Simple and affordable health care protection for you and your family Your guide to Flexcare Province of Ontario
Table of contents How to build your own plan 2 g 3 DrugPlusTM Basic plan details DrugPlusTM Basic plan details For Seniors 65+ 4 5 DrugPlusTM Enhanced plan details DrugPlusTM Enhanced plan details For Seniors 65+ 6 7 DentalPlusTM Basic plan details DentalPlusTM Basic plan details For Seniors 65+ DentalPlusTM Enhanced plan details DentalPlusTM Enhanced plan details For Seniors 65+ 8 11 13 g g ComboPlusTM Starter plan details ComboPlusTM Starter plan details For Seniors 65+ 12 14 15 16 ComboPlusTM Basic plan details ComboPlusTM Basic plan details For Seniors 65+ 17 19 g ComboPlusTM Enhanced plan details ComboPlusTM Enhanced plan details For Seniors 65+ 21 23 g Add-On and Stand-Alone Options 9 10 g g g 18 20 22 24 25
Building your own plan is as easy as 1, 2, 3 Step 1 > Choose a core plan and coverage level Choose the core plan that s just right for your needs and your budget. DrugPlus TM > Basic plan > Enhanced plan DentalPlus TM > Basic plan > Enhanced plan ComboPlus TM > Starter plan > Basic plan > Enhanced plan Step 2 > Customize your Flexcare plan Want to increase your coverage in certain areas? You can customize your core plan with Add-On options, including: > Vision Enhanced 1 > Hospital Basic > Hospital Enhanced > Accidental Death & Dismemberment Enhanced > Catastrophic Coverage 2 > Travel 3 1 Not available with the ComboPlus TM Starter Plan. 2 Only available with the DrugPlus TM and ComboPlus TM Basic and Enhanced Plans. 3 Travel not available to persons age 65 and over; travel coverage ceases at age 65. You can also choose Stand-Alones to give you the coverage you want without purchasing a more comprehensive plan. Choose from: > Hospital > Catastrophic Coverage Step 3 > Apply now Contact your Advisor today. Your coverage can begin as early as the first of the month following your application. Have this information on hand: > The provincial health card numbers of everyone applying for coverage; > Your Physician s name and telephone number; > The name of any prescription medication you are taking; > Your credit card information or bank information for a pre-authorized payment plan; > If you have or recently had group insurance, the name of the insurer, your group plan and subscriber ID, and the date the benefits end; and > Your driver s licence (if applying for Catastrophic Coverage) 2
Step 1 Step 2 Choose your plan Customize your plan Add-On (to a core plan) DrugPlus Basic Plan TM Basic drug coverage (generic drugs). Includes Extended Health Care coverage. DrugPlus Enhanced Plan + TM Enhanced drug coverage (generic and brand-name). Includes Extended Health Care coverage. DentalPlus Basic Plan + TM Basic dental coverage for services such as fillings, cleanings, scalings, examinations, polishing and select extractions. Includes Extended Health Care coverage. + DentalPlus Enhanced Plan TM Provides basic dental coverage with additional coverage for oral surgery, periodontics, root canals, crowns, dentures and orthodontics. Includes Extended Health Care coverage. Vision Enhanced AD&D Enhanced Hospital Basic Travel +8 days Catastrophic Coverage ($4,500 deductible) Hospital Enhanced Travel +21 days Vision Enhanced AD&D Enhanced Hospital Basic Travel +8 days Hospital Enhanced Travel +21 days Catastrophic Coverage ($10,200 deductible) Vision Enhanced AD&D Enhanced Hospital Basic Travel +8 days Vision Enhanced + Travel +8 days Travel +21 days ComboPlus Basic Plan TM Provides a high level of coverage for generic drugs and basic dental services such as fillings, cleanings, scalings, examinations, polishing and select extractions. Includes Extended Health Care coverage. + ComboPlus Enhanced Plan TM Provides the highest level of generic and brand-name drug coverage including birth control and fertility drugs, and basic dental coverage with additional coverage for oral surgery, periodontics, root canals, crowns, dentures and orthodontics. Includes Extended Health Care coverage. + OR Choose Stand-Alone Plans (top up on existing coverage) Step 3 Hospital Basic Hospital Enhanced Travel +21 days Provides coverage for generic drugs and basic dental services such as fillings, cleanings, scalings, examinations, polishing and select extractions. Includes Extended Health Care coverage. + AD&D Enhanced Travel +8 days ComboPlus Starter Plan TM Hospital Enhanced Travel +21 