Common use of List of Eligible Expenses Clause in Contracts

List of Eligible Expenses. Medical Travel: When ordered by the attending physician because in his/her opinion adequate medical treatment is not available within a 100 kilometre radius of the employee’s home campus, the following are included as eligible expenses:  Public transportation (e.g. scheduled air, rail, bus, taxi and/or ferry);  Automobile use as set out in the policy or collective agreement (as applicable) of employee’s institution Accommodation: Where transportation has been provided as outlined above, accommodation in a commercial facility, Easter Seal House, Xxxxxxx House, Vancouver Lodge, Xxxxxx XxXxxxxx House, or other similar institutions as approved by the administrator, before and after medical treatment. Meals: Where transportation has been provided above, reasonable and customary expenses for meals as set out in the policy or collective agreement (as applicable) of the employee’s institution. Attendant: Where necessary, and at the request of the attending physician, transportation and accommodation of an attendant (e.g. family member or registered nurse) in connection with expenses incurred under items 1 and 2 above. Superior Benefits A superior benefit that existed in an institution's Medical Travel Referral Benefit Plan or Collective agreement that was in place prior to the 1998 Common Agreement continues to apply. Exclusions No benefit shall be payable for:  Charges which are considered an insured service of any provincial government plan;  Charges which are considered an insured service under the extended health plan, or any other group plan in force at the time;  Charges for a surgical procedure or treatment performed primarily for beautification, or charges for hospital confinement for such surgical procedure or treatment;  Charges for medical treatment, transport or travel, other than specifically provided under eligible expenses;  Charges not included in the list of eligible expenses;  Charges for services and supplies which are furnished without the recommendation and approval of a physician acting within the scope of his/her license;  Charges which are not medically necessary to the care and treatment of any existing or suspected injury, disease or pregnancy;  Charges which are from an occupational injury or disease covered by any Workers’ Compensation legislation or similar legislation;  Charges which would not normally have been incurred but for the presence of this coverage or for which the employee or dependent is not legally allowed to pay;  Charges which the administrator is not permitted, by any law to cover;  Charges for dental work where a third party is responsible for payments of such charges;  Charges for bodily injury resulting directly or indirectly from war or act of war (whether declared or undeclared), insurrection or riot, or hostilities of any kind;  Charges for services and supplies resulting from any intentionally self-inflicted wound;  Charges for experimental procedures or treatment not approved by the Canadian Medical Association or the appropriate medical speciality society;  Charges made by a physician for travel, broken appointments, communication costs, filling in forms, or physician’s supplies. Claims Adjudication To claim benefits, the employee or dependent must:  Submit original receipts or photocopies of receipts if accompanied by an explanation of benefits from another carrier, and a claim form;  Provide explanation and proof to support the claim including itemized bills and the attending physician’s statement that the referral to the location where treatment was received was medically necessary;  Provide explanation and proof to support the claim that an attendant (if any) was necessary and made at the request of an attending physician. APPENDIX G DENTAL PLAN The nine (9) month limitation applies to 1) polishing, 2) the application of fluoride, and 3) the recall itself. The nine (9) month limitation does not apply to scaling; any current scaling limits in dental contracts apply.

List of Eligible Expenses. Medical Travel: When ordered by the attending physician because in his/her opinion adequate medical treatment is not available within a 100 kilometre radius of the employee’s home campus, the following are included as eligible expenses:  ⮚ Public transportation (e.g. scheduled air, rail, bus, taxi and/or ferry);  ⮚ Automobile use as set out in the policy or collective agreement (as applicable) of employee’s institution Accommodation: Where transportation has been provided as outlined above, accommodation in a commercial facility, Easter Seal House, Xxxxxxx House, Vancouver Lodge, Xxxxxx XxXxxxxx House, or other similar institutions as approved by the administrator, before and after medical treatment. Meals: Where transportation has been provided above, reasonable and customary expenses for meals as set out in the policy or collective agreement (as applicable) of the employee’s institution. Attendant: Where necessary, and at the request of the attending physician, transportation and accommodation of an attendant (e.g. family member or registered nurse) in connection with expenses incurred under items 1 and 2 above. Superior Benefits A superior benefit that existed in an institution's Medical Travel Referral Benefit Plan or Collective agreement that was in place prior to the 1998 Common Agreement continues to apply. Exclusions No benefit shall be payable for:  ⮚ Charges which are considered an insured service of any provincial government plan;  ⮚ Charges which are considered an insured service under the extended health plan, or any other group plan in force at the time;  ⮚ Charges for a surgical procedure or treatment performed primarily for beautification, or charges for hospital confinement for such surgical procedure or treatment;  ⮚ Charges for medical treatment, transport or travel, other than specifically provided under eligible expenses;  ⮚ Charges not included in the list of eligible expenses;  ⮚ Charges for services and supplies which are furnished without