Individual health plans for you and your family. Within your reach

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1 Individual health plans for you and your family Within your reach

2 Designed to meet your needs Alberta Blue Cross individual health and dental plans help you and your family stay healthy by providing practical benefits you ll use on a regular basis including prescription drugs, vision, dental care, travel and more. At the same time, you get affordable protection against the high cost of unexpected illness, accidents, ambulance trips and medical conditions. If you re without employer-sponsored health benefits, we ve got an individual health and dental plan to meet your needs...and your budget. Family protection Without an Alberta Blue Cross plan, you could face substantial out-of-pocket costs for prescription drugs, dental, vision care, ambulance trips and much more. And without coverage, an unexpected illness, accident or medical condition could cost you thousands of dollars. Affordable rates Combine the tax savings of individual health plan coverage with what you ll save on out-of-pocket expenses each year, and you ll be surprised how little a plan actually costs. Convenience of direct billing Enjoy the convenience of direct billing arrangements with health service providers including pharmacies, vision care providers and dental offices. Online services Access your benefits and coverage information via our online secure member services web site and submit many of your claims online anytime, anywhere. All from the name you know and trust At Alberta Blue Cross, your health is our only focus. And as an Alberta-based, not-for-profit organization, we deliver the value and affordability you deserve. You must complete a medical questionnaire to determine eligibility for certain benefits as these plans are medically reviewed and do not cover pre-existing health conditions or medications.

3 Make Alberta Blue Cross part of your healthy future As Alberta s largest benefits carrier, Alberta Blue Cross provides supplementary health and dental benefits to meet the needs of over 1.6 million Albertans. Maintaining a high-tech, yet high-touch approach, we aggressively adopt technology to deliver highly efficient service, but still maintain a strong commitment to personalized and excellent customer service. As a best practices organization, Alberta Blue Cross is a repeat recipient of the Premier s Award of Distinction, a recipient of the Employer of Youth Award of Distinction and has been ranked as one of Alberta s top employers. We offer unique value Alberta based and Alberta grown. With our head office in Edmonton and five branch offices across the province, we specialize in serving the Alberta market. We operate under a mandate with a focus exclusively on the health of Albertans. We re just a phone call away, or you can visit us in person at our Edmonton, Calgary, Lethbridge, Medicine Hat, Red Deer or Grande Prairie locations. Independent and not-for-profit. We are not an insurance company or a government agency; as an independent, not-for-profit organization we can deliver unparalleled value. Experts in supplementary health care. We keep a close watch on health care trends and make the most of our health benefit expertise to consistently bring you affordable coverage. We deliver excellent customer service to Albertans (plan members and service providers) by: seamlessly adjudicating tens of millions of claims with a value exceeding $2 billion, offering direct billing, utilizing sophisticated and secure online technology, and responding in-person to just under one million direct inquiries each year through our call centres and six offices across the province. We play an active role in the communities in which we live and work, by leading and supporting province-wide health and wellness campaigns and activities, as well as community initiatives.