days AD&D Enhanced Hospital Basic Hospital Enhanced Vision Enhanced AD&D Enhanced Hospital Basic Travel +8 days Hospital Enhanced Travel +21 days Catastrophic Coverage ($4,500 deductible) Vision Enhanced AD&D Enhanced Hospital Basic Travel +8 days Catastrophic Coverage ($10,200 deductible) Hospital Enhanced Travel +21 days Hospital Basic Catastrophic Coverage ($4,500 deductible) Hospital Enhanced Catastrophic Coverage ($10,200 deductible) Apply today Apply at any age,* renewable coverage for a lifetime. *For the applicant and co-applicant, minimum age for application is 18. For family plans, children age 20 and under can apply as dependants. Guaranteed to Issue Plan NO MEDICAL UNDERWRITING REQUIRED 3
DrugPlus TM Basic Prescription Drugs > Generic drug plan (brand-name allowed, benefit paid will be the generic equivalent price) > Full coverage of reasonable and customary dispensing fees Prescription Drug coverage Percentage paid On your first $750 of eligible prescription costs 70% $525 On your next $4,972 of eligible prescription costs 90% $4,475 Total benefits payable per person $5,000 Exclusions Smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, erectile dysfunction drugs and drugs not requiring a prescription. The following core benefits are also included with DrugPlus Basic: Vision (Basic) > $250 per 2 consecutive benefit years to cover the costs towards prescription lenses, frames, contact lenses and laser eye surgery. Extended Health Care (Basic) Lifetime Maximum $250,000 Registered Specialists and Therapists: Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist Homecare and Nursing, Prosthetic Appliances, Durable Medical Equipment 20-visit per discipline $35 $80 maximum first visit, $65 maximum subsequent visits, 15-visit $250 $65 maximum first visit, $45 maximum subsequent visits, 10-visit $3,500 for each of these 3 categories of benefits separately $225 $2,000 Unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per person $400 per 4 consecutive benefit years. PVS discounts offer the added advantage of a 10% deduction, depending on the province of residence and hearing practitioner participation in the PVS network. Travel > $5,000,000 emergency health coverage per person for trips lasting a maximum of 9 days. (A $100 deductible applies per claim.) > Additional coverage for either 8 or 21 days can be purchased as an Add-On. Note: Coverage may be limited or excluded for any illness or condition which first manifested itself within the 9-month period immediately preceding each departure date. Not available to persons age 65 and over. > Up to $25,000 upon the Accidental Death or Dismemberment of an adult under 65 or up to $10,000 for a dependent child. > Provides continued coverage for 1 year, following the death of an adult policyholder. 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-month period following the date a claim for a specific benefit is first incurred, and each 12-month period thereafter. Calendar Year means the 12-consecutive-month period commencing January 1 and ending December 31. 4
DrugPlus TM Basic For Seniors 65+ Prescription Drugs > Generic drug plan (brand-name allowed, benefit paid will be the generic equivalent price) > Full coverage of reasonable and customary dispensing fees Prescription Drug coverage Exclusions Smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, erectile dysfunction drugs and drugs not requiring a prescription. The following core benefits are also included with DrugPlus Basic: Renewable Coverage for a Lifetime Vision (Basic) > $250 per 2 consecutive benefit years to cover the costs towards prescription lenses, frames, contact lenses and laser eye surgery. Extended Health Care (Basic) Lifetime Maximum $260,000 Registered Specialists and Therapists: Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist Homecare and Nursing, Prosthetic Appliances, Durable Medical Equipment Percentage paid 20-visit per discipline $35 $80 maximum first visit, $65 maximum subsequent visits, 15-visit $250 $65 maximum first visit, $45 maximum subsequent visits, 15-visit $4,000 for each of these 3 categories of benefits separately $225 $2,000 > Up to $10,000 upon the Accidental Death or Dismemberment of an adult 65 and over. > Provides continued coverage for 1 year, following the death of an adult policyholder. On your first $750 of eligible prescription costs 100% $750 On your next $4,722 of eligible prescription costs 90% $4,250 Total benefits payable per person $5,000 Unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per person $500 per 4 consecutive benefit years. PVS discounts offer the added advantage of a 10% deduction, depending on the province of residence and hearing practitioner participation in the PVS network. 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-month period following the date a claim for a specific benefit is first incurred, and each 12-month period thereafter. Calendar Year means the 12-consecutive-month period commencing January 1 and ending December 31. 5
