UNINSURED FEE SCHEDULE
| Fee Schedule for Stem Health Uninsured Services | ||
|---|---|---|
| Payment of the Block Fee (annual membership fee) exempts the Member from the fees outlined below for the term of the Agreement. | ||
| Category | Item | Pay per Service Fee |
| Medical Records | Health Story | Complimentary |
| Copying or digital reproduction of physical medical records | $30 (first 20 pages) | |
| Copying or digital reproduction of physical medical records | $0.25 per page thereafter | |
| Uninsured Physician Services | Physician Appointment - Uninsured Services | $300/hour |
| Physician Professional Review of Records | $180/hour | |
| Email/Written Medical Advice | $300/hour | |
| Physician Mobile Visit | $1,221.52/year | |
| Medical second opinion coordination (Canada) | TBD - vendor dependent | |
| Medical second opinion coordination (US) | TBD - vendor dependent | |
| Nurse Practitioner Services | Nurse Practitioner Appointment | $200/hour |
| Email/Written Medical Advice | $200/hour | |
| Nurse Services | Email/Telephone Nursing Advice - Regular business hours | $100/hour |
| Email/Telephone Nursing Advice - Weekday Evenings | $150/hour | |
| Email/Telephone Nursing Advice - Overnight and Weekends | $175/hour | |
| Care Coordination | Email/Telephone Care Coordination - Regular business hours | $50/hour |
| Email/Telephone Care Coordination - Weekday Evenings | $65/hour | |
| Email/Telephone Care Coordination - Overnight and Weekends | $95/hour | |
| Forms | Driver's Medical Examination | General assessment plus urine plus form: $339 Form only: $75 |
| Civil Aviation Medical Examination Report 26-0010E (001004) | $300/hour | |
| Pilot’s License Validation 26-0055 (01-91) | $300/hour | |
| MTO – Follow-up Forms for Specific Conditions | $300/hour | |
| CPP Disability Application – Medical Report for Canada Pension Plan Disability Benefit – ISP-2519 | $300/hour | |
| CPP Disability – Reassessment Medical Report, and CPP Disability – Recurrence of the Same Medical Problem | $300/hour | |
| Disability Tax Credit Certificate – T2201 | $300/hour | |
| Medical Certificate for Employment Insurance Compassionate Care Benefits – INS-5216 | $72.00 | |
| Medical Certificate for Employment Insurance Sickness Benefits – INS-5140 | $50.00 | |
| Attending Physician Statement (eg Life/Disability Insurance Application) | $300/hour | |
| Insurance Medical Examinations | $300/hour | |
| Life Insurance Death Certificate | $300/hour | |
| CAS – Medical Report (Adoption/Foster/Kinship/Customary Care Applicants in Ontario) | $246 (form only); plus any necessary assessment fee. | |
| Completion of documentation/forms for physicals for schools, camps, pre-school, daycare, university/educational institutions | $36.25 | |
| Completion of documentation/forms for physicals for pre-employment certification of fitness/fitness clubs or hospital/nursing home employee | $47.75 | |
| OCF 3 – Disability Certificate | $256.00 | |
| OCF 18 – Treatment and Assessment Plan | $272.00 | |
| OCF 19 – Application for Determination of Catastrophic Impairment | $151.00 | |
| OCF 23 – Treatment Confirmation Form | $256.00 | |
| Short Term Disability/Fitness to Work/Functional Abilities Forms (Non-WSIB) | $300/hour | |
| Travel Insurance Cancellation | $300/hour | |
| Proof of Immunization Forms | $300/hour | |
| Sick Note | $25.25 | |
| Uninsured Tests | TB Skin Testing | $80.00 |
| Prescription Services | Prescriptions (Refills, Orthotics, Massage, etc) | $25.25 |
| Appointments | Missed appointment / late cancellation within 24 hours | 150 |
| Late arrival for appointments | $75.00 | |
| Genetics & Genomics | Pharmacogenomic testing that evaluates how your DNA affects your response to medication | $1,075 |
| Proactive genetic screening for cancer and other heriditary risks | $1,075 | |
| Proactive genetic screening for cardiovascular diseases | $1,075 | |
| Proactive genetic screening for metabolic diseases | $1,075 | |
| Consultation with a genetics counsellor on preventative health and its impact on disease | - | |
| Preferred Pricing | Preferred annual health assessment pricing | PPS clients pay full retail prices for other uninsured services |
| Preferred pricing on wellness services & genetics screening, IV etc.. | PPS clients pay full retail prices for other uninsured services | |
| Physical therapy - sessions included with membership tier | PPS clients pay full retail prices for other uninsured services | |
