Benefits Comparison for Watson Lake Hospital transfer

Transcription

1 Benefits Comparison for Watson Lake Hospital transfer COMPARISON OF BENEFITS Premium Rates Life Group Life: YHC Supplementary Death Benefit: YG $1.50/$10,000 of coverage 100% paid by employee $0.15/$1,000 of coverage Employee cost $0.04/$1,000 of coverage Employer cost Long Term Disability 6.43% of insurable earnings; Premium cost-shared: 50% employee/50% employer $1.51/$1000 of insured annual salary Premium cost-shared: 85% employer / 15% employee Dental Care Single $ Couple $ Family $ Indeterminate employees: 100% paid by employer Casual employees: 100% paid by employee Single $ Family $ Premium is cost-shared 85% employer / 15% employee Extended Health Care Single $ Family $ Indeterminate ees 100% paid by employer Single $ Family $ Premium is cost-shared 85% employer / 15% employee Casual ees 100% paid by employee NOTE: YG rates effective May 1, 2009 for Extended Health, Dental Care and Long Term Disability. The Supplementary Death Benefit rate is effective as of September YHC = Yukon Hospital Corp; YG = Yukon Government; Page 1 of 14

2 Benefits Comparison for Watson Lake Hospital transfer COMPARISON OF BENEFITS Group Life YHC Benefit/Coverage 2X basic annual earnings rounded to next higher $1000; If a contributor to the Federal Government Public Service Superannuation Pension plan the Supplementary Death Benefit is provided. YG Death benefit equal to two times annual earnings, reduces by 10% every year starting at age 66. Eligibility - indeterminate full-time (FT) & part-time (PT) employees eligible; - enrollment is optional Included as part of pension plan eligibility. Premium paid by 100% employee paid premium Cost-shared between employee and employer; Employee currently pays $0.15/$1,000 of coverage; Employer currently pays $0.04/$1,000 of coverage. Termination Conversion Option Advance to Terminally Ill Employees The date no longer meets definition of employee; or The date ceases to be eligible under the applicable collective agreement or terms of contract of employment. Employee shall be entitled to convert insurance within 31 days following termination without evidence of insurability to an individual policy. Maximum amount converted after 65 th birthday is $50,000. In certain circumstances advance payments as loans may be provided to terminally ill employees The date cease to be employed or until reappointed in an excluded category of employment. Employee may elect to continue coverage within 30 days following cessation of employment. YHC = Yukon Hospital Corp; YG = Yukon Government; Page 2 of 14

3 Long Term Disability Insurance Coverage YHC If disabled & qualify for Long Term Disability Insurance (LTD) receive 70% of basic monthly earnings; YG If sick or injured for an extended period of time Long Term Disability (LTD) provides income protection. If become totally disabled a monthly benefit is paid equal to 70% of monthly earnings to a maximum of $11,000. Eligibility Indeterminate FT & PT eligible; Indeterminate or term FT/PT employees (PT works at least 1/3 of required FT hours for job category), or auxiliary seasonal employees, and if actively employed with YG, Premium paid by Premium cost-shared: 50% employee / 50% employer. Premium cost-shared: 85% employer / 15% employee Qualifying period later of 13 wks or expiry of paid sick leave; first 13 weeks of total disability, or when sick leave benefits expire, whichever is later. Medical Care Benefits paid while under the full-time care of a physician. Claims Great West Life in Vancouver Sun Life Insurance Company Income Tax LTD benefits are taxable (because employer pays part of contributions). LTD benefits are taxable. COLA COLA annual CPI up to max 3%; COLA benefits increase over time and are based on the CPI, if the CPI increases a cost of living adjustment is applied each January 1 st to a maximum of 3%. Totally disabled and total disability To qualify for LTD for the first 24 months (after qualification period) must be unable to perform normal duties of own occupation; to qualify after 24 months must be unable to perform duties of any commensurate occupation for which you are reasonably qualified, commensurate occupation is one which is at least 66 2/3% of current rate for regular occupation. - During the qualifying period and the next 24 months considered disabled if there is a medical condition which prevents performance of essential function of own job; - After 24 months considered disabled if there is a medical condition that prevents performance of the essential functions of any occupation for which they may be qualified by training, education, experience, and earnings are at least 66 2/3% of members former job; Duration LTD benefits paid as long as the employee remains totally disabled but will stop on the date of recovery, reach age 65 or die, which ever occurs first. LTD benefits are payable as long as the employee remains totally disabled but stops when reaches age 65, dies or recovers, which ever occurs first. YHC = Yukon Hospital Corp; YG = Yukon Government; Page 3 of 14

