BENEFITS TABLE. Benefits Table (Plan 4) Benefits Table Plan 4 Only applicable when Annual Deductible/ Co-insurance option is chosen Please note: Benefit values are per member each year unless otherwise specified and are reduced each time the member claims only by the net amount (less any annual deductible or co-insurance) we have actually paid. Please refer to the policy wordings on full terms applying to these benefits. Overall Annual Limit Yearly maximum limit This is the maximum we will pay for each member each policy year. All benefits paid during the policy period will count against the yearly maximum. S$4,500,000 Area of cover Area of cover This is the geographical area where you can choose to receive treatment. You can select your area of cover at time of application. Your chosen area of cover has an impact on your premium. Options: 1. Worldwide, or 2. Worldwide excluding USA, or 3. Asia Outside area of cover This benefit pays foremergency treatment, or treatment of a medical condition which arises suddenly whilst outside the selected area of cover. Emergency treatment only up to S$250,000 Annual Deductible In-patient and Daycare Treatment Daily accommodation charges While admitted as an in-patient or day-patient, we will pay for the costs of your accommodation in the type of room shown in your benefits table. Wherever a member receives treatment, if the hospital offers several classes for the room type he is entitled for, we will only pay for the cost of a room of a standard class. This corresponds to the lowest cost room class offered in that hospital for that type of room. If a member stays in a room which is more expensive than the standard room, the member may have to pay for the difference in room charges. The member may also have to pay for a share of other medical expenses wherever these increase as a result of the room upgrade. Please check with us prior to admission to avoid unnecessary out of pocket expenses. Standard single room Annual Deductible Hospital charges This benefit pays for hospital charges given between admission and discharge including: a) Diagnostic procedures b) Surgical procedures c) Operating theatre charges d) Nursing care, drugs and dressings e) Surgeons’ and anaesthetists’ charges f) Intensive care unit charges g) Consultations and physiotherapy while admitted for treatment of an eligible medical condition and when such treatment directly relates to it h) Radiotherapy and chemotherapy i) Kidney dialysis j) Computerized tomography, ma...
BENEFITS TABLE. Plan Mandatory (M) Optional (O) Carrier % premium Board % premium Member Description & Comments Life Insurance M Great West Life 100 85 0 15 salary to $65,501 $65,502 - $250,000 For a total of $250,000 Dependent Group Life Insurance O Great West Life 0 100 $15,000 life insurance on spouse and $7,500 on each dependent child Accidental Death and Dismemberment M RBC 85 15 $250,000 Optional Group Life Insurance O Great West Life 0 100 Available in $10,000 units to a maximum of $250,000 with male/female, smoker/non-smoker, age-banded rates. Subject to approval of evidence of insurability. Dental Plan M* Great West Life 85 15 Including, but not limited to: Prescription Drugs Deluxe Travel Plan Outside Canada Coverage Private Nursing / Physiotherapy Accidental Dental / Prosthetic Appliances Rental or at the plan’s discretion, purchase of certain medical supplies, appliances and prosthetic devices prescribed by a physician Ambulance / Chiropractor / Osteopath / Podiatrist and Chiropodist Hearing Aids Eye Glasses / Laser Surgery Eye Exam Orthodontics Major Restorative O.D.A. fee schedule one year behind current effective Jan. 1 of each year Major Restorative and Dentures M* 85 15 Orthodontics M* 85 15 Extended Health Care M* 85 15 Vision Care M* 85 15 Semi-Private O 85 15 Long Term Disability M OTIP Liberty #L7010-902 0 100 Ontario Teachers’ Insurance Plan Employee Assistance Program M Family Counselling Centre Family Service Kent 85 15 Family Counselling Centre - Sarnia Family Service Kent – Chatham-Kent * unless covered by spouse NOTE: Benefit Enhancements to be implemented in September 2009, will be posted on the District website (xxx.xxxxxx00.xx) and Board website (xxx.xxxxx.xxx).
