Health & Dental

Lifetime Maximum – $250,000 per person

Health Service Navigator® – With Health Service Navigator, you and your eligible family members can quickly and easily get answers to your questions and access to support services. Easily accessible on the web or with a simple call to a dedicated toll-free line, you will be connected to Health Service Navigator where you can receive information, medical coordination services and resources on how to navigate the Canadian health care system. And, if you want a second opinion from a world-class hospital, Health Service Navigator will help you get it.

Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist – $20 maximum per visit, 20 visit maximum per person per discipline per anniversary year Chiropractic X-ray – $35 maximum per person per anniversary year Psychologist – $80 maximum first visit, $65 maximum subsequent visits, 15 visit maximum per person per anniversary year Physiotherapist – $250 maximum per person per anniversary year Home care and Nursing, Prosthetic Appliances, Durable Medical Equipment – $3,500 maximum per person per anniversary year, for each of these 3 categories of benefits separately Custom-made Orthotics – $225 maximum per person per anniversary year Speech Pathologist/Therapist – $65 maximum first visit, $45 maximum subsequent visits, 10 visit maximum per person per anniversary year Lifeline ® Personal Response Service – maximum of 6 months of service per person per 3 anniversary years.

Accidental Dental – $2,000 maximum per person per anniversary year Ambulance – unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per person per anniversary year Hearing Aid – $400 maximum per person per 4 consecutive benefit years.

Preferred Vision Services (PVS) discounts offer the added advantage of a 10% deduction, depending on the province of residence and hearing practitioner participation in the PVS network. Extended Health Care benefits are payable only after Government Health Insurance Plan maximums have been reached, as applicable.

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 that first manifested itself within the 9 month period immediately preceding each departure date. Not available to persons age 65 and over.

Accidental Death & Dismemberment (Basic)

Up to $25,000 upon the Accidental Death or Dismemberment of an adult under 65; up to $10,000 upon the Accidental Death or Dismemberment of an adult 65 and over, or a child. Additional coverage can be purchased as an Add-On.

Survivor Benefit

Provides for coverage to be continued 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.

Prescription Drugs

• Name brand or generic drugs, including birth control and fertility drugs
• Full coverage of reasonable and customary dispensing fees

	Percentage Paid	To a maximum of (per anniversary year)
On your first $2,222 of eligibleprescription costs	90%	$2,000
On your next $8,000 of eligibleprescription costs	100%	$8,000
Total benefits payable per person per anniversary year		$10,000

Exclusions – smoking cessation drugs, erectile dysfunction drugs, over-the-counter drugs and drugs not requiring a prescription.

Dental

• Dental coverage is for fillings, cleanings, scalings, examinations, polishing and certain extractions
• Recall visits every 6 months, per person

	Percentage Paid	To a maximum of (per anniversary year)
On your first $500 of eligible services	100%	$500
On your next $700 of eligibleservices	60%	$420
Total benefits payable per person per anniversary year		$920

The following 6 dental services have a combined first anniversary year maximum of $400, and a combined 3 consecutive years maximum of $1,250 per person. 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	60%	60%	80%
Periodontics	60%	60%	80%
Endodontics (Root Canal)	60%	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 Flexcare ComboPlus Dental coverage will be adjusted to match any increases in the fee guide.

Vision

• $250 maximum per person per 2 consecutive benefit years to cover the costs towards prescription lenses, frames, contact lenses and laser eye surgery
• $50 maximum for Optometrist fees per person per 2 consecutive benefit years (payable only after Government Health Insurance Plan maximum has been reached, if applicable)
• Preferred Vision Services (PVS) – allows you to take advantage of discounts available through a specific network of providers and retailers. You can save up to 20% on eyewear purchases made at participating optical retailers, which includes lenses, frames and contact lenses, depending on where you shop. PVS discounts are also available for laser eye surgery. The complete listing of participating retailers and practitioners across Canada is easily accessible online or over-the-phone.