CPAP insurance
CPAP Insurance Coverage in Canada: What Each Insurer Needs
Quick answer
Most Canadian group health plans cover a CPAP machine and supplies, but each insurer asks for different paperwork. Expect to need a prescription from a physician or nurse practitioner, a sleep study, and often pre-approval with an itemized quote. Several insurers only pay when the AHI is 15 or more, some want a 30-day compliance report, and in Ontario, Manitoba and Saskatchewan you may have to apply for provincial funding first. Your own plan booklet has the final word.
Documents most insurers ask for
- Prescription from a physician or nurse practitioner, with the diagnosis.
- Sleep study report showing your AHI. Sun Life and Pacific Blue Cross publish an AHI threshold of 15.
- Itemized quote for pre-approval (predetermination) before you buy.
- 30-day compliance report from the machine, required by Medavie Blue Cross and Veterans Affairs Canada, and accepted by Pacific Blue Cross for replacements.
- Provincial funding decision in Ontario (ADP), Manitoba and Saskatchewan, where Sun Life and Canada Life ask you to apply to the province first.
- Itemized receipt with each item, model and price after you pay.
CPAP coverage by insurer
| Insurer or program | What they publish | Have ready |
|---|---|---|
| Sun Life | Since January 2021, no reimbursement for mild sleep apnea (AHI under 15). In Ontario, Manitoba and Saskatchewan, apply for provincial funding first. | Sleep study showing AHI 15 or more; provincial funding decision where it applies; prescription; itemized receipt |
| Canada Life (including former Great-West Life) | A Positive Airway Pressure Machine Assessment Form (M7476), completed by the referring physician. Residents of Saskatchewan, Manitoba and Ontario apply to the provincial program first. Mild sleep apnea needs extra justification. | The completed M7476 form; diagnostic and titration sleep study results; an estimate or receipt |
| Medavie Blue Cross | Pre-approval is required for durable medical equipment such as CPAP. | Prescription with the diagnosis from a physician or nurse practitioner; sleep study; 30-day compliance report; itemized quote from an approved provider; proof of any provincial contribution |
| Pacific Blue Cross | Covers CPAP when the AHI is 15 or more; for AHI 5 to 15, a physician or nurse practitioner can explain other medical conditions. Predetermination with a quote is recommended. | Prescription; sleep study (or a 30-day compliance report for a replacement); detailed quote |
| Alberta Blue Cross (Blue Choice individual plan) | CPAP appliance: $500 per five years at Level B and $750 at Levels C and D; not covered at Level A. Group plans vary. | Prescription; receipt; your plan level |
| Saskatchewan Blue Cross (Blue Essentials) | Covers CPAP accessories such as masks and tubing when prescribed by a physician. | Prescription for the accessories; receipt |
| Manitoba Blue Cross | CPAP machines can be claimed online through mybluecross; criteria depend on your plan. | Check your booklet for pre-approval rules; receipt |
| Manulife, Green Shield, Desjardins | No public CPAP-specific criteria; rules are set by each employer’s plan. Some items need pre-authorization or a physician’s note. | Your plan booklet; a quote for pre-authorization; prescription; sleep study |
These are the insurers’ published defaults; employer plans can differ. Check your booklet or call the number on your benefits card before you buy.
NIHB and Veterans Affairs Canada
Non-Insured Health Benefits (NIHB) for First Nations and Inuit: prior approval is needed for CPAP and supplies (inlet filters excepted). NIHB covers one machine every 5 years, with up to 3 months’ rental first, and 2 masks, pillows, chin straps and tubing a year. The prescriber can be a physician, nurse practitioner, respirologist or sleep physician, and the supplier must be an NIHB-enrolled respiratory provider. NIHB pays after other plans.
Veterans Affairs Canada (VAC): CPAP falls under Program of Choice 9. It needs prior authorization, covers one device every 5 calendar years, and requires a prescription, a sleep study, a trial of at least 30 days and a quote. Registered providers bill Medavie Blue Cross directly; travel CPAPs, batteries and direct-to-consumer purchases such as Amazon are not authorized.
Virtual Sleep Care is not yet a registered NIHB or VAC provider, so these programs cannot pay us directly. If you are covered by NIHB or VAC, check with your program before you order.
Getting your claim paperwork
- Receipt: every Virtual Sleep Care receipt lists each item with its brand, model and price in Canadian dollars.
- Pre-approval: your insurer will tell you what it needs with the request, usually the prescription, the sleep study and a price estimate. To get the estimate, add the items to your cart and select Download a price estimate (PDF) for an itemized estimate you can send with your request. Some plans only accept quotes from their approved providers, so check first.
- Compliance report: your machine records how many hours you use it each night. Ask your insurer which report format it accepts, and check your machine’s app or user guide for how to view or export your usage history.
See how to claim CPAP on group benefits for the step-by-step claim process.
Sources
- Sun Life. Focus update: CPAP and mild sleep apnea (2020). https://www.sunlife.ca/static/canada/Sponsor/About%20Group%20Benefits/Focus%20Update/2020/1050/1050_Focus.pdf
- Canada Life. Positive airway pressure machine assessment form (M7476). https://www.canadalife.com/content/dam/canadalife/documents/forms/you-and-your-family/1-0-employer/1-3-request-an-assessment/en/request-for-coverage-of-pap-M7476-PAP.pdf
- Medavie Blue Cross. CPAP and BiPAP machines. https://www.medaviebc.ca/en/help/cpap-bipap-machines
- Pacific Blue Cross. Sleep apnea. https://www.pac.bluecross.ca/advicecentre/story/sleep-apnea
- Pacific Blue Cross. Sleep equipment and supplies FAQs. https://www.pac.bluecross.ca/advicecentre/story/sleep-equipment-and-supplies-faqs/
- Alberta Blue Cross. Blue Choice plan summary. https://www.ab.bluecross.ca/pdfs/83143-Blue-Choice.pdf
- Saskatchewan Blue Cross. Blue Essentials coverage details. https://www.sk.bluecross.ca/workplace-benefits/blue-essentials/coverage-details/
- Manitoba Blue Cross. Submit a claim. https://www2.mb.bluecross.ca/customer-service/navigate-your-benefits/submit-a-claim
- Manulife. Group benefits FAQs. https://www.manulife.com/ca/en/personal/support/group-plans/group-benefits/faqs
- Indigenous Services Canada. NIHB respiratory equipment and supplies. https://www.sac-isc.gc.ca/eng/1585323161648/1585323186650
- Veterans Affairs Canada. Oxygen therapy and respiratory equipment (POC 9). https://www.veterans.gc.ca/en/about-vac/reports-policies-and-legislation/policies/oxygen-therapy-and-respiratory-equipment-poc-9
- Veterans Affairs Canada. CPAP/APAP device benefit. https://www.veterans.gc.ca/en/financial-programs-and-services/medical-costs/search-vac-treatment-benefits/continuous-positive-airway-pressure-device-automatic-positive-airway-pressure-device-cpapapap-3
Disclaimer
This page is general health information, not medical advice, and it does not replace an assessment by a qualified health professional. Virtual Sleep Care does not currently serve Quebec, Yukon, the Northwest Territories or Nunavut.