4 LTD Continued.. YHC YG Successive Disabilities During Qualifying period if attempt to return to work during qualifying period but within 31 days cease work because of same disability you are not required to start new qualification period; After LTD benefits are paid if return to work but within 6 months stop work because of same disability or within 31 days stop work because of new disability prior LTD claim is re-opened & do not complete new qualifying period. During qualifying period if return to work during qualifying period and become totally disabled within - one month (if disabilities due to unrelated causes), or - six months (if disabilities due to related causes), or - twelve months (if disabilities due to same cause), then the total disability is considered a continuation for the purposes of calculating the qualifying period. After LTD benefits paid - if return to work during qualifying period and become totally disabled within - one month (if disabilities due to unrelated causes), or - six months (if disabilities due to related causes), or - twelve months (if disabilities due to same cause) then the disability is considered a continuation of previous disability. Rehabilitation If you receive LTD benefits, a rehab consultant at Healthcare Benefit Trust is available to assist you. Rehabilitation Employment If you return to work in a rehab program the LTD benefit is reduced by 50% of rehab earnings for up to 24 months of disability. However, if your income from all sources exceeds 100% of basic monthly earnings at date of disability the LTD benefit will be further reduced by excess. Medical Rehabilitation If you first require medical rehab this may be arranged by consultant & doctor; Retraining Financial assistance available if you are unable to return to own job and need to retrain. Rehabilitation is available for cases that qualify for a program, including assessment, counseling, vocational retraining or education program, and trial work, part-time work or modified work. If LTD recipients receive income under an approved rehabilitation program the LTD benefit is reduced so that income from all sources does not exceed 100% of the gross monthly earnings on the date of disability. Subrogation or Third Party Responsibility The regular monthly benefit shall be reduced by a percentage (rehabilitation percentage). If income from rehab employment, other disability income, and benefit paid under the plan exceeds the maximum percentage of earnings at date of disability, the benefit is reduced by such amount in excess. If your disability results from a third party claim any damages or monies received for wage loss, as a result of either a settlement or damage award against a third party, will reduce the LTD benefit. LTD benefits paid which are for an injury or disease where the damages are the liability of a third party, the carrier has the right to be reimbursed. YHC = Yukon Hospital Corp; YG = Yukon Government; Page 4 of 14

5 LTD Continued.. YHC YG Integration Appeals LTD benefit reduced by 100% of any other disability income received for same illness or injury. LTD income includes but is not limited to: - benefits received under WCB Act - under CPP, including benefits for dependents - from all group insurance plans or policy issued as a result of membership in a union or association - employment income, except as allowed under rehab provision - LTD benefits also reduced by future increases in other disability income to a max of 3% LTD benefit not reduced by income from private or individual disability plans If employee disagrees with determination made entitled to appeal directly to Great-West Life. LTD benefit reduced by disability/retirement income from: - the CPP/QPP, or a similar pension plan; - WCB, or other similar legislation; - an automobile insurance policy; - another government or group insurance policy; - retirement income plan providing income that becomes payable after member no longer actively at work; - disability payments in respect of same disability from the Public Service Superannuation Plan; - Quebec Parental Insurance Plan. LTD benefit not reduced by income from an individual DI or life policy, or a retirement income plan payable before the total disability. An appeal may be made on a decision to decline or terminate an LTD claim; there is a 3 month time limit to submit an appeal. Termination of coverage Limitations An employee ceases to be eligible for benefits under the plan on: - The date they no longer meet the definition of employee; or - Date they cease to be eligible under collective agreement or employment contract. - If in receipt of LTD benefits cease to be eligible for LTD benefits at the end of the benefit payment period. No LTD benefit payable for claims resulting from: - Any period of disability where employee is not under a physician s care; - War, insurrection, rebellion, or service in armed forces; - voluntary participation in a riot or civil commotion, except while an employee is performing duties of position; - intentionally self-inflicted injuries or illness; - a pre-existing condition; - abuse of drugs or alcohol, unless confined in a hospital or satisfactorily participating in a program of rehab within 13 weeks of commencement of disability or an organic disease is present which would still cause disability Coverage could be terminated if employee: - is no longer eligible; - fails to pay their portion of premiums, where applicable, - reaches the termination age (65 for LTD); - retires. No benefit is payable for a total disability related to: - intentionally self-inflicted injuries; - civil disorder or war; - condition which existed on or before date insurance began unless member has been insured for LTD for at least 13 weeks & has been actively working continuously & not been treated by a doctor for condition, or member became disabled more than 12 months after insurance began. Or where - member not under active & continuous care of physician & is following prescribed treatment; - disability is due to use of drugs or alcohol unless member is receiving continuous treatment from a rehabilitation centre or designated institution. - loss of income is due to elective cosmetic or experimental surgery unless for accidental injuries or is medically necessary. YHC = Yukon Hospital Corp; YG = Yukon Government; Page 5 of 14