DrugPlus TM Enhanced Prescription Drugs > Brand-name or generic drugs, including birth control and fertility drugs > Full coverage of reasonable and customary dispensing fees Prescription Drug coverage Percentage paid Exclusions Smoking cessation drugs, over-the-counter drugs, erectile dysfunction drugs and drugs not requiring a prescription. On your first $2,222 of eligible prescription costs 90% $2,000 On your next $8,000 of eligible prescription costs 100% $8,000 Total benefits payable per person $10,000 The following core benefits are also included with DrugPlus Enhanced: Vision (Basic) > $250 per 2 consecutive benefit years to cover the costs towards prescription lenses, frames, contact lenses and laser eye surgery. Extended Health Care (Basic) Lifetime Maximum $250,000 Registered Specialists and Therapists: Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist Homecare and Nursing, Prosthetic Appliances, Durable Medical Equipment 20-visit per discipline $35 $80 maximum first visit, $65 maximum subsequent visits, 15-visit $250 $65 maximum first visit, $45 maximum subsequent visits, 10-visit $3,500 for each of these 3 categories of benefits separately $225 $2,000 Unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per person $400 per 4 consecutive benefit years. PVS discounts offer the added advantage of a 10% deduction, depending on the province of residence and hearing practitioner participation in the PVS network. Travel > $5,000,000 emergency health coverage per person for trips lasting a maximum of 9 days. (A $100 deductible applies per claim.) > Additional coverage for either 8 or 21 days can be purchased as an Add-On. Note: Coverage may be limited or excluded for any illness or condition which first manifested itself within the 9-month period immediately preceding each departure date. Not available to persons age 65 and over. > Up to $25,000 upon the Accidental Death or Dismemberment of an adult under 65 or up to $10,000 for a dependent child. > Provides continued coverage for 1 year, following the death of an adult policyholder. 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-month period following the date a claim for a specific benefit is first incurred, and each 12-month period thereafter. Calendar Year means the 12-consecutive-month period commencing January 1 and ending December 31. 6
DrugPlus TM Enhanced For Seniors 65+ Prescription Drugs > Brand-name or generic drugs, including birth control and fertility drugs > Full coverage of reasonable and customary dispensing fees Prescription Drug coverage Exclusions Smoking cessation drugs, over-the-counter drugs, erectile dysfunction drugs and drugs not requiring a prescription. The following core benefits are also included with DrugPlus Enhanced: Vision (Basic) > $250 per 2 consecutive benefit years to cover the costs towards prescription lenses, frames, contact lenses and laser eye surgery. Extended Health Care (Basic) Lifetime Maximum $260,000 Registered Specialists and Therapists: Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist Homecare and Nursing, Prosthetic Appliances, Durable Medical Equipment Percentage paid 20-visit per discipline $35 $80 maximum first visit, $65 maximum subsequent visits, 15-visit $250 $65 maximum first visit, $45 maximum subsequent visits, 15-visit $4,000 for each of these 3 categories of benefits separately $225 $2,000 > Up to $10,000 upon the Accidental Death or Dismemberment of an adult 65 and over. > Provides continued coverage for 1 year, following the death of an adult policyholder. On your first $750 of eligible prescription costs 100% $750 On your next $10,278 of eligible prescription costs 90% $9,250 Total benefits payable per person $10,000 Renewable Coverage for a Lifetime Unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per person $500 per 4 consecutive benefit years. PVS discounts offer the added advantage of a 10% deduction, depending on the province of residence and hearing practitioner participation in the PVS network. 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-month period following the date a claim for a specific benefit is first incurred, and each 12-month period thereafter. Calendar Year means the 12-consecutive-month period commencing January 1 and ending December 31. 7