the recommendation and approval of a physician acting within the scope of his/her license;  ⮚ Charges which are not medically necessary to the care and treatment of any existing or suspected injury, disease or pregnancy;  ⮚ Charges which are from an occupational injury or disease covered by any Workers’ Compensation legislation or similar legislation;  ⮚ Charges which would not normally have been incurred but for the presence of this coverage or for which the employee or dependent is not legally allowed to pay;  ⮚ Charges which the administrator is not permitted, by any law to cover;  ⮚ Charges for dental work where a third party is responsible for payments of such charges;  ⮚ Charges for bodily injury resulting directly or indirectly from war or act of war (whether declared or undeclared), insurrection or riot, or hostilities of any kind;  ⮚ Charges for services and supplies resulting from any intentionally self-inflicted wound;  ⮚ Charges for experimental procedures or treatment not approved by the Canadian Medical Association or the appropriate medical speciality society;  ⮚ Charges made by a physician for travel, broken appointments, communication costs, filling in forms, or physician’s supplies. Claims Adjudication To claim benefits, the employee or dependent must:  ⮚ Submit original receipts or photocopies of receipts if accompanied by an explanation of benefits from another carrier, and a claim form;  ⮚ Provide explanation and proof to support the claim including itemized bills and the attending physician’s statement that the referral to the location where treatment was received was medically necessary;  ⮚ Provide explanation and proof to support the claim that an attendant (if any) was necessary and made at the request of an attending physician. APPENDIX G DENTAL PLAN The nine (9) month limitation applies to 1) polishing, 2) the application of fluoride, and 3) the recall itself. The nine (9) month limitation does not apply to scaling; any current scaling limits in dental contracts apply.

List of Eligible Expenses. Medical Travel: When ordered by the attending physician because in his/her opinion adequate medical treatment is not available within a 100 kilometre radius of the employee’s home campus, the following are included as eligible expenses:  ⮚ Public transportation (e.g. scheduled air, rail, bus, taxi and/or ferry);  ⮚ Automobile use as set out in the policy or collective agreement (as applicable) of employee’s institution Accommodation: Where transportation has been provided as outlined above, accommodation in a commercial facility, Easter Seal House, Xxxxxxx Heather House, Vancouver Lodge, Xxxxxx XxXxxxxx House, or other similar institutions as approved by the administrator, before and after medical treatment. Meals: Where transportation has been provided above, reasonable and customary expenses for meals as set out in the policy or collective agreement (as applicable) of the employee’s institution. Attendant: Where necessary, and at the request of the attending physician, transportation and accommodation of an attendant (e.g. family member or registered nurse) in connection with expenses incurred under items 1 and 2 above. Superior Benefits A superior benefit that existed in an institution's Medical Travel Referral Benefit Plan or Collective agreement that was in place prior to the 1998 Common Agreement continues to apply. Exclusions No benefit shall be payable for:  ⮚ Charges which are considered an insured service of any provincial government plan;  ⮚ Charges which are considered an insured service under the extended health plan, or any other group plan in force at the time;  ⮚ Charges for a surgical procedure or treatment performed primarily for beautification, or charges for hospital confinement for such surgical procedure or treatment;  ⮚ Charges for medical treatment, transport or travel, other than specifically provided under eligible expenses;  ⮚ Charges not included in the list of eligible expenses;  ⮚ Charges for services and supplies which are furnished without the recommendation and approval of a physician acting within the scope of his/her license;  ⮚ Charges which are not medically necessary to the care and treatment of any existing or suspected injury, disease or pregnancy;  ⮚ Charges which are from an occupational injury or disease covered by any Workers’ Compensation legislation or similar legislation;  ⮚ Charges which would not normally have been incurred but for the presence of this coverage or for which the employee or dependent is not legally allowed to pay;  ⮚ Charges which the administrator is not permitted, by any law to cover;  ⮚ Charges for dental work where a third party is responsible for payments of such charges;  ⮚ Charges for bodily injury resulting directly or indirectly from war or act of war (whether declared or undeclared), insurrection or riot, or hostilities of any kind;  ⮚ Charges for services and supplies resulting from any intentionally self-inflicted wound;  ⮚ Charges for experimental procedures or treatment not approved by the Canadian Medical Association or the appropriate medical speciality society;  ⮚ Charges made by a physician for travel, broken appointments, communication costs, filling in forms, or physician’s supplies. Claims Adjudication To claim benefits, the employee or dependent must:  ⮚ Submit original receipts or photocopies of receipts if accompanied by an explanation of benefits from another carrier, and a claim form;  ⮚ Provide explanation and proof to support the claim including itemized bills and the attending physician’s statement that the referral to the location where treatment was received was medically necessary;  ⮚ Provide explanation and proof to support the claim that an attendant (if any) was necessary and made at the request of an attending physician. APPENDIX G DENTAL PLAN The nine (9) month limitation applies to 1) polishing, 2) the application of fluoride, and 3) the recall itself. The nine (9) month limitation does not apply to scaling; any current scaling limits in dental contracts apply.