6 Dental Eligibility YHC Indeterminate FT & PT employees, and dependents, are eligible for benefit as a condition of employment. YG Indeterminate or term FT & PT employees if actively employed with YG; or on a seasonal auxiliary basis. Effective Date For YG permanent employees transferring to the YHC as part of the Watson Lake Hospital transfer the effective date of coverage will be the date of transfer to the YHC. Waiting Period For YG permanent employees transferring to the YHC as part of the Watson Lake Hospital transfer the waiting period has been waived. Deductible No deductible. $50 per person per benefit year; $75 per family unit per benefit year. Coordination of Benefits If dependents eligible for coverage under more than one dental plan benefits will be coordinated so total payments received will not exceed expenses actually incurred. If you or your spouse are separately insured for dependent dental coverage, you may be eligible for reimbursement up to 100% Eligible Dependants - Husband or wife, or common-law spouse if co-habited as spousal partners for 1 or more yrs; - Unmarried children until 21, if mainly dependent on, and living, with you or spouse; or unmarried children to any age if in full-time attendance at recognized school, college or university and if mainly dependent on your or spouse. - Unmarried physically or mentally handicapped children to any age if they are mainly dependent on, and living with, you or your spouse. - spouse, of either sex, either legally married or living common-law for at least 1 year prior; - unmarried, dependant children, under 21, or under 25 if attending accredited post-secondary institute, college or university on a full-time basis; - physically or mentally disabled children provided they are entirely dependent on you for support and their disability occurred while covered under the plan as a dependant child. Cost/Premium Indeterminate employees: 100% paid by employer Premium is cost-shared 85% employer / 15% employee Casual employees: 100% paid by employee Benefit Year Benefit year is based on a calendar year, January 1 st to December 31 st Benefit year is April 1 st to March 31 YHC = Yukon Hospital Corp; YG = Yukon Government; Page 6 of 14

7 Dental cont d.. YHC YG Benefit 90% reimbursement (Part A) *$1000 maximum per year combined, except Ortho; Basic Services Diagnostic Services - procedures including: - Exams & consultations - 2 standard exams/calendar yr - 1 complete exam in any 3 yr period (provided no other exam has been paid by Plan in preceding 6 months); - X-rays, up to max for calendar yr - Full mouth X-rays once in any 3 yr period - Roentgenology Preventative Services Procedures to prevent oral disease including: cleaning & polishing of teeth 2 /calendar yr; fluoride application 2/calendar yr; space maintainers to maintain more space but not obtain more; sealants once/tooth within 2 yr period Endodontic Services Root canals Periodontic Services Procedures for treatment of gums and bones surrounding and supporting the teeth, but not including tissue grafts Restorative Services: Procedures for filling teeth, including stainless steel crowns. If choose white fillings you are responsible for additional cost. Surgical Services Procedures to extract teeth as well as other surgical procedures performed by dentist. Major Restorative Services Inlays, onlays & gold foils, but only when no other material can be used satisfactorily. Repairs to Bridges and Dentures (Prosthetics) Procedures for repair of bridges as well as repair or reline of dentures by either dentist or licensed dental mechanic (relines not covered more often than once/24 mo period) costs of temporary dentures not eligible Diagnostic/Preventative* - 100% reimbursement - exams & diagnosis, tests, laboratory exams, x-rays, cleanings, space maintainers, laboratory procedures & drug injections - exams & diagnosis - 2 per year; recall exam (twice per benefit year) limited periodontal exam, special oral exams etc. - X-rays full series once every 36 months; bitewing x- ray twice per benefit year. Endodontic Services * 100% reimbursement root canals etc. Periodontic * - 100% reimbursement surgical services related to treatment of gums (i.e. x-rays, anaesthesia and laboratory procedures). Restorative * - 100% reimbursement fillings periodontics, denture repairs and adjustments, denture relining & rebasing, surgical procedures, laboratory procedures and anaesthesia. Crown * - 50% reimbursement crowns, inlays, onlays, repairs and adjustments, examinations and laboratory procedures. Dentures * 50% reimbursement partial or complete dentures, remakes and adjustments, examinations and laboratory procedures. Bridge * - 50% reimbursement fixed bridgework, retainers, repairs and adjustments, examinations, anaesthesia and laboratory procedures YHC = Yukon Hospital Corp; YG = Yukon Government; Page 7 of 14