DentalPlus TM Basic Dental > Dental coverage for fillings, cleanings, scalings, examinations, polishing and select extractions > Recall visits every 9 months, per person Year 1 Percentage paid On your first $1,150 of eligible services 50% $575 Total benefits payable per person in your first anniversary year $575 Year 2 and beyond On your first $400 of eligible services 80% $320 On your next $860 of eligible services 50% $430 Total benefits payable per person in your second and subsequent anniversary years $750 Guaranteed to Issue Plan NO MEDICAL UNDERWRITING REQUIRED Coverages are designed to coincide with your current provincial Dental Association Fee Guide for General Practitioners. The following core benefits are also included with DentalPlus Basic: Vision (Basic) > $250 per 2 consecutive benefit years to cover the costs towards prescription lenses, frames, contact lenses and laser eye surgery. Extended Health Care (Starter) Lifetime Maximum $250,000 Registered Specialists and Therapists: Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist Homecare and Nursing, Prosthetic Appliances, Durable Medical Equipment 20-visit per discipline $35 $80 maximum first visit, $65 maximum subsequent visits, 10-visit $250 $65 maximum first visit, $45 maximum subsequent visits, 10-visit For each of Homecare & Nursing, Prosthetic Appliances and Durable Medical Equipment: Year 1 Year 2 Year 3 Year 4 Year 5+ $1,000 $1,300 $1,500 $1,700 $3,000 $225 $2,000 Unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per person $400 per 4 consecutive benefit years. PVS discounts offer the added advantage of a 10% deduction, depending on the province of residence and hearing practitioner participation in the PVS network. 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-month period following the date a claim for a specific benefit is first incurred, and each 12-month period thereafter. Calendar Year means the 12-consecutive-month period commencing January 1 and ending December 31. 8
DentalPlus TM Basic Travel > $5,000,000 emergency health coverage per person for trips lasting a maximum of 9 days. (A $100 deductible applies per claim.) > Additional coverage for either 8 or 21 days can be purchased as an Add-On. Note: Coverage may be limited or excluded for any illness or condition which first manifested itself within the 9-month period immediately preceding each departure date. Not available to persons age 65 and over. > Up to $25,000 upon the Accidental Death or Dismemberment of an adult under 65 or up to $10,000 for a dependent child. > Provides for coverage to be continued for 1 year, following the death of an adult policyholder. > Available 1 year after policy effective date. Guaranteed to Issue Plan NO MEDICAL UNDERWRITING REQUIRED 9
DentalPlus TM Basic For Seniors 65+ Dental > Dental coverage for fillings, cleanings, scalings, examinations, polishing and select extractions > Recall visits every 9 months, per person Year 1 Percentage paid On your first $1,150 of eligible services 50% $575 Total benefits payable per person in your first anniversary year $575 Year 2 and beyond On your first $400 of eligible services 80% $320 On your next $860 of eligible services 50% $430 Total benefits payable per person in your second and subsequent anniversary years Coverages are designed to coincide with your current provincial Dental Association Fee Guide for General Practitioners. $750 Renewable Coverage for a Lifetime Guaranteed to Issue Plan NO MEDICAL UNDERWRITING REQUIRED The following core benefits are also included with DentalPlus Basic: Vision (Basic) > $250 per 2 consecutive benefit years to cover the costs towards prescription lenses, frames, contact lenses and laser eye surgery. Extended Health Care (Starter) Lifetime Maximum $260,000 Registered Specialists and Therapists: Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist Homecare and Nursing, Prosthetic Appliances, Durable Medical Equipment 20-visit per discipline $35 $80 maximum first visit, $65 