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Pay-Direct card / Drug card

A pay-direct card, also known as a drug card, is a plastic or digital card issued by your health insurance provider that allows pharmacies to bill your insurer directly for eligible prescription drugs. Instead of paying the full cost upfront and submitting a claim later, you pay only your portion - such as a deductible or coinsurance - at the point of sale.

This system simplifies the claims process, reduces out-of-pocket expenses, and provides immediate access to your drug benefits. When the card is presented at a participating pharmacy, the pharmacist inputs your policy details electronically, and the insurer pays its share of the eligible cost directly to the pharmacy. The remaining balance, if any, is paid by you.

Most health and dental plans in Canada now include pay-direct functionality for prescription drugs, and some also extend it to vision care or paramedical services where electronic claims systems are available.

Example:

If your plan covers 80 percent of eligible drug costs and a prescription costs $100, the pharmacy uses your pay-direct card to bill your insurer for $80, and you pay $20 at the counter.

What to Watch For:

Ensure the pharmacy is part of your insurer’s electronic claims network. Keep your card current, as coverage details or policy numbers may change after renewal. Always verify that the prescribed medication is eligible under your plan’s drug formulary before purchasing.

Related Terms

Paramedical Disciplines

Paramedical disciplines refer to regulated health professionals who provide therapy or rehabilitation services outside of hospital settings. Common examples include physiotherapists, chiropractors, massage therapists, acupuncturists, naturopaths, osteopaths, psychologists, and speech-language pathologists.

Per Incident

Per incident refers to the way certain insurance benefits are calculated or limited based on each separate event, illness, or accident rather than by year or lifetime. When a benefit is paid “per incident,” it means you are eligible for reimbursement each time a new, distinct occurrence happens, up to the maximum amount specified for that type of claim.

Per Person / Per Family

Per person and per family describe how benefit limits, deductibles, or maximums are applied within a health or dental insurance plan. A per person limit means the specified amount applies individually to each insured member, while a per family limit represents the total combined coverage for all members under one policy.

Per-Practitioner Annual Maximum (Paramedical)

The per-practitioner annual maximum is the total amount your plan will reimburse for services from one specific type of provider in a single benefit year. For example, if your plan pays up to $500 for massage therapy annually, once that amount is reached, additional treatments from that provider type are no longer covered until the next year.

Per-Visit Cap (Paramedical)

The per-visit cap is the maximum amount your insurance plan will reimburse for a single visit to a paramedical provider, such as a physiotherapist, chiropractor, or massage therapist. If the provider charges more than the cap, you are responsible for the difference. This cap ensures fairness and cost control by aligning payments with typical local pricing.

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