8 Dental cont d.. YHC YG Major Reconstruction Services 50% reimbursement (Part B) Crowns Rebuilding natural teeth where other basic material cannot be used satisfactorily. 50% reimbursement Crown * - crowns, inlays, onlays, repairs and adjustments, examinations and laboratory procedures. - replacement of existing crown, inlay or onlay eligible if required to replace existing which was installed at least 5 yrs before replacement, limited to maximum eligible expense of value and quality of original. Crowns and Bridges (Fixed Prosthetics) Artificial replacement of missing teeth with a crown or bridge Bridge * - fixed bridgework, retainers, repairs and adjustments, examinations, anaesthesia and laboratory procedures - replacement of existing denture or bridgework with a denture is an eligible expense if replacement is required due to addition of one or more teeth & existing denture or bridgework cannot be made serviceable, or replacement is required to replace existing denture which was installed at least 5 years before replacement. Dentures (Removable Prosthetics) The artificial replacement of missing teeth with dentures: full upper and lower dentures or partial dentures of basic, standard design & materials. Full dentures from a dentist or licensed dental mechanic. Partial dentures may be from dentist. Eligible for payment once in any 5 yr period. Dentures * - partial or complete dentures, remakes and adjustments, examinations and laboratory procedures. - replacement of existing denture or bridgework with a denture is an eligible expense if replacement is required due to addition of one or more teeth & existing denture or bridgework cannot be made serviceable, or replacement is required to replace existing denture which was installed at least 5 years before replacement. Orthodontic 50% reimbursement - (Part C) 50% reimbursement; - Up to a lifetime maximum of $2,000 per person; - Cost of lost or stolen braces not eligible; - for employee & dependents takes effect after enrolled for 12 months; - maximum lifetime amount for covered dependant children only is $3,000; - cost of lost, stolen or mislaid appliances not eligible. YHC = Yukon Hospital Corp; YG = Yukon Government; Page 8 of 14

9 Dental cont d.. YHC YG Exclusions - Cosmetic dentistry, temporary dentistry, oral hygiene instruction, tissue grafts, drugs and medicines; - Treatment covered by WCB, YHIP, YHCIP, CD&DBP, Children s Dental Plan or other public supported plans; - services required as result of an accident for which a third party is responsible; - charges for completing forms; - implants for dentures or bridgework; - fees in excess of Pacific Blue Cross Dental Fee Schedule, or fees for services outside the schedule; - expenses resulting from war or act of war, civil insurrection, commission of unlawful act; - expenses resulting from intentionally self-inflicted injuries, while sane or insane; - charges for unkept appointments - charges necessitated as a result of a change of dentist, except in special circumstances; - charges for general anaesthetics and room charges; - expenses incurred prior to eligibility date of following termination of coverage; - charges for services related to the functioning or structure of jaw, jaw muscle or temporomandibular joint. - Charges for appointments not kept; - Charges for completion of claim forms; - Expenses for services rendered prior to the date you became eligible for the benefit; - Expenses for cosmetic services; - Expenses for prosthetic devices ordered while insured, but installed after your benefit coverage terminates; - Expenses for crowns or onlays for teeth not impaired by incisal angle or cuspal damage; - Expenses for permanent splinting; - Expenses for full mouth reconstructions, vertical dimension correction, or for correction of temporomandibular dysfunction; - Expenses for replacement of dentures, crown, inlays, onlay or bridgework within 5 years of the original installation; - Expenses for replacement of space maintainers, periodontal appliances, orthodontic appliances or dentures which have been lost, stolen or mislaid Claims Handled by Pacific Blue Cross Handled by Sun Life of Canada Termination of Coverage Claims must be received within 12 months of date of treatment. Employee ceases to be eligible at the end of the month in which they: - No longer meet definition of employee; or - Cease to be eligible under collective agreement or employment contract. Dependant ceases to be eligible: - End of month when cease to be a dependant; or - Date of termination of employee s coverage. When your coverage terminates with YG you have 90 days from the date of termination to claim expenses incurred while covered with YG. Coverage could be terminated if employee: - is no longer eligible; - fails to pay their portion of premiums, where applicable, - reaches the termination age (65 for LTD); - retires. Coverage is effective last day of the month coincident with or immediately following date of termination; YHC = Yukon Hospital Corp; YG = Yukon Government; Page 9 of 14