maximum subsequent visits, 10-visit $250 $65 maximum first visit, $45 maximum subsequent visits, 15-visit For each of Homecare & Nursing, Prosthetic Appliances and Durable Medical Equipment: Year 1 Year 2 Year 3 Year 4 Year 5+ $1,100 $1,500 $1,700 $2,000 $3,500 $225 $2,000 > Up to $10,000 upon the Accidental Death or Dismemberment of an adult 65 and over. > Provides continued coverage for 1 year, following the death of an adult policyholder. > Available 1 year after policy effective date. Unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per person $500 per 4 consecutive benefit years. PVS discounts offer the added advantage of a 10% deduction, depending on the province of residence and hearing practitioner participation in the PVS network. 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-month period following the date a claim for a specific benefit is first incurred, and each 12-month period thereafter. Calendar Year means the 12-consecutive-month period commencing January 1 and ending December 31. 10
DentalPlus TM Enhanced Dental > Dental coverage for fillings, cleanings, scalings, examinations, polishing and select extractions > Recall visits every 6 months, per person Year 1 Percentage paid On your first $1,200 of eligible services 70% $840 Total benefits payable per person in your first anniversary year $840 Guaranteed to Issue Plan NO MEDICAL UNDERWRITING REQUIRED Year 2 and beyond On your first $500 of eligible services 100% $500 On your next $700 of eligible services 60% $420 Total benefits payable per person in your second and subsequent anniversary years $920 The following 6 dental services have a combined maximum of $1,250 per person per 3-year period. For oral surgery, periodontics and endodontics (root canal), benefits are available beginning Year 2; for orthodontics, crowns, bridges and dentures, no benefit is available until Year 3. The payment percentage increases from the effective date of the contract as follows: Anniversary Year 1 Anniversary Year 2 Anniversary Year 3 & beyond Oral Surgery 0% 60% 80% Periodontics 0% 60% 80% Endodontics (Root Canal) 0% 60% 80% Orthodontics 0% 0% 60% Crowns, Bridges 0% 0% 60% Dentures 0% 0% 60% Coverages are designed to coincide with your current provincial Dental Association Fee Guide for General Practitioners. The following core benefits are also included with DentalPlus Enhanced: Vision (Basic) > $250 per 2 consecutive benefit years to cover the costs towards prescription lenses, frames, contact lenses and laser eye surgery. 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-month period following the date a claim for a specific benefit is first incurred, and each 12-month period thereafter. Calendar Year means the 12-consecutive-month period commencing January 1 and ending December 31. 11
DentalPlus TM Enhanced Extended Health Care (Starter) Lifetime Maximum $250,000 Registered Specialists and Therapists: Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist Homecare and Nursing, Prosthetic Appliances, Durable Medical Equipment 20-visit per discipline $35 $80 maximum first visit, $65 maximum subsequent visits, 10-visit maximum per person $250 $65 maximum first visit, $45 maximum subsequent visits, 10-visit maximum per person For each of Homecare & Nursing, Prosthetic Appliances and Durable Medical Equipment: Year 1 Year 2 Year 3 Year 4 Year 5+ $1,000 $1,300 $1,500 $1,700 $3,000 $225 $2,000 Unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per person $400 per 4 consecutive benefit years. PVS discounts offer the added advantage of a 10% deduction, depending on the province of residence and hearing practitioner participation in the PVS network. Guaranteed to Issue Plan NO MEDICAL UNDERWRITING REQUIRED Travel > $5,000,000 emergency health coverage per person for trips lasting a maximum of 9 days. (A $100 deductible applies per claim.) > Additional coverage for either 8 or 21 days can be purchased as an Add-On. Note: Coverage may be limited or excluded for any illness or condition which first manifested itself within the 9-month period immediately preceding each departure date. Not available to persons age 65 and over. > Up to $25,000 upon the Accidental Death or Dismemberment of an adult under 65 or up to $10,000 for a dependent child. > Provides continued coverage for 1 year, following the death of an adult policyholder. > Available 1 year after policy effective date. 12
