CDSPI Retiree Benefits

Transcription

1 CDSPI Retiree Benefits HEALTH BENEFITS AT GREATLY PREFERRED PRICING EXCLUSIVELY FOR RETIRED DENTISTS In retirement you can continue protecting yourself and your family with personal health insurance through CDSPI Retiree Benefits. This health and dental benefits program, which is offered at greatly preferred pricing without medical information, reflects CDSPI s ongoing commitment to providing relevant financial services solutions for dentists through all stages of their lives and careers. As a retired dentist or soon-to-be retired dentist you may apply for CDSPI Retiree Benefits without providing medical information if you are a participant in an existing health benefits plan when you apply for CDSPI Retiree Benefits, or you were a participant in a plan that has recently ended and your application for CDSPI Retiree Benefits is received within 60 days of the end date of your current health benefits plan. CDSPI Retiree Benefits are provided under the FollowMe Health benefit program* through CDSPI s affiliation with Manulife Financial, a leading Canadian-based insurance company which has earned the trust of Canadians for more than 120 years. GAIN THESE ADVANTAGES Greatly preferred pricing through CDSPI s affiliation with Manulife Financial Coverage for prescription medications, dental, vision, extended health care and more A choice of health benefit plans Basic, Enhanced, Enhanced Plus and Premiere Guaranteed access to coverage if you apply within 60 days of the end date of your current health benefits plan CDSPI Retiree Benefits are not available to dentists in Quebec and Ontario. If you are arranging for coverage to begin on or after your retirement date. *Underwritten by The Manufacturers Life Insurance Company (Manulife Financial). If you have questions about the plan, or would like to obtain no-cost insurance planning advice* from a licensed professional, please call CDSPI Advisory Services Inc. toll-free: * Restrictions may apply to advisory services in certain jurisdictions.

2 CDSPI Retiree Benefits Providing Health Care Protection at Retirement GAIN SOLID PROTECTION In addition to greatly preferred pricing, CDSPI Retiree Benefits offers coverage for a comprehensive range of essential health care services, including: PRESCRIPTION DRUGS Prescription medication that you or your family may require. DENTAL SERVICES (available with the Enhanced Plus and Premiere plans) Expenses such as examinations, cleanings, fillings, extractions, X-rays and more. VISION CARE Prescription lenses and frames, contact lenses and laser eye surgery, plus coverage towards the cost of optometrist visits. HOSPITAL BENEFITS Preferred hospital accommodation, in excess of the standard ward room rate. EXTENDED HEALTH CARE Registered Specialists and Therapists Includes visits to chiropractors, acupuncturists, osteopaths, podiatrists, naturopaths, chiropodists, registered massage therapists, physiotherapists, psychologists and speech therapists. Homecare and Nursing Medical care in your home from a registered nurse, registered practical nurse, certified home support worker, occupational therapist, registered dietician, registered nursing assistant or health care aide. Prosthetic Appliances and Durable Medical Equipment Surgical bandages and dressings, purchase or rental of equipment such as crutches, non-electric wheelchairs and hospital beds, oxygen and more. Also includes prosthetic appliances such as artificial limbs, eyes, splints, casts and breast prostheses. Accidental Dental Payment over-and-above your regular dental coverage, when dental treatment is required due to an accidental blow to the head or mouth. Hearing Aids Payment towards the purchase and/or repair of hearing aids. Ambulance Services Covers trips to hospitals in a licensed ground ambulance or air ambulance. Lifeline Emergency Response Service Provides 24-hour monitoring service for people coping with medical problems at home and wanting to lead more independent lives. Obtain Additional Benefits and Services With the coverage, you ll also gain a Survivor Benefit and Accidental Death and Dismemberment insurance coverage. You can also take advantage of helpful services, including the Health Service Navigator (which provides information and resources to help you navigate the Canadian healthcare system) and PVS Preferred Vision Services (which provides discounts for vision and hearing aid products and services). Choose the Plan That s Right for You CDSPI Retiree Benefits allow you to decide which level of protection best suits your needs and budget so you only pay for the health coverage you really want and need. There are four different plans to choose from: Basic, Enhanced, Enhanced Plus and Premiere. Each one offers varying levels of coverage and benefits (see Plan Comparison Chart on pages 6-7). Fast and Convenient Service With hassle-free electronic claims submission most of your prescription drug and dental claims can be settled automatically using your personalized health benefits card giving you one less thing to worry about. Eligibility You are eligible to apply for CDSPI Retiree Benefits as long as you are a dentist who is: a Canadian resident (excluding residents of Quebec and Ontario); retired (or soon-to-be retired ) and was previously or is currently licensed as a dentist in any Canadian province or territory; a participant in a health benefits plan (or were a participant in one that has recently ended) and your application is received within 60 days of the end date of your current health benefits plan. Conditions and Limitations This information is provided for your general guidance. Precise details, terms, conditions and exclusions are set out in the insurance policy. Monthly Premiums by Province and Territory These greatly preferred premium rates (see following pages) are provided through CDSPI s affiliation with Manulife Financial. Select your province or territory of residence to see the monthly premium amount. Premiums are based on an individual s age at the time of application. Premiums will change as an individual s age increases in accordance with published age groups. Premiums for couples and children are per each individual. Premiums are effective January 1, Health Service Navigator is offered through service providers Novus Health and WorldCare Inc. PVS Preferred Vision Services are offered through Manulife Financial. Lifeline is a trademark of Lifeline Systems Inc. TM/ Trademarks of The Manufacturers Life Insurance Company. 2

