|
Basic Life and Accidental Death and Dismemberment |
|
Flat
amount:
OR |
Formula amount:
X
Annual Salary |
|
Dependent Life
(Spouse: $10,000 Child
: $5,000)
Yes
No |
|
Short Term Disability |
|
|
Elimination period:
for accident
for
sickness (optional)
|
|
Benefit period:
|
Benefit Amount:
* Employee pays
premium for non-taxable benefit
|
|
Long Term Disability |
|
|
Elimination period:
|
|
Benefit period:
|
Benefit Amount:
* Employee pays
premium for non-taxable benefit |
|
Extended Health Care |
|
Co-insurance (insurance company pays):
|
|
Paramedical services:
Annual maximum per paramedical discipline
|
|
Hospital Accommodation (private or semi-private)
Yes
No |
|
Prescription Drug |
|
Co-insurance (insurance company pays):
|
|
Deductible per
prescription
Annual limit :
|
|
Vision Care |
|
Maximum every 24 months |
|
|
Dental Benefits |
|
BASIC
& SUPPLEMENTARY
SERVICES |
|
Co-insurance (insurance company pays):
|
|
Deductible per year (single/family) |
|
|
Recall Visit -
once every |
|
|
Annual maximum |
|
|
[Annual
maximum applies to basic services only or where available, basic
and major
services ] |
|
MAJOR SERVICES
|
|
Include major services at 50%
co-insurance
Yes
No |
|
ORTHODONTIC SERVICES
[Major services must also be selected] |
|
Include orthodontic services at 50% co-insurance
Yes
No
(for
children 18 years of age and under)
|
|
Critical Illness |