DentalPlus TM Enhanced For Seniors 65+ Dental > Dental coverage for fillings, cleanings, scalings, examinations, polishing and select extractions > Recall visits every 6 months, per person Year 1 Percentage paid On your first $1,200 of eligible services 70% $840 Total benefits payable per person in your first anniversary year $840 Year 2 and beyond On your first $500 of eligible services 100% $500 On your next $700 of eligible services 60% $420 Total benefits payable per person in your second and subsequent anniversary years $920 Renewable Coverage for a Lifetime Guaranteed to Issue Plan NO MEDICAL UNDERWRITING REQUIRED The following 6 dental services have a combined maximum of $1,250 per person per 3-year period. For oral surgery, periodontics and endodontics (root canal), benefits are available beginning Year 2; for orthodontics, crowns, bridges and dentures, no benefit is available until Year 3. The payment percentage increases from the effective date of the contract as follows: Anniversary Year 1 Anniversary Year 2 Anniversary Year 3 & beyond Oral Surgery 0% 60% 80% Periodontics 0% 60% 80% Endodontics (Root Canal) 0% 60% 80% Orthodontics 0% 0% 60% Crowns, Bridges 0% 0% 60% Dentures 0% 0% 60% Coverages are designed to coincide with your current provincial Dental Association Fee Guide for General Practitioners. The following core benefits are also included with DentalPlus Enhanced: Vision (Basic) > $250 per 2 consecutive benefit years to cover the costs towards prescription lenses, frames, contact lenses and laser eye surgery. 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-month period following the date a claim for a specific benefit is first incurred, and each 12-month period thereafter. Calendar Year means the 12-consecutive-month period commencing January 1 and ending December 31. 13
DentalPlus TM Enhanced For Seniors 65+ Extended Health Care (Starter) Lifetime Maximum $260,000 Registered Specialists and Therapists: Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist Homecare and Nursing, Prosthetic Appliances, Durable Medical Equipment 20-visit per discipline $35 $80 maximum first visit, $65 maximum subsequent visits, 10-visit maximum per person $250 $65 maximum first visit, $45 maximum subsequent visits, 15-visit maximum per person For each of Homecare & Nursing, Prosthetic Appliances and Durable Medical Equipment: Year 1 Year 2 Year 3 Year 4 Year 5+ $1,100 $1,500 $1,700 $2,000 $3,500 $225 $2,000 Unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per person $500 per 4 consecutive benefit years. PVS discounts offer the added advantage of a 10% deduction, depending on the province of residence and hearing practitioner participation in the PVS network. Renewable Coverage for a Lifetime Guaranteed to Issue Plan NO MEDICAL UNDERWRITING REQUIRED > Up to $10,000 upon the Accidental Death or Dismemberment of an adult 65 and over. > Provides continued coverage for 1 year, following the death of an adult policyholder. > Available 1 year after policy effective date. 14
ComboPlus TM Starter Prescription Drugs > Generic drug plan (brand-name allowed, benefit paid will be the generic equivalent price) > Shared dispensing fee to a maximum of $6.50 Prescription Drug coverage 15 Percentage paid On your first $750 of eligible prescription costs (shared dispensing fee inclusive) 70% $525 Guaranteed to Issue Plan Exclusions Smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, erectile dysfunction drugs and drugs not requiring a prescription. NO MEDICAL UNDERWRITING REQUIRED Dental > Dental coverage with a 70% payment for fillings, cleanings, scalings, examinations, and polishing on the first $575 of these services to a maximum of $400 in coverage per person > Recall visits every 9 months, per person Coverages are designed to coincide with your current provincial Dental Association Fee Guide for General Practitioners. The following core benefits are also included with ComboPlus Starter: Vision (Starter) > $150 per 2 consecutive benefit years to cover the costs towards prescription lenses, frames, contact lenses and laser eye surgery. Extended Health Care (Starter) Lifetime Maximum $250,000 Registered Specialists and Therapists: Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist Homecare and Nursing, Prosthetic Appliances, Durable Medical Equipment 20-visit per discipline $35 $80 maximum first visit, $65 maximum subsequent visits, 10-visit $250 $65 maximum first visit, $45 