3 Territories Residents Age Group Basic Enhanced (Without Enhanced (With Premiere $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $23.05 $29.45 $61.90 $ $23.05 $29.45 $61.90 $ $20.72 $26.46 $55.58 $ $20.72 $26.46 $55.58 $84.20 Alberta Residents $56.58 $ $ $ $65.40 $ $ $ $72.97 $ $ $ $76.79 $ $ $ $62.82 $ $ $ $68.31 $ $ $ $75.13 $ $ $ $96.84 $ $ $ $50.75 $ $ $ $59.57 $ $ $ $66.98 $ $ $ $70.89 $ $ $ $57.24 $ $ $ $62.48 $ $ $ $69.47 $ $ $ $91.19 $ $ $ $17.97 $22.96 $47.01 $ $17.97 $22.96 $47.01 $ $16.39 $20.63 $42.35 $ $16.39 $20.63 $42.35 $63.81 British Columbia Residents $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $17.14 $22.30 $45.43 $ $17.14 $22.30 $45.43 $ $15.48 $20.13 $40.77 $ $15.48 $20.13 $40.77 $60.24 Saskatchewan Residents $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $16.89 $21.72 $41.85 $ $16.89 $21.72 $41.85 $ $15.14 $19.47 $37.52 $ $15.14 $19.47 $37.52 $55.83 All premium rates are quoted on a per month per person basis and exclude any applicable PST. 3

4 4 Manitoba Residents $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $17.31 $22.30 $44.76 $ $17.31 $22.30 $44.76 $ $15.56 $20.05 $40.10 $ $15.56 $20.05 $40.10 $59.65 Prince Edward Island Residents Age Group Basic Enhanced (Without Enhanced (With Premiere $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $18.47 $23.88 $47.84 $ $18.47 $23.88 $47.84 $ $16.81 $21.63 $43.18 $ $16.81 $21.63 $43.18 $63.81 All premium rates are quoted on a per month per person basis and exclude any applicable PST. New Brunswick Residents $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $19.22 $24.71 $48.42 $ $19.22 $24.71 $48.42 $ $17.31 $22.30 $43.60 $ $17.31 $22.30 $43.60 $64.90 Nova Scotia Residents $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $18.30 $23.71 $45.93 $ $18.30 $23.71 $45.93 $ $16.47 $21.30 $41.52 $ $16.47 $21.30 $41.52 $60.74

