O. Reg. 562/05: PRESCRIBED POLICY STATEMENTS

Column A

Column B

MEDICAL CONDITION that requires a Special Diet

Monthly Amount for Special Diet Unless Otherwise Specified

Amyotrophic Lateral Sclerosis

$10

Cardiovascular Disease

$10

Celiac Disease

less than 2 years of age

$58

2-10 years of age

$115

11-18 years of age

$147

19 years of age or older

$131

Chronic Constipation

$10

Chronic wounds requiring protein

$10

Congenital Abnormalities of the Metabolic Type — Adults

$10

Congenital Abnormalities of the Metabolic Type — Infants & Children

$10

Congestive Heart Failure

$44

Crohn’s Disease/Ulcerative Colitis

weight loss ≤2% of usual body weight

$75

weight loss > 2% and ≤5% of usual body weight

$150

weight loss > 5% and ≤10% of usual body weight

$180

weight loss > 10% of usual body weight

$240

Cystic Fibrosis

weight loss ≤2% of usual body weight

$75

weight loss > 2% of usual body weight

$150

Diabetes

$42

Diverticulum/Diverticulitis

$10

Dysphagia/Swallowing or Mastication Difficulties

$25 AND $75 one-time amount for the cost of a blender, if funding for a blender has not been previously provided

Extreme Obesity: Class III BMI > 40

$20

Food Allergy — Eggs

$10

Food Allergy — Milk/Dairy or Lactose Intolerance

less than 2 years of age

$95

2-10 years of age

$97

11-18 years of age

$55

19 years of age or older

$35

Food Allergy — Soya

$83

Food Allergy — Wheat

less than 2 years of age

$38

2-10 years of age

$77

11-18 years of age

$98

19 years of age or older

$57

Gestational Diabetes

$44

[Diet is available during pregnancy and for 3 months post partum]

Gout

$32

Hepatic Disorders

$10

HIV/AIDS

weight loss ≤2% of usual body weight

$75

weight loss > 2% and ≤5% of usual body weight

$150

weight loss > 5% and ≤10% of usual body weight

$180

weight loss > 10% of usual body weight

$240

Hyperlipidemia

$10

Hypertension

$10

Hypertension and Congestive Heart Failure and Grade 1 to 2 left ventricular function

$44

Hypercholesterolemia

$22

Inadequate lactation to sustain breast-feeding or breast-feeding is contraindicated during the first 12 months of infant’s life

lactose tolerant

$75

lactose intolerant

$83

A Special Diet Allowance will be paid during the first 12 months of an infant’s life, if formula is necessary due to inadequate quantity of breast milk or if breastfeeding is contraindicated [e.g. infant is unable to tolerate breast milk; mother’s milk is contaminated due to other conditions or medical treatments such as HIV/AIDS, chemotherapy; infant has galactosemia].

Liver Failure

$10

Macrocytic Anaemia

$10

Malabsorption

$20

Malignancy

weight loss ≤2% of usual body weight

$75

weight loss > 2% and ≤5% of usual body weight

$150

weight loss > 5% and ≤10% of usual body weight

$180

weight loss > 10% of usual body weight

$240

Marasmus or Kwashiorkor or Anorexia

weight loss ≤2% of usual body weight

$75

weight loss > 2% of usual body weight

$150

Microcytic Anaemia

$30

Osteoporosis/Osteomalacia/Osteopenia

$10

Ostomies [e.g., jejunostomy, ileostomy]

weight loss ≤2% of usual body weight

$75

weight loss > 2% and ≤5% of usual body weight

$150

weight loss > 5% and ≤10% of usual body weight

$180

weight loss > 10% of usual body weight

$240

Pancreatic Insufficiency

weight loss ≤2% of usual body weight

$75

weight loss > 2% and ≤5% of usual body weight

$150

weight loss > 5% and ≤10% of usual body weight

$180

weight loss > 10% of usual body weight

$240

Post-gastric surgery

$10

Prediabetes: Impaired Glucose Tolerance (IGT) or Impaired Fasting Glucose (IFG)

$42

Renal Failure — Dialysis

$44

Renal Failure — Pre-Dialysis

$44

Short Bowel Syndrome

weight loss ≤2% of usual body weight

$75

weight loss > 2% and ≤5% of usual body weight

$150

weight loss > 5% and ≤10% of usual body weight

$180

weight loss > 10% of usual body weight

$240