4 Blue Choice Plan A Extended Health coverage Ambulance services: Ground and air ambulance to an active treatment hospital. Accidental dental care: Up to a maximum of $2,000 per participant for the repair, extraction or replacement of natural teeth. Psychologist: Up to $75 per visit to a maximum of $150 per participant each benefit year. Drug coverage 70% reimbursement for eligible prescription drugs. Least Cost Alternative (LCA) pricing. $10,000 maximum per participant each benefit year. Dental coverage All dental services paid according to the Alberta Blue Cross Usual and Customary fee guide. 70% basic dental coverage for standard check-ups, cleanings, fillings, extractions and root canals to a maximum of $600 per participant in each benefit year. (Three month waiting period from enrolment date.) Travel coverage 10 day travel coverage anywhere in the world outside of Alberta with up to $5,000,000 in emergency medical benefits. This coverage can be used for any number of trips lasting up to 10 days each. A 10% discount offered on purchase of additional coverage. Accidental Death benefit $15,000 in the event of an accidental death of a participant. Accidental Death Benefit underwritten by the Blue Cross Life Insurance Company of Canada. Now is the time to assess your health coverage needs. Whether you re self-employed, working without group benefits or an early retiree, Alberta Blue Cross individual health plans are a smart choice for you and your family. Please review the plan choices and select one today. Blue Choice Plan B Extended Health coverage Ambulance services: Ground and air ambulance to an active treatment hospital. Preferred hospital accommodation: Semi-private and private rooms. Up to $100 per day to a maximum of $2,000 per participant each benefit year. Hospital cash: $20 per day to a maximum of 20 days per participant each benefit year when admitted to a hospital. Physiotherapist/chiropractor/massage therapist: Up to $50 per visit for services provided by a physiotherapist, $35 per visit for services provided by a chiropractor or $50 per visit for services provided by a massage therapist to a combined maximum of $350 per participant each benefit year. Home nursing: Up to a maximum of $3,000 per participant each benefit year. Psychologist: Up to $75 per visit to a maximum of $750 per participant each benefit year. Podiatrist/chiropodist: Up to $20 per visit to a maximum of $400 per participant each benefit year for services provided by a podiatrist or chiropodist. Accidental dental care: Up to a maximum of $2,500 per participant for the repair, extraction or replacement of natural teeth. Hearing aids: Up to a maximum of $500 per participant in any four-year period for the purchase or repair of hearing aids. Custom made foot orthotics: 70% coverage up to a maximum of $200 per participant each benefit year. Custom fitted braces: 70% coverage up to a maximum of $750 per participant in any two-year period. Oxygen: Up to a maximum of $2,500 per participant each benefit year for oxygen and purchase or rental of equipment. Wheelchair: Up to a maximum of $1,500 once in any three-year period. Hospital beds: Up to a lifetime maximum of $1,500 per participant. Medical aids: Crutches, casts, canes, cervical collars, walkers, splints, trusses and traction kits. CPAP machines: Sleep apnea appliances up to a combined maximum of $500 per participant once in any five-year period. Drug coverage 70% direct bill for eligible prescription drugs. Least Cost Alternative (LCA) Pricing. $10,000 maximum per participant each benefit year. Dental coverage All dental services paid according to the Alberta Blue Cross Usual and Customary fee guide 75% basic dental coverage for standard check-ups, cleanings, fillings, extractions and root canals to a maximum of $600 per participant in each benefit year. (Three month waiting period from enrolment date.) 50% extensive dental for periodontics and dentures in the second year to a combined basic and extensive maximum of $1,250 per participant in the second and each subsequent benefit year. (12 month waiting period from enrolment date.) Vision care coverage Combined maximum of $200 per participant towards an eye examination (maximum of $85) and the purchase or repair of eyeglasses, contact lenses and intraocular lenses in any two-year period. Travel coverage 17 day travel coverage anywhere in the world outside of Alberta with up to $5,000,000 in emergency medical benefits. This coverage can be used for any number of trips lasting up to 17 days each. A 10% discount offered on purchase of additional coverage. Accidental Death benefit $20,000 in the event of an accidental death of a participant. Accidental Death Benefit underwritten by the Blue Cross Life Insurance Company of Canada.

