Group Insurance Plan Summary Ostéopathie Québec

Transcription

1 Group Insurance Plan Summary Ostéopathie Québec Administered by AGA Benefit Solutions

2 This explanatory brochure gives you an overview of the coverage offered by the Ostéopathie Québec group insurance plan. Four different coverage options are available to you and some optional coverages are also available. You have 60 days to change your option after each renewal rates apply and the changes will be effective retroactively to the renewal date. If you would like more information about your coverage, or to view the list of exclusions and limitations please contact AGA Benefit Solutions or refer to the insurance brochure prepared by the insurer of your plan, Medavie Blue Cross. In case of discrepancy between this summary and the insurance brochure of the insurer, the latter prevails. Life Insurance This coverage is only available to members choosing options 3 or 4. Here are the details of the coverage: Member amount (without proof) Reduction at age 65 Termination Spouse amount Children amount Termination $30,000 50% Age 70 or end of member eligibility $10,000 $5,000 Age 70 or end of member eligibility Accidental Death and Dismemberment This coverage is offered to all members who join the plan. This coverage pays an amount in case of death or dismemberment during an accident. Here are the details of the coverage: Member amount (without proof) Reduction at age 65 Termination $30,000 50% Age 70 or end of member eligibility This coverage does not cover dependents. Critical Illness This coverage is offered to all members who join the plan. This coverage pays an amount when a diagnosis of a serious illness is pronounced. Here are the details of the coverage: Member amount (without proof) Termination $6,000 Age 65 or end of eligible member This coverage does not cover dependents. Pre-existing conditions apply. See the section "Some Definitions" for a list of covered illnesses.

3 Medical Care This coverage is offered to all members who join the plan. This benefit covers your medical expenses to varying degrees, as well as those of your dependents, according to the option chosen. Here are the details of coverage: Drugs Option 1 Option 2 Option 3 Option 4 Type of coverage Requiring a perscription Requiring a prescription Requiring a prescription Requiring a prescription Deductible (Ind./Family) $100 / $200 per calendar year $750 / $750 per calendar year Coinsurance (percentage of reimbursement) Hospitalization 75% of the first $2,725 of admissible fees per family and 100% of the balance 100% $100 / $200 per calendar year combined with other medical services 75% of the first $2,725 of admissible fees per family and 100% of the balance Deductible None None Coinsurance 100% 100% Room Semi-private Semi-private Maximum / day $100 $100 Maximum duration 60 days 60 days Other Medical Care Deductible (Ind./Family) None None 100$/200$ per calendar year combined with drugs Coinsurance 100% 100% 75% 100% $750 / $750 per calendar year combined with other medical care 100% $750/$750 per calendar year combined with drugs Convalescence $20 / 120 days per calendar year $20 / 120 days per calendar year $20/120 days per calendar year $20/120 days per calendar year Nursing $10,000 per calendar year $10,000 per calendar year $10,000 per calendar year $10,000 per calendar year Ambulance Unlimited * Air travel: Maximum of $2,000 per calendar year Unlimited * Air travel: Maximum of $2,000 per calendar year Unlimited * Air travel: Maximum of $2,000 per calendar year Wheelchair Unlimited * Unlimited * Unlimited * Unlimited * Standard manual hospital bed Unlimited * Unlimited * Unlimited * Unlimited * Dental accident Unlimited * Unlimited * Unlimited * Unlimited * Orthopedic shoes and podiatric orthesis Custom made compression Stocking Unlimited * Air travel: Maximum of $2,000 per calendar year $300 per calendar year $300 per calendar year 2 pairs per calendar year 2 pairs per calendar year Mammary Prostheses $200 per calendar year $200 per calendar year Wigs & Hairpiece $500 lifetime $500 lifetime $500 per 36 consecutive $500 per 36 consecutive Auditive Prostheses months months Glucometer $700 lifetime $700 lifetime Diagnostic tests $500 per calendar year $500 per calendar year Other supplies unlimited * unlimited * Eye examination $50 for 24 consecutive months $50 for 24 consecutive months

4 Medical Care (following) Paramedicals Deductible (Ind./Family) $100 / $200 per calendar year combined with drugs Coinsurance 75% 100% Acupuncturist Chiropractor X-Ray chiropractor Massage Therapist (with medical referral) Naturopath Speech Therapist Osteopath Physiotherapist Podiatrist Psychologist Sport Therapist Overall maximum Travel Insurance $750 / $750 per calendar year combined with drugs $50 / visit - maximum allowable of $800 per calendar year (G) $50 / visit - maximum allowable of $600/calendar year (G) Allowable maximum of $50 per Allowable maximum of $50 per calendar year calendar year $30 / visit - maximum of 10 visits $30 / visit - maximum of 10 visits per calendar year (G) per calendar year Total maximum for all Total maximum for all paramedicals paramedicals Deductible None None None None Medical and hospital Insurance Cancellation and Interruption Insurance 100% - $2,000,000 per occurrence 100% - $2,000,000 per occurrence 100% - $2,000,000 per occurrence 100% - $2,000,000 per occurrence 100% - $5,000 per trip 100% - $5,000 per trip 100% - $5,000 per trip 100% - $5,000 per trip Baggage Insurance 100% - $500 per trip 100% - $500 per trip 100% - $500 per trip 100% - $500 per trip Duration of coverage -Less than 65 years The first 180 days of travel The first 180 days of travel The first 180 days of travel The first 180 days of travel 65 years and over The first 60 days of travel The first 60 days of travel The first 60 days of travel The first 60 days of travel * Limited to reasonable and usual fees The following features apply to all options: A direct pay card for drugs is included. The coverage ends when the member reaches the age of 70 or ceases to meet the membership criteria.

