48. (1) The Supplementary Health and Hospital Insurance Plan shall provide the benefits set out under this section. O. Reg. 11/19, s. 31. (2) The Supplementary Health and Hospital Insurance Plan shall provide the following benefits by reimbursing an eligible recipient for the following in respect of goods and services provided to him or her: 1.  The cost of prescribed drugs and medicines that require the written prescription of a legally qualified medical practitioner, to the following extent: i.  Before the eligible recipient reaches Ontario drug benefit eligibility age, 90 per cent of the cost, to a maximum for each calendar year of $10,000. ii.  Once the eligible recipient reaches Ontario drug benefit eligibility age, 75 per cent of the cost, to a maximum for each calendar year of $10,000. 2.  The cost of a generic equivalent of a drug or medicine described in paragraph 1, to the extent specified in subparagraphs 1 i and ii. 3.  The cost of medically necessary vaccines or immunizations for which reimbursement is not provided under a provincial health plan, to the extent specified in subparagraphs 1 i and ii. 4.  Subject to paragraph 5, 100 per cent of the cost of semi-private or private hospital accommodation of eligible recipients to a maximum of $120 each day over and above the cost of standard ward care. 5.  Charges for semi-private or private accommodation in a licensed chronic care or convalescent hospital of eligible recipients who are at least 65 years of age, up to $25 each day for a maximum of 120 days each calendar year. 6.  75 per cent of charges imposed by a licensed hospital for out-patient treatment not paid for under a provincial health plan. 7.  75 per cent of charges for private-duty nursing in the home by a registered nurse or a registered nursing assistant who is not normally resident in the eligible recipient’s home and who is not related to the eligible person or any of his or her eligible dependants, if the nursing service is approved by a licensed physician or surgeon and is certified by the physician or surgeon to be necessary to the health care of the eligible recipient, to an annual maximum of $20,000. 8.  Charges in excess of amounts, if any, reimbursed by a provincial health plan for the services of a chiropractor, osteopath, naturopath, podiatrist, physiotherapist, massage therapist or speech therapist, if licensed and practising within the scope of their licence, or of a psychologist, including a person holding a Master of Social Work degree, to an annual maximum of $500 in respect of all such services combined. 9.  75 per cent of the cost of artificial limbs and eyes, crutches, splints, casts, trusses and braces. 10.  80 per cent of either the cost of one pair of custom-made or specially modified orthopaedic shoes, or the cost of repairs to an existing pair, per calendar year up to a maximum of $500, if the shoes are medically necessary and are prescribed by a licensed physician. 11.  80 per cent of the cost of either one pair of any custom-made orthotics that are prescribed by a licensed physician, podiatrist or chiropractor or of the cost of repairs to an existing pair per calendar year, up to a maximum of $500. 12.  75 per cent of rental charges for wheelchairs, hospital beds and iron lungs required for temporary therapeutic use. 13.  75 per cent of the cost of a wheelchair recommended by the attending physician, if the rental charge would exceed the purchase cost. 14.  50 per cent of the cost of repairs, including batteries and modifications, to a purchased wheelchair, to a maximum of $500 for any one repair, battery or modification. 15.  75 per cent of the cost of ambulance services to and from a local hospital that is qualified to provide treatment, excluding benefits allowed under a provincial health plan. 16.  75 per cent of charges for oxygen and its administration. 17.  75 per cent of charges for blood transfusions outside a hospital. 18.  75 per cent of the cost of dental services and supplies provided by a dental surgeon within a period of 24 months following an accident for the treatment of accidental injury to natural teeth, including replacing teeth injured in the accident and setting a jaw that is fractured or dislocated in the accident, but excluding any benefits payable under a provincial health plan. 19.  The cost of hearing aids and eye glasses required as a result of accidental injury. 20.  