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Desjardins Financial Security


 

 SOLO HealthCare

SUMMARY OF BENEFITS

Health Plus (Basic Plan)  

Health Plus (Enhanced Plan)

   

Optional Benefits  (can be purchased with any Health Plus plans):

Hospitalization (Basic and Enhanced)

Prescription Drugs (Basic and Enhanced)

Dental Benefits (Basic and Enhanced)

 

 

SOLO Health Plus plans

 

Benefits

Health Plus (Basic Plan)

Health Plus (Enhanced Plan)

Medical & Paramedical Services

Combined Maximum: $250,000 for the life of the contract Combined Maximum: $350,000 for the life of the contract

Chiropractor, Registered Massage Therapist, Acupuncturist

$20 maximum per visit, and up to a $400 maximum per person per year for all these services combined

80% co-insurance and

$750 per year per person for all these services combined

Homeopath, Naturopath, Osteopath, Orthotherapist, Podiatrist, Chiropodist

$20 maximum per visit, up to a $400 per year per insured person per specialty

Physiotherapist $25 maximum per visit, up to a $250 per year per insured person
Speech Therapist, Hearing Therapist $40 maximum per visit, up to a $400 per year per insured person for all  these services combined

80% co-insurance and

$400 per year per person for all these services combined

Psychologist, Physiatrist, Guidance Counselor, Family and Couple Therapist, Social Worker

$80 maximum for the first visit and $65 for subsequent visits, up to a $400 per year, per insured person for all these services combined

80% co-insurance and

$400 per year per person for all these services combined

 

Accidental Dental

$1,000 maximum per accident per insured person

$2,000 maximum per accident per insured person

Ambulance Services

$1,000 per year, per insured person

$2,000 per year per insured person

Durable Medical Equipment and Orthopedic Devices

$1,000 per year, per insured person for all these services combined

 $2,500 per year, per insured person for all these services combined

Prostheses and Orthopedic appliances

$500 per year, per insured person for all these services combined

$1,000 per year, per insured person for all these services combined

Orthopedic Shoes and Foot Orthotics

$200 per year per insured person

$200 per year per insured person

Hearing Aids (excluding batteries) $300 per 36 months, per insured person $500 per 36 months, per insured person
Home Nursing Care, Occupational Therapy

$2,500 per year per insured person

$5,000 per year per insured person

 Lab tests: Blood tests (including PSA), Urinalyses,
Throat swabs,  X-ray (including Pet scans), Ultra-sound, MRI,

CT scans

$200 per year per insured person for all these services combined

$500 per year, per insured person for all these services combined
   

 

Travel Insurance

30 days of trip,

$5,000,000; per insured person, 90 days per year.

 30 days of trip,

$5,000,000; per insured person, 90 days per year.

Vision Care
 
$100 for glasses, lenses, laser eye surgery and $50 for consultation with an optometrist every 2 years per insured person $100 for glasses, lenses, laser eye surgery and $50 for consultation with an optometrist every 2 years per insured person

NOTE: This summary explains some of the key coverage details of SOLO Healthcare.  The policy contract contains important information concerning details, terms, provisions and specific limitations.

Term "year" is every 12 consecutive months following the effective date of the policy

 

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Hospitalization

(can be purchased with any SOLO Health Plus plans)

 

Basic Plan

Max benefit per person

Semi-Private or Private Room

100% coverage of a cost of a semi-private room,

up to $150 per day,

No limit on number of days

Cash benefit as of the 4th day of hospitalization if a private or semi-private room is not available

$25 per day,  30-day maximum

 Enhanced Plan

Max benefit per person

Semi-Private or Private Room

 

100% coverage of a cost of a semi-private room,

up to $200  per day,

No limit on number of days

Cash benefit as of the 4th day of hospitalization if a private or semi-private room is not available

$50 per day,  60-day maximum

NOTE: This Hospitalization Benefit summary explains some of the key coverage details of Solo Healthcare. The policy contract contains important information concerning details, terms, provisions and specific limitations.

 

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Prescription Drugs

  (can be purchased with any SOLO Health Plus plans)

 

Basic Plan

Reimbursement percentage

Max benefit per person per year

Eligible prescription drugs are generic or original brand name drugs that can only be obtained by prescription.

Reimbursement is based on the lowest-cost generic equivalent, if available

70 % reimbursement for eligible prescribed medication

 $4,285 of the cost of eligible prescriptions

 ( the company pays max $3,000)

 Enhanced Plan

Reimbursement percentage

Max benefit per person per year
Eligible prescription drugs are generic or original brand name drugs available only  by prescription, including contraceptives (oral contraceptives, patches, injections and Mirena intra-uterine device)

Reimbursement is based on the lowest-cost generic equivalent, if available

70 % reimbursement for first $4,285 of eligible prescribed medications and 90% thereafter

No limit

 Reimbursement is made with a payment card

NOTE: This Prescription Drugs Benefit summary explains some of the key coverage details of Solo Healthcare. The policy contract contains important information concerning details, terms, provisions and specific limitations.

 

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Dental Benefit 

(can be purchased with any SOLO Health Plus plans)

 

Dental Benefit (Basic Plan)

1) Preventive Care

Period

Reimbursement percentage

Max benefit per person per year

Complete oral examination,

Complete set of radiograph and panoramic radiograph

Once every 36 months

 

80%

 

 

 

$700 for all these services combined

Recall examination,

Cleaning (scaling and polishing,

Topical application of fluoride ( for dependents age 15 and younger)

Once every 9 months

2) Basic Care

Reimbursement percentage

Metal Fillings (Amalgam restorations),

Non-metallic fillings (Composite resin restorations),

Periodontal curettage and root planning (deep scaling under the gum),

Extractions of erupted teeth (uncomplicated),

Extractions of retained roots,

Emergency care out of Canada

 

50%

 Reimbursement is made with a payment card

 

 

 

Dental Benefit (Enhanced Plan)

1) Preventive Care

Period

Reimbursement percentage

Max benefit per person per year

Complete oral examination,

Complete set of radiograph and panoramic radiograph

Once every 24 months

 

100%

 

 

 

$750 for the first year

$750 for the second  year

$1,000 as of the third year

Recall examination,

Cleaning (scaling and polishing,

Topical application of fluoride ( for dependents age 15 and younger)

Once every 6 months

2) Basic Care

Reimbursement percentage

Metal Fillings (Amalgam restorations),

Non-metallic fillings (Composite resin restorations),

Periodontal curettage and root planning (deep scaling under the gum),

Extractions of erupted teeth (uncomplicated),

Extractions of retained roots,

Emergency care out of Canada

 

60%

3) Major Care

Reimbursement percentage

Max benefit per person per year

Root canal treatment,

Gingival graft,

Appliance (occlusal guard for bruxism (grinding of the teeth),

Extractions of erupted teeth (with complication),

Extraction of unerupted teeth (inside gum, such as wisdom teeth),

Removable prosthodontics,

Fixed prosthodontics (bridges),

Recovery, veneer, inlays and crowns (including CEREC technology)

 

60%

As of the 3rd year,

$ 500 per year

4) Orthodontics Care

Reimbursement percentage

Max benefit per person
Complete orthodontics treatment

 

60%

As of the 3rd year, $1,000 for contract duration

 Reimbursement is made with a payment card

NOTE: This Dental Care Benefit summary explains some of the key coverage details of Solo Healthcare. The policy contract contains important information concerning details, terms, provisions and specific limitations.

 

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 Call 416-493-0101 for a quote and more information

 

 

 

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                                                       December 16, 2013