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Desjardins Financial Security

SOLO HEALTH - SUMMARY OF BENEFITS

► Basic Core Health Benefit  (Option 1)

► Enhanced Core Health Benefit  (Option 2)

    Optional Benefits  (can be purchased with any Core Health Benefits):

► Hospital Coverage

► Prescription Drug Benefit

► Dental Care Benefit

 

 

Benefits

Basic Core Health Benefit

(Option 1)

Enhanced Core Health Benefit (Option 2)

100% reimbursement, no deductible, subject to a $50,000 lifetime maximum per insured for all services combined.  However, for the first calendar year during which this coverage is in force, the maximum amounts of eligible expenses are proportional to the number of months of insurance in this first calendar year.

Alternative Practitioners:
Chiropractor, Registered Massage Therapist, Acupuncturist, Homeopath, Naturopath, Osteopath and Occupational Therapist, etc

$18 maximum per visit, up to a $300 maximum per year, per insured person and up to a $600 maximum per year per family for all these services combined

$25 maximum per visit, up to a $500 maximum per year, per insured person and up to a $1000 maximum per year per family for all these services combined
Physiotherapy

$25 maximum per visit, up to a $250 per year per insured person

$25 maximum per visit, up to a $375 per year per insured person
Psychologist, Physiatrist, Social Worker and Guidance Counselor

$40 maximum per visit, up to a $400 per year, per insured person for all these services combined

$60 maximum per visit, up to a $600 per year, per insured person for all these services combined
Speech Therapist/Hearing Therapist

$40 maximum per visit, up to a $400 per year per insured person for all  these services combined

$40 maximum per visit, up to a $480 per year per insured 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 excess of amount paid by the provincial  health plan, if applicable

$2,000 per year, per insured person excess of amount paid by the provincial  health plan, if applicable
Durable Medical Equipment including wheelchair, conventional hospital bed, therapeutic devices or equipment

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

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

Assistive Devices / Prosthetic Appliances,

including orthopedic prostheses,  orthoses (excluding plantar orthosis), orthopedic apparatus and crutches, external breast prostheses, artificial eyes and limbs

$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

$150 per year per insured person (see combined maximum)

$300 per year per insured person (see combined maximum)
Plantar Orthosis

$300 per year per insured person (see combined maximum)

Combined maximum of $300 per year per insured person for Orthopedic Shoes and Plantar Orthosis

$500 per year per insured person (see combined maximum)

Combined maximum of $500 per year per insured person for Orthopedic Shoes and Plantar Orthosis
Hearing Aids (excluding batteries)

$300 per 36 months, per insured person

$500 per 36 months, per insured person
 Home Nursing Care $2,500 per year per insured person $5,000 per year per insured person
Imaging Techniques (including X-ray, ultra-sound and MRI examinations), diagnostic laboratory tests, radiotherapy or radium therapy, oxygen therapy and blood, blood plasma and transfusions

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

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

First 9 days of trip,

lifetime maximum $1,000,000; per insured person.

First 30 days of trip,

lifetime maximum $1,000,000; per insured person.
Vision Care
 

N/A

$150 every 2 years (waiting period is 3 months), per insured person

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

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► Hospital Coverage (can be purchased with any Core Health Benefits)
- 100% coverage for up to $175 per day for semi-private accommodations (per insured person) in a public general hospital.

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► Prescription Drug Benefit  (can be purchased with any Core Health Benefits)

- 80% reimbursement for eligible prescribed medications;
- $5 per prescription co-payment on drugs;
- Reimbursement is based on the lowest-cost generic equivalent, if available;
- Annual maximum payable: $2,000 per insured person;
- Eligible Drugs: prescription drugs and life-sustaining products.

 

Please note that individuals age 65 and over, are only eligible for prescription drugs that are not listed in the Provincial Governmental Drug Formulary.  Please refer to policy contract for further details/provisions/exclusions.

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► Dental Care Benefit  (can be purchased with any Core Health Benefits)

Reimbursement Formula
70% reimbursement, no deductible (3-month waiting period)

Maximum:
1st year: $500,
2nd year: $750, and
Each subsequent year: $1,000

Coverage continues to age 70

Dental Services covered under Solo Health :

Diagnostic:
- Complete X-ray series OR Panoramic radiograph once every three years
- Complete examination: Once every three years
- Recall examinations: Once every nine months
- Emergency OR specific examination every nine months
- Maximum of four Bitewing or Periapical radiographs annually.
- Biopsies and Cytological examinations

Preventative Services:
- THREE units of periodontal scaling OR root planing every nine months
- One unit of polishing every nine months
- Pit and Fissure Sealants on molars (primary and permanent) and  bicuspids for dependants age 14 and younger
- Topical fluoride application for dependants age 14 and younger once  every nine months
- Space maintainers, once per two year period, maintenance included.

Basic Restorations:
- Amalgam restorations (non-Bonded only)
- Composite resin (Bonded and non-Bonded) restorations
- Retentive pins
- Caries/Trauma/Pain Control: one unit per nine month period.
- Emergency pulpectomy or pulpotomy.

Periodontal Benefits:
- Occlusal Adjustment: One unit per nine-month frequency period
- Root planing: as noted above (see scaling under Preventive.)
- Periodontal abscess or pericoronitis, includes Lancing, Scaling,
- Curettage, Surgery or Medication, allowed up to one unit per nine month period

Surgical Services:
- Extractions (removals) of uncomplicated erupted teeth and retained roots.
- Impaction removals (cost of least costly impaction fee in applicable Fee Guide)
- Alveoplasty (in conjunction or not in conjunction with extractions)
- Surgical incision and drainage
- Frenectomy (maximum of one procedure per arch)
- Surgical excision of cyst or neoplasm
- Repair of soft tissue laceration
- Repair through and through laceration

Adjunctive Services:
- General Anaesthesia:  This service is allowed only in conjunction with surgical services, to a maximum of $150 per session of work.

Denture Services:
- Denture repairs
- Relining of complete and partial dentures once every 3 years.

 

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

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Investments:    RESP     RRSP     TFSA     Guaranteed Investments     Segregated Funds

                                                       July 18, 2010