BENEFITS TABLE. Plan Mandatory (M) Optional (O) Policy # & Carrier % premium Board % premium Member Description & Comments Life Insurance M Great West Life 100 0 First $25,000 of insurance (September 1, 2004) #15336 100 0 For next $40,500 of insurance (September 1, 2004) Division 002 50 50 Of the premium $65,501 up to $140,500 (Sept 1/04 – Aug 31/05) 0 100 Additional units up to $200,000 total insurance (Sept 1/04 – Aug 31/05) 85 15 $65,501 - $225,000 (September 1, 2005) $65,501 - $250,000 (September 1, 2007) Dependent Group Life Insurance O Great West Life #133740 Division 002 0 100 $15,000 life insurance on spouse and $7,500 on each dependent child Accidental Death and Dismemberment M RBC 16238 85 15 Coverage of 3 times salary to a maximum of $135,000 (Sept 1/04 - Aug 31/05) 85 15 $225,000 (September 1, 2005) $250,000 (September 1, 2007) Optional Group Life Insurance O Great West Life 0 100 Available in $10,000 increments with male/female, smoker/non-smoker, age- banded rates Dental Plan M* Great West Life #51804 Division 002 85 15 Including, but not limited to: Prescription Drugs Deluxe Travel Plan Outside Canada Coverage (Effective April 1, 1991) Private Nursing Physiotherapy Accidental Dental Prosthetic Appliances Durable Medical Equipment Radium Ambulance Chiropractor, Osteopath, Podiatrist and Chiropodist Hearing Aids $500 three year replacement Eye Glasses $200/2 years (September 1, 2004) Eye Glasses / Laser Surgery $250/2 years (September 1, 2005) Eye Glasses / Laser Surgery $275/2 years (September 1, 2006) Eye Glasses / Laser Surgery $325/2 years (September 1, 2007) Eye Exam $75/2 years (September 1, 2006) Orthodontics $2500/person lifetime 50/50 Major Restorative $2500/person annual 50/50 O.D.A. fee schedule one year behind current effective Jan. 1 of each year Major Restorative and Dentures M* 85 15 Orthodontics M* 85 15 Extended Health Care M* 85 15 Vision Care M* 85 15 Semi-Private O 85 15 Long Term Disability M OTIP Liberty #L7010-902 0 100 Ontario Teachers’ Insurance Plan Employee Assistance Program M Family Counselling Centre Family Service Kent 85 15 Family Counselling Centre (Sarnia) Family Service Kent (Chatham-Kent) * unless covered by spouse
BENEFITS TABLE. Plan Mandatory (M) Optional (O) Policy # & Carrier % premium Board % premium Member Description & Comments Life Insurance M Great West Life 100 $8.04/month 50% 0 00 50% 100 First $25,000 of insurance. For next $40,500 of insurance. Of the premium $65,500 up to $140,500. Additional units up to $200,000 total insurance. Dependent Group Life Insurance O Great West Life 0 100 $15,000 life insurance on spouse and $7,500 on each dependent child Accidental Death and Dismemberme nt M UNUM 85 15 Coverage of 3 times salary to a maximum of $135,000 Optional Group Life Insurance O Great West Life 0 100 Available in $10,000 increments with male/female, smoker/non-smoker, age-banded rates Dental Plan M* Great West Life 85 15 Including, but not limited to: Major Restorative and Dentures M* (policy numbers for Great West Life will be listed when it is confirmed the coverage is identical to Liberty's as in the 2000-2001 Collective Agreement) 85 15 Prescription Drugs Deluxe Travel Plan Outside Canada Coverage (Effective April 1, 1991) Private Nursing Physiotherapy Accidental Dental Prosthetic Appliances Durable Medical Equipment Radium Ambulance Chiropractor, Osteopath, Podiatrist and Chiropodist Hearing Aids $500 three year replacement Eye Glasses $200/2 years Orthodontics $2500/person lifetime 50/50 Major Restorative $2500/person annual 50/50 O.D.A. fee schedule one year behind current effective Jan. 1 of each year Orthodontics M* 85 15 Extended Health Care M* 85 15 Vision Care M* 85 15 Semi-Private O 85 15 Long Term Disability M OTIP Liberty #L7010-902 0 100 Ontario Teachers’ Insurance Plan Employee Assistance Program M Sarnia Counselling Centre Family Services Kent 85 15 Family Counselling Centre Family Service Kent * unless covered by spouse
BENEFITS TABLE identifies specific carriers, it is understood that from time to time the Board will market the benefit plans to ensure the service and costing are competitive. Marketing of the benefit plans may result in a change in carrier. However, it is the intent that the marketing of the plan(s) would not result in a change in the benefit plan(s).
BENEFITS TABLE. Some words and phrases have special meanings. When we use these terms they are in bold print and they are defined under the definitions section of this handbook. What You’re Covered For – MultiCare International Health Plan Please refer to the column showing the benefits table applicable to your plan. Your latest membership statement will show which plan is applicable to you and give other details which are relevant to you. Benefits Premiere Value Plus SmartStart (not available for groups) Student Care(not available for groups) Areas of cover Area 1 or Area 2 Area 1 or Xxxx 0 Xxxx 0 xx Xxxx 0 Xxxx 1 or Area 2 Level of cover Benefits applicable to your plan. Standard benefits are highlighted. Standard: Benefits 1-17 Comprehensive: Benefits 1-26 Standard: Benefits 1-17 Comprehensive: Benefits 1-26 Comprehensive: Benefits 1-20 (excluding 5, 7, 10, 11, 13, 14, 16 & 17) Standard: Benefits 1-17(excluding 5, 10, 11, 13, 14, 16 & 17)Comprehensive: Benefits 1-26(excluding 5, 10, 11, 13, 14, 16, 17,22-26) Yearly maximum We will pay up to the maximum shown each year for each member. €3,000,000 €200,000 €100,000 €100,000 Annual excess payable The excess payable for each member each year. No excess or optional: €1,000 / €2,500 / €5,000 €85 each year or optional*: €1,000 / €2,500 / €5,000 No excess Option 1 – No excessOption 2 – €85 each yearOption 3 – €170 each year In-patient and daycare treatment
BENEFITS TABLE. Benefit Classification Personal Days Sick Days Health Insurance Clothing Allowance Part-time/ summer 0 3 Available at own cost $75 Full-time/ year round 2 12 HSA contributions and BCBS premiums per state caps $175 Full-time/ 10 month 1.5 10 HSA contributions and BCBS premiums per state caps $175 Part-time/ year round Prorated from 2 Prorated from 12 Available at own cost $175 Part-time/ 10 month Prorated from 1.5 Prorated from 10 Available at own cost $175 Notes: Full-time employment will be considered 37 or more scheduled hours per week. Part-time employment will be considered up to 37 scheduled hours per week.
