Coverage Foreign Health MUNSU Plan GSU Plan. 100 % of eligible expenses. $2,000 per student year. Unlimited. Covered Covered by MCP Covered by MCP

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1 Coverage Insurance covers losses arising from sudden and unforeseeable circumstances. Insurance covers expenses for services which are medically necessary. Insurance covers expenses for services which are medically necessary. Deductible Nil Nil Nil Reimbursement - Drugs 100% of eligible expenses 70% of eligible expenses 90% to a maximum of $50/yr for Hepatitis vaccine for medical students 100 % of eligible expenses - Other Expenses 100% of eligible expenses 100 % of eligible expenses 100% of eligible expenses Maximum - Drugs 30 day supply, unless provided on an inpatient basis, in which case unlimited. $2,000 per student year $10,000/benefit year, combined with other health benefits - Other Expenses $2,000,000 Overall (internal maximums apply) Unlimited $10,000/benefit year combined with drug benefit Hospitalization Up to semi-private room accommodation; psychiatric ward hospitalization maximum 30 days. Ward accommodation covered by MCP Ward accommodation covered by MCP Psychotherapy 100% of charges for: a) Psychiatrist inpatient fees following an emergency up to $10,000 + hospitalization b) Up to $1,000 for out-patient psychiatrist or psychologist care Medical, Surgical, Anesthetic Services Covered 1 P a g e D e c e m b e r 2,

2 Maternity Benefit Where pregnancy commences after the effective date of this policy, or within the 30 days prior to the effective date, pre-natal care, childbirth and newborn care are covered up to a combined benefit maximum of $20,000. The insurance must be in effect for the entire term of the pregnancy. (Family premium not required.) Complications due to pregnancy are paid up to the policy maximum. Ambulance Services Local professional air, land or sea ambulance to nearest hospital; or taxi fare to or from a hospital or medical clinic for eligible medical care to a maximum of $100. Ground or emergency air ambulance to nearest hospital equipped to provide required treatment. Ground or air ambulance to nearest hospital equipped to provide the required treatment. Diagnostic X-rays, Laboratory Testing Covered Blood or Oxygen Products Covered in hospital in hospital Professional Nursing Services Includes private nursing care to a maximum of $15,000 in hospital or at home when ordered by attending physician. In hospital nursing covered by MCP. Out of hospital nursing care not covered. In hospital nursing covered by MCP. Out of hospital nursing care not covered. Prescription Drugs 100% when prescribed by a physician or dentist; maximum 30 day supply unless provided on an inpatient basis unlimited. Drugs requiring a prescription; insulin and supplies; other approved injectibles; Hepatitis vaccine ($50/year) required for course of study. Drugs requiring a prescription; insulin and supplies; other approved injectibles. 2 P a g e D e c e m b e r 2,

3 Medical Equipment & Supplies Purchase of medical supplies, including dressings and prosthetic appliances. Rental charges for wheelchairs, crutches, hospital-type bed or other appliances, not to exceed purchase price. Rental or purchase of medical appliances and supplies prescribed by a physician, subject to benefit maximums. Rental or purchase of medical equipment and supplies (not to exceed purchase price) prescribed by a physician. Glasses/Contact Lenses When required as the result of a covered sickness or injury up to $200 for prescription glasses or contact lenses. Maximum $150 every 24 months; Laser eye surgery $150 per eye, lifetime maximum. Maximum $150 every 24 months Hearing Aids Up to $300 required as the result of a covered sickness or injury. $500/5 calendar years Not specified Non-emergency Eye Examination $100 for one non-emergency eye exam One examination every 24 months, maximum $40 Annual Non-Emergency Medical Examination One exam and associated tests per 365 day period to a maximum of $150 and one consultation and prescription of the morning after pill. Medical examination and tests covered by MCP Medical examination and tests covered by MCP Accidental Dental Coverage Maximum $4,000 Covered; treatment must be completed within 12 months of the accident and while coverage is in force. Covered; treatment must be completed within 6 months of the accident and while coverage is in force. Physiotherapy Unlimited while hospitalized. Maximum $1,000 on out-patient basis, no referral required. Or Athletic Therapist combined maximum $300 per year Or Athletic Therapist combined maximum $300 per benefit year 3 P a g e D e c e m b e r 2,

4 Paramedical Practitioners - Speech Therapy - Chiropractic - Osteopath - Podiatrist/Chiropodist - Psychologist - Naturopath - Acupuncturist - Massage therapy Unlimited while hospitalized; maximum. $1,000 out-patient. Not Covered Covered under Psychotherapy plus 1 x-ray per year plus 1 x-ray per year $300/year $300/year (medical referral required) (medical referral required Tutorial Benefit 30 consecutive school days confinement $10/hour, maximum $ consecutive school days confinement to home or hospital $15/hour, maximum $1, consecutive school days confinement to home or hospital $15/hour, maximum $1,000 Accessibility Benefit Up to $1,000 to replace or repair a necessary Corrective Device including prosthetic limbs, wheelchairs, seeing-eye dogs, and hearing aids. Some coverage under medical equipment and supplies Some coverage under Extended Health Services. Reimbursements for reasonable and customary charges including prosthetic limbs, braces, casts, etc. Trauma Counseling Up to 6 sessions if an insured suffers a loss as listed under the Schedule of Losses. (AD&D Benefit) Medical Repatriation Transportation to the nearest appropriate medical facility or hospital in their home country if medically necessary, not to exceed $200,000, including roundtrip transportation of accompanying medical attendant. Transportation to their residence or to a hospital near their residence (in NL). Reasonable and customary cost for transportation to their residence or to a hospital near their residence (in NL). 4 P a g e D e c e m b e r 2,

5 Family Transportation & Subsistence Allowance Roundtrip costs to a maximum of $5,000 for 2 persons to go to the host country, as well as $1,500 for accommodation and meals, for a maximum of 10 days, when the insured person s hospitalization is expected to last 7 or more days. Roundtrip transportation (& $150/day for maximum 5 days for accommodation & meals) for one family member to visit insured if hospitalized for at least 7 days. Roundtrip transportation (& $150/day for accommodation & meals) for one member to visit insured if hospitalized for at least 7 days, maximum $15,000. Repatriation of Deceased Preparation and transportation home of the body maximum $15,000 Cdn $. Preparation and transportation of the body to province of residence maximum $5,000 Cdn $. Preparation and transportation of the body to province of residence maximum $5,000 Cdn. Burial in Host Country Up to $5,000 for preparing remains, cremation or burial and burial plot in locality where death occurs. Not Covered Not Covered Accidental Death & Dismemberment Up to $50,000 Principal Sum $10,000, plus ancillary benefits Principal Sum $10,000, plus ancillary benefits Dental Care Emergency: Up to $600 for relief of pain and suffering. 1) Exam/x-rays/cleaning (1/year) - 100% of eligible expenses. 2) Fillings/extractions 80% of eligible expenses. 3) Removal of 2 impacted wisdom teeth & root planning 75% of eligible expenses. 4) Endodontic, periodontics, surgery, crowns, bridges, dentures 10% of eligible expenses. Maximum - $750/year 1) Exams/x-rays/cleaning/fillings, extractions, surgery 100% of eligible expenses 2) Endodontic treatment, periodontics treatment, dentures, crowns, bridges 10% of eligible expenses Maximum - $1,000 per benefit year. Cost/semester - $90.43 Cost/year - $ Cost per Semester $ per person insured (maximum 4) $ Single $ Single 5 P a g e D e c e m b e r 2,

6 6 P a g e D e c e m b e r 2,

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