1 The Ontario Nurses Association Benefi t Program VOLUNTARY EXTENDED HEALTH CARE PLAN with Optional Hospital Coverage Available to ONA Members without Employer, Spousal, or Retiree Coverage
2 ONA Benefi t Program Extended Health Care Plan The Extended Health Care (EHC) Plan covers many medical expenses not eligible under government plans, such as vision care, hearing aids, practitioners and drug coverage, which is often a family s single largest health care expense. Member s Status Open Enrollment Opportunity Single: 1 participant Couple: 1 participant + 1 dependant Family: 1 participant + 2 or more dependants Prescription Drug Features Pay Direct Drug Card: Eligible expenses may be submitted electronically through a pharmacy. Reimbursement: Eligible expenses are reimbursed up to 95% of the reasonable and customary fees in your province of residence. Deductible: There is a deductible for prescription drug coverage, which is equal to your pharmacy s dispensing fee. No other eligible expenses are subject to a deductible. Other Plan Features Maximums: All maximums are per insured, per calendar year, unless otherwise indicated. Portability: Coverage can continue if you change employers and/or when you retire. Termination: Coverage can be maintained for life There is NO age limit! You may qualify for EHC coverage without providing medical evidence*. Refer to the 60-Day Open Enrollment details provided in this brochure or the General Plan Details * Late Applicant: If you do not qualify for the Open Enrollment, you are required to complete the Medical Evidence Questionnaire in the application. Coverage will be subject to underwriting review and may be approved or declined.
3 Covered Expenses Prescription Drugs (95% co-insurance) Drugs that legally require a prescription and are dispensed by a pharmacist are eligible. The calendar maximum is $1,800, with a lifetime maximum of $60,000 per insured. The plan does not cover: Fertility drugs, treatment for erectile dysfunction, smoking cessation aids, or anabolic steroids; Drugs that can be purchased without a physician s prescription (some exceptions may apply). Benefits at 80% co-insurance: Vision Care Prescription eyewear (lenses, frames, and contact lenses) and laser eye surgery to a maximum of $200, and one eye exam, every two calendar years (one year for dependent children). Professional Services Services of a licensed physiotherapist, chiropractor, chiropodist, osteopath, speech therapist, podiatrist, or registered massage therapist as recommended by a physician to a maximum of $400 per calendar year per practitioner. In addition, $50 for one X-ray per calendar year per practitioner is covered. Private Duty Nursing In-home nursing care by a registered nurse or nursing assistant, licensed practical nurse, or certifi ed nursing assistant is covered when recommended by a physician for a calendar year maximum of $10,000; $5,000 if over age 65. Aids and Appliances Purchase, rental or repair of medically necessary items including: hospital beds, braces, wheelchairs, prosthetic appliances, diabetic supplies, respiratory equipment, TENS machines, and orthotics. Ambulance Emergency ground ambulance to and from the nearest medical facility. Dental Care for Accidents Dental treatment required as a result of an accidental blow to the mouth. Hearing Aids Purchase or repair of hearing aids to a maximum of $600 every three calendar years.
4 Professional Counselling Services Treatment for depression, substance abuse, family/work concerns, bereavement, and child/elder care issues through the ONA Member Assistance Plan MAP. Note: The Optional Hospital benefit can be added to, and is only available with, the EHC coverage. Optional Hospital Coverage begins on the fi rst day of hospitalization, and pays 100% of the cost of a semi-private room for a maximum of 60 consecutive days in a calendar year. The lifetime maximum is $30,000 per insured. Coverage includes a Convalescent Home Care benefi t at 80% reimbursement up to a maximum of $75 per day, for a maximum of 30 days following an active, acute care hospital stay for a minimum of 24 hours, and a maximum of three days following non-elective day surgery. EHC Plan 60-Day Open Enrollment As a new Member or if you are losing coverage, you can enroll in the EHC Plan without providing medical evidence (subject to being actively at work) within 60 days of: the fi rst day you became an ONA Member; the day you lost coverage due to a change from full-time to part-time status; the day you lost coverage under your (or your spouse s) employer benefi t program, or any other group plan; or the day you lost coverage due to retirement. Note: Retired Members can enroll without providing medical evidence within 60 days of losing retiree or spousal coverage.
5 How is Premium Calculated? Please see the following rate charts for the EHC Plan and Optional Hospital benefi ts: Extended Health Care Monthly Premiums Member s Age Single Couple Family Under 50 $ $ $ to 64 $ $ $ and over $ $ $ Optional Hospital Monthly Premiums Member s Age Single Couple Family Under 50 $ 9.71 $15.13 $ to 64 $15.13 $22.55 $ and over $38.55 $57.95 $96.47 The above rates are effective January 1, Rates are not guaranteed and are subject to change. The Optional Hospital benefi t can be added to, and is only available with, the EHC coverage. Sales Tax will be added to the EHC and Optional Hospital premiums (Ontario Retail Sales Tax - 8%, Quebec Sales Tax - 9%). Your premiums will be re-calculated on each policy anniversary date (January 1), based on your age at that time. Note: Provincial government health plan coverage is required to be eligible for EHC coverage. Please refer to the General Plan Details brochure for additional information, including details on Eligibility and How to Apply. For contact information, please refer to the back page of this brochure.
