|
HEALTH
SERVICES no
deductible and no co-payment |
|
Benefits |
Base Plan |
Deluxe Plan |
Platinum Plan |
|
Paramedical Services |
Physiotherapist,
Psychologist, Speech Therapist, Chiropractor, Osteopath, Homeopath,
Podiatrist/Chiropodist, Naturopath :
Maximum of $400
per person, per calendar year for each practitioner
Acupuncturist & Registered Massage Therapist :
$20.00 per visit to a
maximum of 20 visits per person per calendar year |
|
Ambulance Transportation |
by land or air to the
nearest hospital.
|
|
Accidental Dental coverage |
maximum $10,000.
|
|
Hearing
Aids |
up to $500 per person every 36 months.
|
Home
Support Services, charges for the services of a
Registered Nurse (R.N.) or Registered Practical
Nurse/Licensed Practical Nurse (R.P.N./L.P.N.) in the
home only on a full
or part shift bases. |
$5,000
|
$7,500
|
$10,000 |
|
Medical
Items including, prosthetic appliances, braces,
wheelchair & hospital bed.
Orthotics |
Not Covered
|
$200
every 3 years |
$300 every
3 years |
|
Vision care
All Plan members
have access to a national preferred provider vision network
arrangement, where you are eligible to receive a discount on eye
wear. |
Eye
exams - Not covered
Eyeglasses, Contact Lenses/Laser Eye Surgery - Not
Covered
|
Eye
exams - $60
every 2 years
Eyeglasses, Contact Lenses/ Laser Eye Surgery - Not
Covered |
Eye
exams - $60 every 2 years
Eyeglasses, Contact Lenses/ Laser Eye Surgery - $250
every 2 years |
|
Semi-Private Hospital Accommodations |
Not covered |
Not covered |
Reimbursement for the difference in cost between
standard ward charges and the cost of semi-private
accommodations (maximum 30 days/ benefit year) |
|
Emergency Out of Province |
Up to $1,000,000 coverage per insured for up to 60
consecutive days, with unlimited trips per year. |
|
|
|
Prescription Drugs |
|
Benefits |
Base Plan |
Deluxe Plan |
Platinum Plan |
|
Prescription Drugs
Benefits do not include medication for the
treatment of anti-obesity, smoking cessation products,
erectile dysfunction and fertility. Serums and vitamins are
also ineligible unless injected and medically necessary. |
Covered at
80% to a maximum of $1,000 per person, per benefit year
|
Covered at
90% to the following maximums per person, per benefit
year:
First 12
months - $1,000
Next 12 months
- $1,500 Each 12 months thereafter - $2,000
|
Covered at
90% to the following maximums per person, per benefit
year:
First 12
months - $1,500 Next 12 months - $2,500 Each 12 months thereafter
-
$3,500
|
|
|
|
Dental Benefits
(optional, can only be purchased in
conjunction with the Health Benefits) |
|
Benefits |
Base Plan |
Deluxe Plan |
Platinum Plan |
|
Basic Dental Services |
Covered at 80% |
Covered at 80% |
Covered at 80% |
|
• Preventive services
include preventive cleaning of teeth; topical
application of fluoride for persons age 19 or under; pit
and fissure sealants on permanent molars, for children
age 15 or under; space maintainers that replace
prematurely lost teeth for persons age 18 or under. |
|
recall examinations every 9 months;
|
recall examinations every 9 months
|
recall examinations every 6 months
|
|
• Periodontal scaling/
cleaning
the fees for periodontal treatment are based on units of
time (15 minutes per unit) and/or number of teeth in a
surgical site in accordance with the Fee Guide for
General Practitioners:
|
|
up to 6 units every 12 months.
|
up to 8 units every 12 months.
|
up to 8 units every 12 months.
|
|
• Diagnostic services
including complete oral examinations once every 3 years;
emergency and specific oral examinations once every 3
years; full series x-rays and panoramic x-rays once
every 3 years; bitewing x-rays once every 9 months.
• Basic oral surgery
including extractions of teeth and/or residual roots.
|
|
Comprehensive Services |
Covered at 70%
|
Covered
at 70%
|
Covered
at 80% |
|
• Endodontic treatment
including root canal therapy; removal of the pulp from
the crown and root portion of the tooth; assistance of
root tip closure; root resections and retrograde
fillings, root amputation; emergency procedures.
• Periodontal treatment
including provisional splinting and certain periodontal
appliances; displacement packing, management of
infections and desensitization.
• Standard denture services
including, denture cleaning once every 9 months; denture
repairs and/or tooth/teeth additions; standard relining
and rebasing of dentures; denture adjustments, remount
and equilibration procedures.
• Comprehensive oral surgery
including, surgical exposure, repositioning,
transplantation or enucleation of teeth; removal of
cysts and tumours; incision, drainage and/or exploration
of soft or hard tissue.
|
|
DENTAL BENEFIT
MAXIMUMS |
$750.00 in the first 12
months,
$1,000 every 12 months thereafter |
$1,000
in the first 12 months,
$1,000 in the second 12 months and
$1,200 every 12 months thereafter |
$1,000
in the first 12 months,
$1,000 in the second 12 months and
$1,200 every 12 months thereafter |