5 Newfoundland Residents Age Group Basic Enhanced (Without Enhanced (With Premiere $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $17.14 $22.38 $45.34 $ $17.14 $22.38 $45.34 $ $15.48 $20.13 $40.68 $ $15.48 $20.13 $40.68 $60.40 All premium rates are quoted on a per month per person basis and exclude any applicable PST. 5

6 Plan Comparison Chart PRESCRIPTION DRUGS Generic* coverage Shared dispensing fee Co-payment Anniversary year maximums DENTAL SERVICES Covers services, paid at a percentage of the current Dental Association Fee Schedule or the reasonable and customary charge in your province of residence. Reimbursement on exams, cleanings, fillings, scaling, polishing, root planing, diagnostic, select extractions and other basic dental services Reimbursement on extensive services including oral surgery, endodontics and periodontics, as well as denture services Reimbursement on crowns, bridges, dentures and orthodontics Anniversary year maximums Recall visits Note: If applicable, dental coverage begins at the age when your provincial health insurance plan coverage ends. VISION CARE Covers the costs towards prescription lenses and frames, contact lenses and laser eye surgery. This benefit does not include industrial safety glasses. HOSPITAL BENEFITS Preferred hospital accommodation in excess of the standard ward room rate made by a general (acute care) hospital. Also included is a cash benefit in lieu of the room cost for each day you are not able to obtain preferred accommodation. Type of accommodation Maximum charge per day Reimbursement per anniversary year Cash benefit in lieu of accommodation: Per day Maximum EXTENDED HEALTHCARE BENEFITS: Registered Specialists and Therapists Includes visits to Acupuncturists, Chiropractors, Osteopaths, Podiatrists, Naturopaths, Chiropodists, Registered Massage Therapists, Physiotherapists, Psychologists and Speech Therapists. Registered Specialists and Therapists Maximum claims paid Per visit maximum Chiropractic x-rays Registered Psychologist Maximum per first visit Maximum per subsequent visit Maximum visits per year Registered Speech Therapist Maximum per first visit Maximum per subsequent visit Maximum visits per year Basic Enhanced Enhanced Plus Premiere Generic No maximum $450 N/A N/A $150 per 2 benefit years plus $50 for Optometrist visit per 2 benefit years Semi-private room $175 50% for 150 days $25/day $1,500 maximum Lifetime maximum $100, visit maximum per specialist per year $15 per visit $35 per year $80 $45 Generic No maximum $900 N/A N/A $200 per 2 benefit years plus $50 for Optometrist visit per 2 benefit years Semi-private room $175 0% first 60 days; 50% next 90 days $50/day $3,000 maximum Lifetime maximum $200,000 $600 combined per $35 per year $80 $45 Generic No maximum $900 Year 1 $700; Year 2 $850; Year 3+ $1,000 9 months $200 per 2 benefit years plus $50 for Optometrist visit per 2 benefit years Semi-private room $175 0% first 60 days; 50% next 90 days $50/day $3,000 maximum Lifetime maximum $200,000 $600 combined per $35 per year $80 $45 Generic No maximum $2,000 60% commencing in Year 3 Year 1 $800; Year 2 $1,000; Year 3+ $1,500 6 months $250 per 2 benefit years plus $50 for Optometrist visit per 2 benefit years Semi-private or private room $200 0% first 100 days; 60% next 90 days $50/day $5,000 maximum Lifetime maximum $300,000 $600 combined per $35 per year $80 12 $

