| |
| Ambulance |
-
Other than airline, to and from the nearest hospital qualified to provide the
necessary treatment.
-
Emergency transportation within the insured's province of residence by airline
to and from the nearest hospital, subject to a maximum benefit equal to the
economy airfare for the insured, and, if medically required, a medical
attendant who is neither a resident in your home nor a relative of your family.
|
Changing Options
(Options 3 and 4 only) |
-
You must select one of the medical options you wish the first time you enroll
in the plan. On subsequent re-enrollments you may only move one Option level
per year up or down (i.e. if in Option 4 initially you can only move down to
Option 3 and then Option 2 the next year before choosing Option 1).
-
If you have coverage under your spouse's plan you can choose to waive the
benefit.
|
| Hearing Aids |
-
Charges for the purchase of hearing aids (excluding batteries). Covered
expenses, per insured person, are limited to $500 for each consecutive 60 month
period.
|
| Preferred Accommodation in Canadian Hospitals |
-
In Canada - either semi-private or private coverage in a licensed Canadian
hospital.
-
Outside Canada - semi-private.
|
| Convalescent Hospital |
-
While under the care of a physician or registered nurse provided the stay
commences not less than fourteen days following a period of hospitalization and
prescribed by a physician.
-
Maximum of $75 per day, up to a maximum of 60 days.
|
| Orthopaedic Shoes, Orthotics and Arch Supports |
-
Purchase of orthopaedic shoes, orthotics and arch supports specially designed
and molded, prescribed in writing by a Chiropodist or Podiatrist and are
required to correct a diagnosed physical impairment.
-
Limited to an overall maximum benefit of $500 per policy year.
|
| Out-of-Province and Country Medical & Emergency Travel
Assistance |
-
Duration of stay outside Canada - 180 days.
-
Travel Assistance Services - provides on the spot help in case of emergency for
covered associates and family members travelling outside province of residence.
Full details can be downloaded.
-
If on leave of absence, the maximum amount is $50,000 for a stay abroad that
must not exceed 3 months; if not actively at work due to a lay-off, strike or
lock-out for a period exceeding 3 months, the maximum amount as of the end of
such period is $50,000.
|
| Outside Canada Referral |
-
If referred by a physician for non-emergency treatment outside your province of
residence, or for non-emergency treatment outside Canada, when treatment is
unavailable in Canada and for which there is no medically sufficient alternate
treatment available in Canada, the following are covered, in excess of any
provincial government plan allowance, provided they are eligible for
reimbursement in whole or in part by any provincial government plan.
-
Semi-private accommodation in hospital (reasonable & customary charges).
-
Services of a physician (reasonable & customary).
-
Hospital services and supplies furnished during hospitalization, and for x-ray
examinations and laboratory tests related to medical treatment rendered without
hospitalization.
-
Outside Canada referral expenses are subject to a maximum benefit of $100,000
per policy year.
|
| Prescription Drugs |
-
There is a $6 dispensing fee cap on drugs for all Options. Any amount charged
over $6 will be the responsibility of the insured.
-
Drugs or medicine (including preventive vaccines) required for therapy and
which can only be obtained on the written prescription of a physician and
dispensed by a pharmacist.
-
No benefit will be payable for any single purchase of drugs which would not
reasonably be used within 100 days from the date of purchase for maintenance
drugs and 34 days from the date of purchase for other drugs.
-
Fertility drugs are covered to a maximum of $1,000/year and $3,000/lifetime.
-
Generic drug is a term for products that contain the same medicinal
ingredient(s) as the original brand name drug.
|
| Private Duty Nursing |
-
If recommended by a physician and only if medically necessary charges for
services of a Registered Nurse, licensed practical nurse, Certified Nursing
Assistant or member of Victorian Order of Nurses, while not confined to a
hospital, provided such nurse is not a resident in your home or a relative of
your family.
-
Limited to an overall maximum benefit of $10,000 per policy year.
|
|
Professional Services |
-
Services, without written medical recommendation, of a Psychologist,
Chiropractor*, Naturopath, Podiatrist/Chiropodist* and Speech Therapist to a
maximum of $300 or $500 per policy year, per insured person.*Option 2 & 3 -
Reimbursement begins once the provincial plan maximum has been reached.X-ray
examinations made by a Chiropractor are limited to a maximum of four per policy
year, at a maximum rate of $25.00 per examination.
-
Services, with written medical recommendation, of an Osteopath, Physiotherapist
and Masseur to a maximum of $300 or $500 per policy year, per insured person.
-
Eligible expenses are limited to one professional visit per day for each type
of specialist.
|
|
Accidental Dental |
-
Necessary dental treatment required as a result of an accidental injury to
natural teeth provided by a dentist or specialist in accordance with the normal
suggested fee for a general practitioner.
-
The dental work must be completed within 12 months of the accident to be
considered. All other dental expenses are excluded.
|
|
Durable Medical Equipment |
-
Rental (or initial purchase at the option of Insurer) of a non-motorized
wheelchair, crutches, manual hospital bed, respiratory equipment and any other
durable medical equipment, excluding batteries and repairs, required on a
temporary basis for therapeutic purposes (as approved by Insurer).
|
|
Laboratory tests/x-rays |
-
Which are not covered by any provincial government plan, subject to a maximum
benefit of $500 per policy year.
|
|
Extension of Coverage |
-
Upon your death, eligible dependents' Medical insurance is extended, without
premium payment, for twenty-four months from the date of death or to the date
the policy or benefit terminates, whichever is earlier.
|
|
Exclusions |
-
Eligible expenses shall not include any of the following:
| - |
charges which are considered an insured service of any provincial
government plan, |
| - |
charges for general health examinations, and examinations required
for use of third party, |
| - |
charges for a surgical procedure or treatment performed primarily
for beautification, or charges for hospital confinement for such surgical
procedure or treatment, |
| - |
charges for medical treatment or surgical procedure by a physician
other than as provided under Out of Province and Country expenses, |
| - |
charges for transport or travel, other than as specifically
provided under eligible expenses, |
| - |
charges not specified in the foregoing list of eligible medical
expenses, |
| - |
charges for services or supplies which are furnished without the
recommendation and approval of a physician acting within the scope of his
license, |
| - |
charges which are not medically necessary to the care and
treatment of any existing or suspected injury, disease or pregnancy, |
| - |
charges which are from an occupational injury or disease covered
by any Workers' Compensation law or similar legislation, |
| - |
charges which would not normally have been incurred but for the
presence of this insurance or for which you are not legally obligated to pay, |
| - |
charges which the Insurer is not permitted, by any law or
regulation, to cover, |
| - |
charges for dental work where a third party is responsible for
payment for such charges, |
| - |
charges for bodily injury resulting directly or indirectly from
war or act of war (whether declared or undeclared), insurrection or riot, or
hostilities of any kind, |
| - |
charges for services or supplies resulting from any intentionally
self-inflicted wound, |
| - |
charges for drugs, sera, injectable drugs or supplies which are
not approved by Health and Welfare - Canada or are experimental or limited in
use whether or not so approved, |
| - |
charges for experimental medical procedures or treatment not
approved by the Canadian Medical Association or the appropriate medical
specialty society, |
| - |
charges made by a physician for travel, broken appointments,
communication costs, filling in of forms, or physician's supplies, |
| - |
eye examinations |
|
|
Termination of Benefit |
-
Age 70 or earlier retirement.
|
|
|