List of Eligible Expenses. Medical Travel: When ordered by the attending physician because in his/her their opinion adequate medical treatment is not available within a 100 kilometre radius of the employee’s home campus, the following are included as eligible expenses:  ⮚ Public transportation (e.g. scheduled air, rail, bus, taxi and/or ferry);  ⮚ Automobile use as set out in the policy or collective agreement (as applicable) of employee’s institution Accommodation: Where transportation has been provided as outlined above, accommodation in a commercial facility, Easter Seal House, Xxxxxxx House, Vancouver Lodge, Xxxxxx XxXxxxxx House, or other similar institutions as approved by the administrator, before and after medical treatment. Meals: Where transportation has been provided above, reasonable and customary expenses for meals as set out in the policy or collective agreement (as applicable) of the employee’s institution. Attendant: Where necessary, and at the request of the attending physician, transportation and accommodation of an attendant (e.g. family member or registered nurse) in connection with expenses incurred under items 1 and 2 above. Superior Benefits A superior benefit that existed in an institution's Medical Travel Referral Benefit Plan or Collective agreement that was in place prior to the 1998 Common Agreement continues to apply. Exclusions No benefit shall be payable for:  ⮚ Charges which are considered an insured service of any provincial government plan;  ⮚ Charges which are considered an insured service under the extended health plan, or any other group plan in force at the time;  ⮚ Charges for a surgical procedure or treatment performed primarily for beautification, or charges for hospital confinement for such surgical procedure or treatment;  ⮚ Charges for medical treatment, transport or travel, other than specifically provided under eligible expenses;  ⮚ Charges not included in the list of eligible expenses;  ⮚ Charges for services and supplies which are furnished without the recommendation and approval of a physician acting within the scope of his/her their license;  ⮚ Charges which are not medically necessary to the care and treatment of any existing or suspected injury, disease or pregnancy;  ⮚ Charges which are from an occupational injury or disease covered by any Workers’ Compensation legislation or similar legislation;  ⮚ Charges which would not normally have been incurred but for the presence of this coverage or for which the employee or dependent is not legally allowed to pay;  ⮚ Charges which the administrator is not permitted, by any law to cover;  ⮚ Charges for dental work where a third party is responsible for payments of such charges;  ⮚ Charges for bodily injury resulting directly or indirectly from war or act of war (whether declared or undeclared), insurrection or riot, or hostilities of any kind;  ⮚ Charges for services and supplies resulting from any intentionally self-inflicted wound;  ⮚ Charges for experimental procedures or treatment not approved by the Canadian Medical Association or the appropriate medical speciality society;  ⮚ Charges made by a physician for travel, broken appointments, communication costs, filling in forms, or physician’s supplies. Claims Adjudication To claim benefits, the employee or dependent must:  ⮚ Submit original receipts or photocopies of receipts if accompanied by an explanation of benefits from another carrier, and a claim form;  ⮚ Provide explanation and proof to support the claim including itemized bills and the attending physician’s statement that the referral to the location where treatment was received was medically necessary;  ⮚ Provide explanation and proof to support the claim that an attendant (if any) was necessary and made at the request of an attending physician. APPENDIX G DENTAL PLAN The nine (9) month limitation applies to 1) polishing, 2) the application of fluoride, and 3) the recall itself. The nine (9) month limitation does not apply to scaling; any current scaling limits in dental contracts apply.. The process for an individual faculty employee to have their teeth cleaned more frequently than every nine

List of Eligible Expenses. Medical Travel: When ordered by the attending physician because in his/her opinion adequate medical treatment is not available within a 100 kilometre radius of the employee’s home campus, the following are included as eligible expenses:  ⮚ Public transportation (e.g. scheduled air, rail, bus, taxi and/or ferry);  ⮚ Automobile use as set out in the policy or collective agreement (as applicable) of employee’s institution Accommodation: Where transportation has been provided as outlined above, accommodation in a commercial facility, Easter Seal House, Xxxxxxx House, Vancouver Lodge, Xxxxxx XxXxxxxx House, or other similar institutions as approved by the administrator, before and after medical treatment. Meals: Where transportation has been provided above, reasonable and customary expenses for meals as set out in the policy or collective agreement (as applicable) of the employee’s institution. Attendant: Where necessary, and at the request of the attending physician, transportation and accommodation of an attendant (e.g. family member or registered nurse) in connection with expenses incurred under items 1 and 2 above. Superior Benefits A superior benefit that existed