maximum subsequent visits, 10-visit For each of Homecare & Nursing, Prosthetic Appliances and Durable Medical Equipment: Year 1 Year 2 Year 3 Year 4 Year 5+ $1,000 $1,300 $1,500 $1,700 $3,000 $225 $2,000 Unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per person $400 per 4 consecutive benefit years. PVS discounts offer the added advantage of a 10% deduction, depending on the province of residence and hearing practitioner participation in the PVS network. Travel > $5,000,000 emergency health coverage per person for trips lasting a maximum of 9 days. (A $100 deductible applies per claim.) > Additional coverage for either 8 or 21 days can be purchased as an Add-On. Note: Coverage may be limited or excluded for any illness or condition which first manifested itself within the 9-month period immediately preceding each departure date. Not available to persons age 65 and over. > Up to $25,000 upon the Accidental Death or Dismemberment of an adult under 65 or up to $10,000 for a dependent child. > Provides continued coverage for 1 year, following the death of an adult policyholder. > Available 1 year after policy effective date. 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-month period following the date a claim for a specific benefit is first incurred, and each 12-month period thereafter. Calendar Year means the 12-consecutive-month period commencing January 1 and ending December 31.
ComboPlus TM Starter For Seniors 65+ Prescription Drugs > Generic drug plan (brand-name allowed, benefit paid will be the generic equivalent price) > Full coverage of reasonable and customary dispensing fees Prescription Drug coverage Percentage paid On your first $750 of eligible prescription costs 100% $750 Exclusions Smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, erectile dysfunction drugs and drugs not requiring a prescription. Dental > Dental coverage with a 70% payment for fillings, cleanings, scalings, examinations, and polishing on the first $575 of these services to a maximum of $400 in coverage per person > Recall visits every 9 months, per person Coverages are designed to coincide with your current provincial Dental Association Fee Guide for General Practitioners. Renewable Coverage for a Lifetime Guaranteed to Issue Plan NO MEDICAL UNDERWRITING REQUIRED The following core benefits are also included with ComboPlus Starter: Vision (Starter) > $150 per 2 consecutive benefit years to cover the costs towards prescription lenses, frames, contact lenses and laser eye surgery. Extended Health Care (Starter) Lifetime Maximum $260,000 Registered Specialists and Therapists: Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist Homecare and Nursing, Prosthetic Appliances, Durable Medical Equipment 20-visit per discipline $35 $80 maximum first visit, $65 maximum subsequent visits, 10-visit $250 $65 maximum first visit, $45 maximum subsequent visits, 15-visit For each of Homecare & Nursing, Prosthetic Appliances and Durable Medical Equipment: Year 1 Year 2 Year 3 Year 4 Year 5+ $1,100 $1,500 $1,700 $2,000 $3,500 $225 $2,000 Unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per person $500 per 4 consecutive benefit years. PVS discounts offer the added advantage of a 10% deduction, depending on the province of residence and hearing practitioner participation in the PVS network. > Up to $10,000 upon the Accidental Death or Dismemberment of an adult 65 and over. > Provides continued coverage for 1 year, following the death of an adult policyholder. > Available 1 year after policy effective date. 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-month period following the date a claim for a specific benefit is first incurred, and each 12-month period thereafter. Calendar Year means the 12-consecutive-month period commencing January 1 and ending December 31. 16