5 Pricing Options Here is the current monthly pricing (including the 9% sales tax). These prices include the cost of all the benefits described above. Individual Couple Single Parent Family Option 1 Less than 40 years $45.63 $85.74 $77.81 $ years and over $72.61 $ $ $ Option 2 Less than 40 years $27.54 $49.51 $45.20 $ years and over $42.33 $76.26 $69.55 $93.19 Option 3 Less than 40 years $92.39 $ $ $ years and over $ $ $ $ Option 4 Less than 40 years $62.03 $ $ $ years and over $ $ $ $ Long Term Disability This coverage is optional. Therefore, you can decide to take it or not, no matter which option you choose. This coverage will pay you a monthly income if an illness or an injury prevents you from working. Evidence of insurability is required for any amount as well as a copy of your last Income Tax return. Amount Maximum without proof Maximum with proof Waiting period Duration of benefits Cost of Living Increase (optional) Taxation Definition of disability Maximum benefit Termination Multiple of $100 (minimum of $500) $0 $5, days Until Age 65 Maximum of 3% Non-Taxable 36 months, own occupation 85% Age 65 or end of member eligibility Here are the current monthly rates per $100 of monthly indemnity (including the 9% sales tax): Without Cost of Living Increase With Cost of Living Increase Less than 40 years $1.76 $ years and over $5.24 $6.09

6 Dental Care This coverage is optional and is only available with options 3 or 4. It will cover your dental care fees, as well as those of your dependents. This benefit includes among other things the routine exam, the extraction and filling of teeth, root canal and more. Deductible Examination Frequency Coinsurance Preventive Preventive Care Basic Care Endodontics Periodontics Major Dental Care Orthodontics Termination None 1 per 6 consecutive months 80% $1,500 combined per calendar year* $1,500 combined per calendar year* $1,500 combined per calendar year* $1,500 combined per calendar year* Not Covered Not Covered Age 70 or end of member eligibility * Please note that: You must adhere to this coverage for a minimum period of 2 years. If the coverage is canceled, it won t be possible to put it back in force at a later date. In your first year of membership, the maximum is $1,000 (prorated to the number of months covered in the year). In case of late enrollment, the maximum will be $250 for the first 12 months of coverage. Here is the current monthly pricing (including the 9% sales tax): Individual Couple Single Parent Family Less than 40 years $61.91 $ $92.53 $ years and over $61.91 $ $92.53 $147.34

7 Some definitions Eligible member: A person who resides in Canada, who is a member in good standing of Ostéopathie Québec and who works as an osteopath at a minimum wage of $20,000 per year. Spouse: Spouse by virtue of a wedding or any other formal union recognized by law, or a person of the opposite sex or same sex with whom you have lived together for at least twelve months and who is publicly presented as your spouse. No minimum period of cohabitation is required if a child is born from your union. Child: Your child or your spouse s child who is neither married nor related by another type of legally recognized formal union and who is 21 years of age or is under (or under 26 if he is a full-time student whom you fully support). No age limit applies if the child is totally disabled due to a physical or mental disability. However, the disability must have occurred before the age of 18 when the child met the definition of dependent child. Pre-existing condition: Any condition for which, during the 24 months immediately preceding the effective date of the protection for critical illness, the participant received a prescription for drugs or for which he received medical treatment, consultation, care or services from a physician, including diagnostic measures for any symptom or medical problem that causes the diagnosis or treatment of a serious illness as defined in the contract provision, Insured Diseases. Critical illnesses covered: Cerebral vascular accident, severe burns, cancer, blindness, aortic surgery, coma, heart attack, dementia, main organ transplant, kidney failure, Parkinson's disease, motor neuron disease, paralysis, loss of speech, coronary artery bypass, multiple sclerosis, deafness, benign brain tumor. BILL 33 : Did you know On January 1st, 1997, Bill 33 (Quebec Universal Drug Plan) became effective for all Quebec residents. Any person under the age of 65 that has access to a group insurance plan necessarily has to join the group plan. Unless this person is covered by another group plan or if a person is covered under a spouse s group plan. Proof of such coverage must be provided. When you join the group plan of Ostéopathie Québec, you have to insure all your admissible dependents unless they are already insured under another group insurance plan. Your eligible dependents cannot be insured with R.A.M.Q. (Quebec Universal Drug Plan) if you are covered under a group plan, with the exception of a spouse, age 65 years and over. When filing your Quebec Income Tax return, you will be asked if you have met the requirements of Bill 33.

8 3500 de Maisonneuve Blvd., W., Suite 2200 Westmount (QC) H3Z 3C1 Building Delta Laurier Blvd., Suite 700 Québec (QC) G1V 2M