in an institution's Medical Travel Referral Benefit Plan or Collective agreement that was in place prior to the 1998 Common Agreement continues to apply. Exclusions No benefit shall be payable for:  ⮚ Charges which are considered an insured service of any provincial government plan;  ⮚ Charges which are considered an insured service under the extended health plan, or any other group plan in force at the time;  ⮚ Charges for a surgical procedure or treatment performed primarily for beautification, or charges for hospital confinement for such surgical procedure or treatment;  ⮚ Charges for medical treatment, transport or travel, other than specifically provided under eligible expenses;  ⮚ Charges not included in the list of eligible expenses;  ⮚ Charges for services and supplies which are furnished without the recommendation and approval of a physician acting within the scope of his/her license;  ⮚ Charges which are not medically necessary to the care and treatment of any existing or suspected injury, disease or pregnancy;  ⮚ Charges which are from an occupational injury or disease covered by any Workers’ Compensation legislation or similar legislation;  ⮚ Charges which would not normally have been incurred but for the presence of this coverage or for which the employee or dependent is not legally allowed to pay;  ⮚ Charges which the administrator is not permitted, by any law to cover;  ⮚ Charges for dental work where a third party is responsible for payments of such charges;  ⮚ Charges for bodily injury resulting directly or indirectly from war or act of war (whether declared or undeclared), insurrection or riot, or hostilities of any kind;  ⮚ Charges for services and supplies resulting from any intentionally self-inflicted wound;  ⮚ Charges for experimental procedures or treatment not approved by the Canadian Medical Association or the appropriate medical speciality society;  ⮚ Charges made by a physician for travel, broken appointments, communication costs, filling in forms, or physician’s supplies. Claims Adjudication To claim benefits, the employee or dependent must:  ⮚ Submit original receipts or photocopies of receipts if accompanied by an explanation of benefits from another carrier, and a claim form;  ⮚ Provide explanation and proof to support the claim including itemized bills and the attending physician’s statement that the referral to the location where treatment was received was medically necessary;  ⮚ Provide explanation and proof to support the claim that an attendant (if any) was necessary and made at the request of an attending physician. APPENDIX G DENTAL PLAN The nine (9) month limitation applies to 1) polishing, 2) the application of fluoride, and 3) the recall itself. The nine (9) month limitation does not apply to scaling; any current scaling limits in dental contracts apply.

List of Eligible Expenses. Medical Travel: When ordered by the attending physician because in his/her their opinion adequate medical treatment is not available within a 100 100-kilometre radius of the employee’s home campus, the following are included as eligible expenses:  Public transportation (e.g. scheduled air, rail, bus, taxi and/or ferry);  Automobile use as set out in the policy or collective agreement (as applicable) of employee’s institution Accommodation: Where transportation has been provided as outlined above, accommodation in a commercial facility, Easter Seal House, Xxxxxxx House, Vancouver Lodge, Xxxxxx XxXxxxxx House, or other similar institutions as approved by the administrator, before and after medical treatment. Meals: Where transportation has been provided above, reasonable and customary expenses for meals as set out in the policy or collective agreement (as applicable) of the employee’s institution. Attendant: Where necessary, and at the request of the attending physician, transportation and accommodation of an attendant (e.g. family member or registered nurse) in connection with expenses incurred under items 1 and 2 above. Superior Benefits A superior benefit that existed in an institution's Medical Travel Referral Benefit Plan or Collective agreement that was in place prior to the 1998 Common Agreement continues to apply. Exclusions No benefit shall be payable for:  Charges which are considered an insured service of any provincial government plan;  Charges which are considered an insured service under the extended health plan, or any other group plan in force at the time;  Charges for a surgical procedure or treatment performed primarily for beautification, or charges for hospital confinement for such surgical procedure or treatment;  Charges for medical treatment, transport or travel, other than specifically provided under eligible expenses;  Charges not included in the list of eligible expenses;  Charges for services and supplies which are furnished without the recommendation and approval of a physician acting within the scope of his/her their license;  Charges which are not medically necessary to the care and treatment of any existing or suspected injury, disease or pregnancy;  Charges which are from an occupational injury or disease covered by any Workers’ Compensation legislation or similar legislation;  Charges which would not normally have been incurred but for the presence of this coverage or for which the employee or dependent is not legally allowed to pay;  