5 Blue Choice Plan C Blue Choice Portability Extended Health coverage Ambulance services: Ground and air ambulance to an active treatment hospital. Preferred hospital accommodation: Semi-private and private rooms. Up to $100 per day to a maximum of $3,000 per participant each benefit year. Hospital cash: $20 per day to a maximum of 30 days per participant each benefit year when admitted to a hospital. Physiotherapist/chiropractor/massage therapist: Up to $50 per visit for services provided by a physiotherapist, $35 per visit for services provided by a chiropractor or $50 per visit for services provided by a massage therapist to a combined maximum of $350 per participant each benefit year. Acupuncture/homeopath/osteopath/naturopath: Up to $50 per visit to a licensed practitioner in acupuncture, homeopathy, osteopathy or naturopathic medicine, to a combined maximum of $350 per participant each benefit year. Home nursing: Up to a maximum of $5,000 per participant each benefit year. Psychologist: Up to $75 per visit to a maximum of $750 per participant each benefit year. Podiatrist/chiropodist: Up to $20 per visit to a maximum of $400 per participant each benefit year for services provided by a podiatrist or chiropodist. Accidental dental care: Up to a maximum of $3,000 per participant for the repair, extraction or replacement of natural teeth. Hearing aids: Up to a maximum of $750 per participant in any four-year period for the purchase or repair of hearing aids. Auxiliary care: Up to a maximum of $1,000 per participant each benefit year. Custom made foot orthotics: 70% coverage up to a maximum of $200 per participant each benefit year. Custom fitted braces: 70% coverage up to a maximum of $750 per participant in any two-year period. Oxygen: Up to a maximum of $2,500 per participant each benefit year for oxygen and purchase or rental of equipment. Wheelchair: Up to a maximum of $1,500 once in any three-year period. Hospital beds: Up to a lifetime maximum of $1,500 per participant. Medical aids: Crutches, casts, canes, cervical collars, walkers, splints, trusses and traction kits. CPAP machines: Sleep apnea appliances up to a combined maximum of $500 per participant once in any five-year period. Drug coverage 80% direct bill for eligible prescription drugs. Least Cost Alternative (LCA) Pricing. $10,000 maximum per participant each benefit year. Dental coverage All dental services paid according to the Alberta Blue Cross Usual and Customary fee guide. 80% basic dental coverage for standard check-ups, cleanings, fillings, extractions and root canals to a maximum of $600 per participant in each benefit year. (Three month waiting period from enrolment date.) 50% extensive dental for periodontics and dentures in the second year to a combined basic and extensive maximum of $1,250 per participant in the second and each subsequent benefit year. (12 month waiting period from enrolment date.) 50% extensive dental for crowns, bridges and implants in the third year to a combined basic and extensive maximum of $1,250 per participant in the third and each subsequent benefit year. (24 month waiting period from enrolment date.) 50% for orthodontics in the third year up to a lifetime maximum of $2,000 per participant. (24 month waiting period from enrolment date.) Vision care coverage Combined maximum of $250 per participant towards an eye examination (maximum of $85) and the purchase or repair of eyeglasses, contact lenses and intraocular lenses in any two-year period. Travel coverage 17 day travel coverage anywhere in the world outside of Alberta with up to $5,000,000 in emergency medical benefits. This coverage can be used for any number of trips lasting up to 17 days each. A 10% discount offered on purchase of additional coverage. Accidental Death benefit $25,000 in the event of an accidental death of a participant. Accidental Death benefit underwritten by the Blue Cross Life Insurance Company of Canada. In the future, you may have an opportunity to acquire group benefits through an employer. But there s no need to leave your Blue Choice individual health plan behind. You can maintain the option to resume your coverage sometime in the future, without a medical review. This guarantees you and your family will always have access to an Alberta Blue Cross individual health plan, regardless what medical conditions may develop. Some restrictions will apply. Secure online services for plan members Access your claims and benefit information anywhere, anytime. Visit services to access our passwordprotected, secure services. Submit claims. View a summary of completed claims. Check claim reimbursement status. View claim statements for the past 24 months. Check coverage levels and when you are next eligible for vision and dental services. Print claim forms. Update your mailing address. Arrange to have your claim payments deposited directly into your bank account and access your statements online. Print or order additional ID cards. And much more. This brochure provides an overview of Blue Choice plans offered by Alberta Blue Cross. It is not a contract or complete listing of all benefits.

6 It s easy to apply 1. Select the plan that suits your needs. 2. Refer to the Rate Chart that accompanies this brochure. 3. Complete all parts of the application form, or contact a representative to find out how to apply online. Be sure to sign and date the application. Incomplete information will cause delays. 4. Forward your fully completed application. Your application will be medically reviewed and you will be notified whether you have been accepted or declined. If you are accepted, coverage will begin the first day of the month following the acceptance of your application. Dental coverage waiting periods apply. Don t delay you never know when an illness or accident may occur. If you have any questions, just call us! There s an Alberta Blue Cross representative ready to help you. Enjoy the benefits of a Blue Choice individual health plan apply today in Edmonton in Calgary Alberta Blue Cross Individual Health Plans Street Edmonton, AB T5J 3C5 The Blue Cross symbol and name and Blue Choice name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC Benefits Corporation for use in operating the Alberta Blue Cross Plan. ABC /07

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