6 For more information contact the ONA Plan Administrator, Johnson Inc. at: Local callers: Toll-free: Website: th Avenue Suite 700 Richmond Hill, Ontario L4B 3S5 Fax number: Important Notice: This brochure does not constitute a contract. ONA holds the Group Master Policy for this Insurance Program. Details of the coverage are found in the Master Policy. Should there be a discrepancy between this brochure and the Master Policy, the provisions of the Master Policy will govern. The ONA Base Plan and Voluntary Life, Accidental Death and Dismemberment, Long Term Disability, Health and Dental Insurance Plans are underwritten by The Manufacturers Life Insurance Company (Manulife Financial). The Critical Illness Plan is underwritten by Western Life Assurance Company. The Home and Auto Insurance is underwritten by Unifund. The MEDOC Travel Insurance Plan is underwritten by Royal Sun Alliance Insurance Company of Canada
Wisconsin Guide to Health Insurance for People with Medicare 2015 For more information on health insurance call: MEDIGAP HELPLINE 1-800-242-1060 This is a statewide toll-free number set up by the Wisconsin
MEDICAID AND FAMIS PLUS HANDBOOK Commonwealth of Virginia Department of Medical Assistance Services dmasva.dmas.virginia.gov Department of Medical Assistance Services 600 East Broad Street Richmond, Virginia
Same-Sex Domestic Partner Benefits UPS Health and Welfare Package UPS Health and Welfare Package for Retired Employees UPS Health and Welfare Package Select UPS Health and Welfare Package Select for Retired
Questions and Answers About Health Insurance A Consumer Guide Agency for Healthcare Research and Quality Advancing Excellence in Health Care www.ahrq.gov Note to reader: This guide offers general information
MEMBER SCHEDULE OF BENEFITS including PLAN ELIGIBILITY AND COVERAGE RULES and DESCRIPTION OF PLAN BENEFITS DUKE SELECT Administered by Coventry Health Care of the Carolinas, Inc. 2801 Slater Road, Suite
Solutions 2015 for Individuals Helping You Choose the Plan That s Right for You Blue Cross and Blue Shield of Louisiana and HMO Louisiana, Inc. are Qualified Health Plan Issuers on the Health Insurance
BlueEssentials SM Individual and Family Plans NEW INSURANCE PLANS FROM BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA Important Enrollment Dates ENROLLMENT DATE EFFECTIVE DATE November 15 through December 15,
A Shopper s Guide to Long-Term Care Insurance About the NAIC The National Association of Insurance Commissioners (NAIC) is the oldest association of state government officials. Its members are the chief
Health Guide to Insurance This guide: Describes how to find, keep and use health insurance Explains how to appeal a decision by your health plan John Kasich Governor Mary Taylor Lt. Governor / Director
Questions and Answers about the Federal Employees' Compensation Act (FECA) Double-click here to go to the Table of Contents U. S. Department of Labor Elaine L. Chao, Secretary Employment Standards Administration
STATE OF NEW JERSEY DEPARTMENT OF THE TREASURY DIVISION OF PENSIONS AND BENEFITS MEMBER HANDBOOK FOR EMPLOYEES AND RETIREES ENROLLED IN THE STATE HEALTH BENEFITS PROGRAM OR SCHOOL EMPLOYEES HEALTH BENEFITS
MEDICAL, DENTAL AND MORE 2015 A Complete Guide to Your UC Health Benefits Listed below are telephone numbers and website addresses for some of the resources UC employees routinely use. MEDICAL PLANS Blue
Workers Compensation What happens if I m hurt on the job? A guide to Oregon s workers compensation benefits, rights, and responsibilities January 2015 Workers Compensation Division Claim Information Record
Medicare Part D A Guide For Advocates and Providers Who Work With Older Adults in Pennsylvania Written by M. Francesca Chervenak, Esq. and Erin E. Guay, MA Pennsylvania Health Law Project Pittsburgh Office
CENTERS FOR MEDICARE & MEDICAID SERVICES 2015 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare This official government guide has important information about: Medicare Supplement
CPP Platinum Protection Plan Designed for the Guests of Holland America Line SECTION I Cancel for Any Reason Waiver Provided by Holland America Line Holland America Line offers guests the opportunity to
Uniform Life, Accident & Health, Annuity and Credit Product Coding Matrix FOR USE WITH THE UNIFORM LIFE, ACCIDENT & HEALTH, ANNUITY CREDIT TRANSMITTAL DOCUMENT: Item 8, Type of Insurance, on the Uniform
Protecting Your Health Insurance Coverage This booklet explains... Your rights and protections under recent Federal law How to help maintain existing coverage Where you can get more help For additional
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.modahealth.com or by calling 1-888-873-1395. Important
CENTERS for MEDICARE & MEDICAID SERVICES Medicare Coverage of Kidney Dialysis & Kidney Transplant Services This official government booklet explains: The basics of Medicare How Medicare helps pay for kidney
We want this to be the best vacation of your life. So to make sure you have nothing to think about except having a good time, we offer the CruiseCare package of benefits to our valued guests. We encourage
GENERAL INFORMATION FOR PROVIDERS MEDICAID AND OTHER MEDICAL ASSISTANCE PROGRAMS Published by: Medical Services Division North Dakota Department of Human Services 600 E Boulevard Avenue, Dept 325 Bismarck,
Arkansas &You Medicaid, ARKids First Arkansas Medicaid Beneficiary Handbook A GUIDE to YOUR RIGHTS and RESPONSIBILITIES Revised 2010 Table of Contents Your Guide to Arkansas Medicaid and ARKids First..............
Preface Care at Home: A Handbook for Parents is a guide that is intended to help parents/guardians meet some of the challenges of caring for a physically disabled child at home. It includes information
CALIFORNIA Effective January 1, 2015 2015 Small Group Guide EmployeeElect for medical groups with 1-50 employees Plans that offer choices and meet Affordable Care Act requirements 37046CABENABC Rev. 04/15
Alberta Child Care Accreditation Funding Program GUIDE FOR CONTRACTED FAMILY DAY HOME AGENCIES NCN 1383 Rev. September 2014 Table of Contents Introduction... 1-1 The Accreditation Process... 1-1 Available