10 Extended Health Care (EHC) Eligibility YHC Indeterminate FT & PT employees, and dependents, are eligible for benefit as a condition of employment. YG Indeterminate or term FT & PT employees if actively employed with YG; or on a seasonal auxiliary basis. Casual employees may elect to purchase benefit for themselves & eligible dependents. Effective Date For YG permanent employees transferring to the YHC as part of the Watson Lake Hospital transfer the effective date of coverage will be the date of transfer to the YHC. Cost/Premium Indeterminate employees - 100% paid by employer Casual employees - 100% paid by employee Premium is cost-shared 85% employer / 15% employee Reimbursement % 80% of eligible expenses until $1,000 of benefits have been paid in a calendar year. Thereafter 100% of all other eligible expenses incurred in that calendar year shall be paid. 80% of eligible expenses for most expenses 100% of eligible hospital expenses; 100% of eligible hospital expenses; and 100% of eligible out-ofterritory/out-of-country emergency expenses. Maximum lifetime amount payable per person is unlimited. 100% for travel assistance coverage; 80% for out of province referral. Deductible $25 per calendar year deductible per person or family $6.00 per prescription Claims Handled by Pacific Blue Cross Handled by Sun Life of Canada Claims must be submitted by June 30 th of the following year. When your coverage terminates with YG you have 90 days from the date of termination to claim expenses incurred while covered with YG. Benefit Year Benefit year is based on a calendar year, January 1 st to December 31 st Benefit year is April 1 st to March 31 YHC = Yukon Hospital Corp; YG = Yukon Government; Page 10 of 14

11 EHC cont d.. YHC YG Eligible Dependants Travel Assistance coverage & Out of Province/Country coverage Husband or wife or common-law spouse if co-habited as spousal partners for 1 or more yrs; Unmarried children until 21, if mainly dependent on, and living, with you or spouse; or unmarried children to any age if in full-time attendance at recognized school, college or university and if mainly dependent on you or spouse; Unmarried physically or mentally handicapped children to any age if they are mainly dependent on, and living with, you or your spouse. Out-of-Territory / Out-of-Country Emergencies in the event of an emergency while traveling outside of the Yukon/outside of Canada, the EHC covers: - reasonable charges for physician s services, less any amounts paid or payable by the Territorial medical plans - hospital room charges, less amounts paid by Territorial medical plan (includes private or semi-private rooms) and short stays as well as hospital co-insurance - Worldwide Emergency Medical Assistance (MediAssist) - spouse, of either sex, either legally married or living common-law for at least 1 year prior; - unmarried, dependant children, under 21, or under 25 if attending accredited post-secondary institute, college or university on a full-time basis; - physically or mentally disabled children provided they are entirely dependent on you for support and their disability occurred while covered under the plan as a dependant child. Travel Assistance coverage - if faced with an emergency while outside province or territory, for treatment of an injury or disease covered up to $1,000,000 per period of travel (not exceeding 60 consecutive days); - covered at 100%; - includes family assistance benefits, medical evacuation, airfare for returning home, services of a physician, ward accommodation in a hospital. - worldwide assistance network; Out of province referral - $50,000 in a lifetime. ** NOTE: combined maximum of $1,000 in a benefit year for massage, physiotherapist, chiropractor, acupuncturist, speech language pathologist, osteopath, naturopath, podiatrist or chiropodist Acupuncturist Ambulance Fees of approved or licensed acupuncturist, up to $100 per person per year. Cost of ambulance in an emergency from place where sickness or injury occurs to nearest acute care hospital; also covers round trip fare for one attending person (doctor, nurse, first aid attendant) where necessary. **combined maximum of $1,000 in a benefit year;- acupuncture treatments by an acupuncturist; - licensed ground ambulance service to the nearest hospital; - emergency air ambulance to nearest hospital equipped to provide treatment when condition prevents use of another means. Chiropractor Fees up to $500 per person per year, not including cost of x-rays ** combined maximum of $1,000 in a benefit year; - for treatments performed by a chiropractor YHC = Yukon Hospital Corp; YG = Yukon Government; Page 11 of 14

