act”.
Contact number: 867-667-5092
Website: https://yukon.ca/en/health-and-wellness/care-services/get-help-costs-if-you-have-chronic-disease-or-disability

The program provides help with eye care and prescription drug costs to children below 18 years and from low-income families.
If a child needs ostomy supplies, they will go through Chronic Disease and Disability Benefits.
Contact number: 867-667-8494

Supplies approved for those who meet the criteria for Palliative Care as per Insured health have an increased amount of supplies that can be approved for funding.
There is a form that must be filled out by the physician called “Palliative care acknowledgement.”
Contact number: 867-667-5403

They provide eligible registered First Nations and recognized Inuit coverage for a range of medically necessary health benefits including ostomy supplies when these benefits are not otherwise covered through private or provincial/territorial health insurance plans or programs.
Contact number for Regional Office: 867-393-3800
See NIHB Section for more information. (Hyperlink to NIHB)

Benefit Coverage

The Pharmacare Program for seniors covers 100% of the cost of ostomy supplies.
Chronic Disease Program recipients must pay the first $250 of eligible costs per year, to a maximum of $500 per family. You may apply for a reduction waiver of the deductible depending on income and family size.
This program is the payer of last resort. Suppose you have health benefits coverage through your employer or a private or group insurance agency. In that case, you must submit claims to those insurers first.

How to Apply for Benefits

Your doctor must apply to the program for you. They should apply before you make a purchase. If you live in a community without a resident doctor, a community health nurse can apply for you.

Authorization

Preapproval with a health care professional (doctor, community health nurse, NSWOC) is mandatory.

What Products Are Covered?

YHCIP covers a comprehensive list of ostomy supplies:

One and two-piece ostomy appliances
Ostomy Pouches, drainable, closed, & urostomy
Skin Barrier Wafers / Flanges: flat, convex
Ostomy accessories include skin barrier rings/sheets/seals, skin barrier paste/strips, convex inserts, filters, barrier powder, absorbent flakes/capsules, lubricant gel
Odour control
Ostomy irrigation kits, sleeves
Ostomy belt
Pouch cover

Purchasing Ostomy Supplies

Ostomy supplies can be purchased from some pharmacies. Still, it is essential to note that while some sell ostomy supplies, they may not carry stock. It would be best to place your order well in advance.

NOTE ON COMMUNITY HEALTH CENTRES

Community health centres have a small and limited supply.
Pharmacies will send supplies to communities, but there is a delay.
Arrangements need to be made before you are discharged from the hospital to avoid arriving back in your community without ostomy supplies. This includes your funding application, ordering supplies required through the pharmacy, and picking up supplies before heading back into the community.

Reimbursement Procedure

Although you should not purchase your ostomy supplies until you know if you get funding, your doctor or community health nurse can apply for you to be reimbursed. For this, we will need:

documentation for the recommendation from your health practitioner; and
documentation for the purchase

Your doctor or community health nurse must make a claim within one year of the purchase.

If you buy anything outside Yukon, you must:

already have approval from the program; or
pay for it yourself and then apply for reimbursement; and
submit your reimbursement claim within one year of the purchase.

A Yukon NSWOC is working on putting ostomy supplies info on Yukon.ca website. It should be up in a few weeks. Laura.Pit@yukon.ca

Contact Information:

GOVERNMENT OF YUKON
Yukon Insured Health

Box 2703
Whitehorse Yukon Y1A 2C6

Phone: 867-667-5403
Email: Yukon.Healthcare@yukon.ca

Disclaimer: The information contained in this page have been researched and sourced from a variety of provincial and federal sites. However information may change and we encourage individuals to check for updates of policies, plans and forms.

give your support

give your support