The amount by which the lesser of the amount charged for services provided in Canada but outside Ontario by physicians, surgeons and specialists licensed to practise medicine in their particular jurisdictions and the amount provided for the same services in the current Ontario Medical Association Fee Schedule exceeds the amount in the O.H.I.P fee schedule for the same services. 21.  In addition to the benefits provided under paragraph 8, charges for surgery performed by a podiatrist in his or her office, to a maximum of $100. 22.  Charges for diabetic pumps and supplies in accordance with the following: i.  For the purchase of insulin infusion pumps, to a maximum of $2,000 for every five-year period, per person. ii.  For the purchase of insulin jet injectors, to a lifetime maximum of $1,000 per person. iii.  For the purchase or repair of a single blood glucose monitoring machine, to a maximum of $400 for every four-year period, per person. iv.  For the purchase of supplies, other than insulin, required for the use of an item referred to in subparagraph i, ii or iii, to an annual maximum of $2,000 per person. O. Reg. 11/19, s. 31. (3) Despite paragraph 1 of subsection (2), if an equivalent generic product exists and a brand name product is dispensed, the benefit payable under the Plan shall be limited to applicable cost of the equivalent generic product, subject to the maximum referred to in that paragraph. O. Reg. 11/19, s. 31. (4) Benefits payable under the Supplementary Health and Hospital Insurance Plan for vision care and hearing aids shall, (a)  be reduced by a $10 deductible amount for single coverage and a $20 deductible amount for family coverage, for each calendar year; (b)  reimburse the eligible recipient for the cost of vision care up to a maximum for every 36 months of $340 and, until the eligible recipient reaches the Ontario drug benefit eligibility age, for the cost of one eye examination; and (c)  reimburse the eligible recipient for the cost of hearing aids up to a maximum of $900 every 48 months. O. Reg. 11/19, s. 31. (5) No reimbursement respecting a benefit referred to in clause (4) (b) or (c) is payable if reimbursement in respect of the benefit is otherwise payable under subsection (2). O. Reg. 11/19, s. 31. (6) It is not necessary for an eligible recipient to be confined to a hospital to be eligible for benefits under the Supplementary Health and Hospital Insurance Plan. O. Reg. 11/19, s. 31. (7) The Supplementary Health and Hospital Insurance Plan shall provide a drug card permitting the holder of the card to obtain point of sale reimbursement of the costs of drugs and medicines under paragraphs 1 and 2 of subsection (2) to, (a)  every eligible person; and (b)  if the eligible person enrols him or herself and all of his or her eligible dependants in the Plan, those of his or her eligible dependants who are selected under the Plan for the purpose. O. Reg. 11/19, s. 31. (8) The Crown shall make available to eligible recipients, (a)  an information booklet relating to the Supplementary Health and Hospital Insurance Plan; and (b)  periodic updates when necessary, within a reasonable period of time after changes are made. O. Reg. 11/19, s. 31. (9) The Supplementary Health and Hospital Insurance Plan must include a Catastrophic Drug Coverage Plan that provides reimbursement of 100 per cent of the costs of drugs, medicines, vaccines and immunizations referred to in paragraphs 1 to 3 of subsection (2) that exceed $10,000 in a calendar year in respect of each eligible recipient. O. Reg. 11/19, s. 31. (10) The Supplementary Health and Hospital Insurance Plan must include an optional upgrade package consisting of Emergency Out-of-Country Medical Coverage and Global Medical Assistance in accordance with the conditions and restrictions set out in the applicable agreement made with the insurance underwriters. O. Reg. 11/19, s. 31. (11) Despite subsection 44 (3), the premiums for the optional upgrade shall be paid for by the eligible person by deduction from the pension payments. O. Reg. 11/19, s. 31. (12) The termination by an eligible person of his or her enrolment in the optional upgrade package is irrevocable. O. Reg. 11/19, s. 31. (13) In this section, “Ontario drug benefit eligibility age” means the age set out in paragraph 4 of subsection 2 (1) of Ontario Regulation 201/96 (General) made under the Ontario Drug Benefit Act. O. Reg. 11/19, s. 31.