ComboPlus TM Basic Prescription Drugs > Generic drug plan (brand-name allowed, benefit paid will be the generic equivalent price) > Full coverage of reasonable and customary dispensing fees Prescription Drug coverage Percentage paid On your first $750 of eligible prescription costs 70% $525 On your next $4,972 of eligible prescription costs 90% $4,475 Total benefits payable per person $5,000 Exclusions Smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, erectile dysfunction drugs and drugs not requiring a prescription. Dental > Dental coverage is for fillings, cleanings, scalings, examinations, polishing and select extractions > Recall visits every 9 months, per person Dental coverage Percentage paid On your first $400 of eligible services 80% $320 On your next $860 of eligible services 50% $430 Total benefits payable per person $750 Coverages are designed to coincide with your current provincial Dental Association Fee Guide for General Practitioners. The following core benefits are also included with ComboPlus Basic: Vision (Basic) > $250 per 2 consecutive benefit years to cover the costs towards prescription lenses, frames, contact lenses and laser eye surgery. Extended Health Care (Basic) Lifetime Maximum $250,000 Registered Specialists and Therapists: Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist Homecare and Nursing, Prosthetic Appliances, Durable Medical Equipment 20-visit per discipline $35 $80 maximum first visit, $65 maximum subsequent visits, 15-visit $250 $65 maximum first visit, $45 maximum subsequent visits, 10-visit $3,500 for each of these 3 categories of benefits separately $225 $2,000 Unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per person $400 per 4 consecutive benefit years. PVS discounts offer the added advantage of a 10% deduction, depending on the province of residence and hearing practitioner participation in the PVS network. 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-month period following the date a claim for a specific benefit is first incurred, and each 12-month period thereafter. Calendar Year means the 12-consecutive-month period commencing January 1 and ending December 31. 17
ComboPlus TM Basic Travel > $5,000,000 emergency health coverage per person for trips lasting a maximum of 9 days. (A $100 deductible applies per claim.) > Additional coverage for either 8 or 21 days can be purchased as an Add-On. Note: Coverage may be limited or excluded for any illness or condition which first manifested itself within the 9-month period immediately preceding each departure date. Not available to persons age 65 and over. > Up to $25,000 upon the Accidental Death or Dismemberment of an adult under 65 or up to $10,000 for a dependent child. > Provides continued coverage for 1 year, following the death of an adult policyholder. 18
ComboPlus TM Basic For Seniors 65+ Prescription Drugs > Generic drug plan (brand-name allowed, benefit paid will be the generic equivalent price) > Full coverage of reasonable and customary dispensing fees Prescription Drug coverage Percentage paid On your first $750 of eligible prescription costs 100% $750 On your next $4,722 of eligible prescription costs 90% $4,250 Total benefits payable per person $5,000 Exclusions Smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, erectile dysfunction drugs and drugs not requiring a prescription. Dental > Dental coverage is for fillings, cleanings, scalings, examinations, polishing and select extractions > Recall visits every 9 months, per person Dental coverage Percentage paid On your first $400 of eligible services 80% $320 On your next $860 of eligible services 50% $430 Total benefits payable per person $750 Coverages are designed to coincide with your current provincial Dental Association Fee Guide for General Practitioners. Renewable Coverage for a Lifetime The following core benefits are also included with ComboPlus Basic: Vision (Basic) > $250 per 2 consecutive benefit years to cover the costs towards prescription lenses, frames, contact lenses and laser eye surgery. Extended Health Care (Basic) Lifetime Maximum $260,000 Registered Specialists and Therapists: Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist Homecare and Nursing, Prosthetic Appliances, Durable Medical Equipment 20-visit per discipline $35 $80 maximum first visit, $65 maximum subsequent visits, 15-visit $250 $65 maximum first visit, $45 maximum subsequent visits, 15-visit $4,000 for each of these 3 categories of benefits separately $225 $2,000 Unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per person $500 per 4 consecutive benefit years. PVS discounts offer the added advantage of a 10% deduction, depending on the province of residence and hearing practitioner participation in the PVS network. 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-month period following the date a claim for a specific benefit is first incurred, and each 12-month period thereafter. Calendar Year means the 12-consecutive-month period commencing January 1 and ending December 31. 19