12 EHC cont d.. YHC YG Psychologist Clinical Psychologist fees of a registered psychologist subject to $1,000 per person per year; Includes services of Yukon Family Services Assoc. - $1000 per benefit year maximum; - for services of a certified psychologist. Dentist Dentist fees of a dentist for repairs, including replacement, of natural teeth, which have been injured accidentally. Treatment must be obtained within one year of accident. Orthodontic services not covered, nor are amounts paid by Dental benefit; and are subject to fee schedule. Services of a dental surgeon and charges for dental prosthesis, for treatment of fractured jaw or for accidental injuries to natural teeth, provided treatment within 12 month from accident; prescription required. Diabetic supplies Testing equipment, including glucose meters. For blood glucose monitors prescribed by a physician up to a lifetime max of $700; insulin pumps when prescribed by a physician, limited to a max of one over a 5 year benefit year period. Hearing Aids Hospital Room Charges Cost of purchasing hearing aids when prescribed by a Certified Ear, Nose and Throat Specialist. Maximum is $500 per person every 60 months. Includes repair, but not maintenance, batteries, re-charging devices etc. Charges for occupying a private or semi-private room in an acute care hospital. For hearing aids, including repairs and batteries to a max of $600 every 5 benefit years; Reasonable & customary charges for semi-private accommodation in a hospital, limited to the difference between the charges for public ward & semi-private accommodation. Naturopath Naturopathic Physician fees up to $300 per person per year, not including x-rays ** combined maximum of $1,000 in a benefit year for services of a naturopath. Orthopedic shoes shoes which are not available for general purchase and which are intended to modify or correct a disability. One pair per person, with replacements covered only when due to normal wear. Must be prescribed by a physician or podiatrist. - $150 in a benefit year; - orthopedic shoes and orthopedic modifications to shoes, when required for correction of deformity of bones and/or muscles & provided they are not solely for athletic use and are prescribed by a physician, podiatrist, chiropodist or chiropractor. Orthotics Paramedical items and Prosthetic Devices Note: see wording under orthopedic shoes; one pair per lifetime combined with orthopedic shoes. Oxygen, blood, blood plasma, artificial limbs or eyes, crutches, splints, casts, trusses, braces and ostomy and ileostomy supplies. limited to a maximum of $150 in a benefit year; - for temporary/permanent artificial limbs and eyes including myoelectric appliances where medically necessary; oxygen and equipment used for it s administration, trusses and crutches, casts, cervical collars, splints; braces, colostomy, ileostomy and tracheostomy supplies and catheters & drainage bags. - External breast prosthetic, if required as a result of surgery, to a max of $200 per benefit year YHC = Yukon Hospital Corp; YG = Yukon Government; Page 12 of 14