7 Homecare and Nursing, Prosthetic Appliances and Durable Medical Equipment Covers the services of registered health professionals including Registered Nurse, Registered Practical Nurse, Certified Home Support Worker, Occupational Therapist, Registered Dietician, Registered Nursing Assistant or healthcare aide; includes surgical bandages and dressings and the purchase or rental of medically necessary equipment. Payment will be coordinated where benefits are available through the Assistive Devices Program. Custom-Made Orthotics Covers charges for the purchase of custom-made orthotics (plaster cast or computer topography). Accidental Dental Covers dental treatment required as a result of an accidental blow to the head or mouth. Treatment must be sought within the 90-day period following the accident. Hearing Aids Covers the costs to purchase and/or repair up to the allowed maximum. Ambulance Services Covers trips to hospitals in a licensed ambulance. Covers charges up to the amount between what your provincial health plan covers and what is reasonable and customary. Lifeline Emergency Response Service Provides 24-hour monitoring service for people coping with medical problems at home. HEALTH SERVICE NAVIGATOR Offers evaluation of medical records upon diagnosis of serious illness or injury. PREFERRED VISION SERVICES (PVS) Offers discounts for vision and hearing aid products and services through participating optical outlets and PVS Preferred provider Hearing Healthcare Centres. FRACTURE BENEFIT Pays a scheduled amount depending on which bone is fractured. If more than one bone is fractured in a single accident, the amount payable is for the most severe fracture. ACCIDENTAL DEATH AND DISMEMBERMENT Payment for accidental death or dismemberment directly resulting from an accident, occurring within one year of the date of the accident. SURVIVOR BENEFIT Provides for continuous coverage for 1 year, following the death of an adult policyholder Basic Enhanced Enhanced Plus Premiere For each of Homecare & Nursing, Prosthetic Appliances and Durable Medical Equipment: Year 1: $500 Year 2: $750 Year 3+: $1,250 $250 maximum per Maximum of $2,000 per year For each of Homecare & Nursing, Prosthetic Appliances and Durable Medical Equipment: Year 1: $1,000 Year 2: $1,500 Year 3+: $3,000 $250 maximum per Maximum of $2,500 per year For each of Homecare & Nursing, Prosthetic Appliances and Durable Medical Equipment: Year 1: $1,000 Year 2: $1,500 Year 3+: $3,000 $250 maximum per Maximum of $2,500 per year For each of Homecare & Nursing, Prosthetic Appliances and Durable Medical Equipment: $3,000 per year $250 maximum per Maximum of $3,000 per year $300/5 benefit years $400/5 benefit years $400/5 benefit years $600/4 benefit years Unlimited ground transport Up to $4,000 air ambulance per year Maximum of 6 months per lifetime Unlimited ground transport Up to $4,000 air ambulance per year Maximum of 6 months per lifetime Unlimited ground transport Up to $4,000 air ambulance per year Maximum of 6 months per lifetime Unlimited ground transport Up to $4,000 air ambulance per year Included Included Included Included Included Included Included Included Maximum of 6 months per lifetime Not available Up to $350 Up to $350 Up to $500 $10,000 for adults $5,000 for children and persons aged 65 years or over $25,000 for adults $10,000 for children and persons aged 65 years or over $25,000 for adults $10,000 for children and persons aged 65 years or over Included Included Included Included $50,000 for adults $15,000 for children and persons aged 65 years or over * Generic Drug A generally less expensive alternative to an interchangeable brand-name drug product. Exclusions: smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, erectile dysfunction drugs,and drugs not requiring a prescription. Other exclusions apply; please consult your policy for details. Prescription drug coverage in the provinces of British Columbia and Saskatchewan is based on calendar year. Benefits are only payable after yearly maximums allowed under your provincial health insurance plan have been reached, if applicable. Benefits payable are up to reasonable and customary charges. Anniversary year means the consecutive 12 months following the effective date of the agreement, and each 12-month period thereafter. Benefit year means the 12 consecutive months following the incurred date of the claim. Calendar year means each successive 12-month period commencing January 1 and ending December 31. All references to year refer to. When it relates to Hearing Aids and Vision Care benefits, year refers to benefit year. Please note: Not all drugs have a generic equivalent. If a non-generic drug is purchased, payment will be based on the lowest generic drug cost equivalent. If no generic brand exists, payment of the brand-name price will be made at the co-payment level of your plan. Health Service Navigator is offered through service providers Novus Health and WorldCare Inc. PVS Preferred Vision Services are offered through Manulife Financial. Lifeline is a trademark of Lifeline Systems Inc. TM/ Trademarks of The Manufacturers Life Insurance Company. 7

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