13 EHC cont d.. YHC YG Physician Physiotherapists and Massage Practitioners Fees for medical exam required by law for employment purposes unless payable by employer. Reasonable and customary fees for; maximum for massage practitioner is $250 per person per year. ** combined maximum of $1,000 in a benefit year including services of a registered massage therapist and a physiotherapist. Podiatrist Fees of registered podiatrist up to $300 per person per year, not including x-rays. ** combined maximum of $1,000 in a benefit year for services of a podiatrist. Prescription Drugs Cost of prescription drugs, including oral contraceptives, purchased from a licensed pharmacy. - $6.00/prescription deductible; - the cost of drugs according to a frozen drug formulary. - Eligible expenses are the reasonable and customary charges provided they are medically necessary for the treatment of disease or injury, prescribed by a physician or dentist and dispensed by a registered pharmacist or physician. Psychologist Fees for registered psychologist or counselor from Yukon Family Services Assoc, up to maximum of $1,000 per person per year. $1,000 in a benefit year per person for services of a psychologist. Nurse Registered Nurse fees for special duty nursing in acute cases where recommended by physician (not covered if performed in a hospital). - $25,000 every 3 benefit years; - services of a nurse providing private duty nursing services in patient s private residence, as prescribed by a physician. Rental of Medical Equipment Rental costs, unless purchase is more economical, of durable medical equipment including hospital beds. Wheelchairs or scooters are eligible expenses if physician certifies that they are the sole means of mobility. Electric wheelchairs covered only when physician certifies that patient cannot operate a manual chair. for rental, or purchase of durable equipment for use in the patient s private residence (i.e. walkers, wheelchair, hospital beds, apnea monitors); Speech Therapist Fees when referred by a physician, up to $500 per person per year. ** combined maximum of $1,000 in a benefit year for fees of a speech language pathologist when prescribed by a physician. Surgical Stockings and Brassieres 2 pairs of stockings per person per year; 1 brassiere per person per year when required as a result of medical treatment for injury or illness. Orthopedic surgical or mastectomy brassieres, limited to 2 in a benefit year; elastic support stockings including pressure gradient hose, up to a maximum of 2 pairs per person per benefit year. YHC = Yukon Hospital Corp; YG = Yukon Government; Page 13 of 14

14 EHC cont d.. YHC YG Vision Care Cost of prescribed eyeglasses and/or frames or contact lenses. Optometrist visits up to maximum of one per person every 24 months. Maximum is $200 per person every 24 months, includes visits. - Reasonable & customary charges for eye examinations limited to one every 2 benefit years; - Eyeglasses or contact lenses and repairs to them to a maximum of $200 per 2 benefit years. Wigs or Hairpieces Cost of when required as a result of medical treatment or injury up to a lifetime maximum of $500 per person. Accidental coverage of eye glasses & contact lenses due to surgical procedure or treatment of keratoconus, lifetime max of $200 for non-surgical treatment of keratoconus and $200 for expenses within 6 months of procedures. Wigs, when patient suffering from total hair loss as a result of illness, limited to $300 every benefit year. Exclusions - Charges for benefits, care or services payable by or under the YHIP, YHCIP, CD&DBP or any public or tax supported agency; - Charges for benefits, care or services payable by or under any other authority such as a third party, travel insurance plans etc. - Charges for a physician except as described in Eligible Expenses for out of Territory/country or physician. - Charges for dental services except as described as eligible; - Expenses contributed to, or caused by occupational disabilities which are covered by WCB. - Charges for orthoptic treatment including prescriptions; - Charges for services and supplies of an elective nature. - Expenses resulting from war or an act of war; participation in riot or civil insurrection. Termination of Coverage Employee ceases to be eligible at the end of the month in which they: - No longer meet definition of employee; or - Cease to be eligible under collective agreement or employment contract. Dependant ceases to be eligible: - End of month when cease to be a dependant; or - Date of termination of employee s coverage. - Where benefits are payable under a Workers Compensation Act, or similar statue of any Government agency; - Services and supplies, rendered or prescribed, by a person who is ordinarily a resident in the patient s home, or is related by blood or marriage; - Services or products for cosmetic purposes; - Services or products normally rendered without charge - Services rendered in connection with medical examinations for insurance, school, camp, association, employment, passport, or similar purposes; - Services or charges by a physician, or any other charges, that are covered by a provincial or territorial plan; - Products or treatments considered experimental by the insurance company; - Portion of charges which is the legal liability of any other party. Coverage could be terminated if employee: - is no longer eligible; - fails to pay their portion of premiums, where applicable, - reaches the termination age (65 for LTD); - retires. Coverage is effective last day of the month coincident with or immediately following date of termination; YHC = Yukon Hospital Corp; YG = Yukon Government; Page 14 of 14