Charges which the administrator is not permitted, by any law to cover;  Charges for dental work where a third party is responsible for payments of such charges;  Charges for bodily injury resulting directly or indirectly from war or act of war (whether declared or undeclared), insurrection or riot, or hostilities of any kind;  Charges for services and supplies resulting from any intentionally self-inflicted wound;  Charges for experimental procedures or treatment not approved by the Canadian Medical Association or the appropriate medical speciality society;  Charges made by a physician for travel, broken appointments, communication costs, filling in forms, or physician’s supplies. Claims Adjudication To claim benefits, the employee or dependent must:  Submit original receipts or photocopies of receipts if accompanied by an explanation of benefits from another carrier, and a claim form;  Provide explanation and proof to support the claim including itemized bills and the attending physician’s statement that the referral to the location where treatment was received was medically necessary;  Provide explanation and proof to support the claim that an attendant (if any) was necessary and made at the request of an attending physician. APPENDIX G DENTAL PLAN The nine (9) month limitation applies to 1) polishing, 2) the application of fluoride, and 3) the recall itself. The nine (9) month limitation does not apply to scaling; any current scaling limits in dental contracts apply.. The process for an individual faculty employee to have their teeth cleaned more frequently than every nine

List of Eligible Expenses. Medical Travel: When ordered by the attending physician because in his/her opinion adequate medical treatment is not available within a 100 kilometre radius of the employee’s home campus, the following are included as eligible expenses:  Public transportation (e.g. scheduled air, rail, bus, taxi and/or ferry);  Automobile use as set out in the policy or collective agreement (as applicable) of employee’s institution Accommodation: Where transportation has been provided as outlined above, accommodation in a commercial facility, Easter Seal House, Xxxxxxx House, Vancouver Lodge, Xxxxxx XxXxxxxx House, or other similar institutions as approved by the administrator, before and after medical treatment. Meals: Where transportation has been provided above, reasonable and customary expenses for meals as set out in the policy or collective agreement (as applicable) of the employee’s institution. Attendant: Where necessary, and at the request of the attending physician, transportation and accommodation of an attendant (e.g. family member or registered nurse) in connection with expenses incurred under items 1 and 2 above. Superior Benefits A superior benefit that existed in an institution's Medical Travel Referral Benefit Plan or Collective agreement that was in place prior to the 1998 Common Agreement continues to apply. Exclusions No benefit shall be payable for:  Charges which are considered an insured service of any provincial government plan;  Charges which are considered an insured service under the extended health plan, or any other group plan in force at the time;  Charges for a surgical procedure or treatment performed primarily for beautification, or charges for hospital confinement for such surgical procedure or treatment;  Charges for medical treatment, transport or travel, other than specifically provided under eligible expenses;  Charges not included in the list of eligible expenses;  Charges for services and supplies which are furnished without the recommendation and approval of a physician acting within the scope of his/her license;  Charges which are not medically necessary to the care and treatment of any existing or suspected injury, disease or pregnancy;  Charges which are from an occupational injury or disease covered by any Workers’ Compensation legislation or similar legislation;  Charges which would not normally have been incurred but for the presence of this coverage or for which the employee or dependent is not legally allowed to pay;  Charges which the administrator is not permitted, by any law to cover;  Charges for dental work where a third party is responsible for payments of such charges;  Charges for bodily injury resulting directly or indirectly from war or act of war (whether declared or undeclared), insurrection or riot, or hostilities of any kind;  Charges for services and supplies resulting from any intentionally self-inflicted wound;  Charges for experimental procedures or treatment not approved by the Canadian Medical Association or the appropriate medical speciality society;  Charges made by a physician for travel, broken appointments, communication costs, filling in forms, or physician’s supplies. Claims Adjudication To claim benefits, the employee or dependent must:  Submit original receipts or photocopies of receipts if accompanied by an explanation of benefits from another carrier, and a claim form;  Provide explanation and proof to support the claim including itemized bills and the attending physician’s statement that the referral to the location where treatment was received was medically necessary;  Provide explanation and proof to support the claim that an attendant (if any) was necessary and made at the request of an attending physician. APPENDIX G DENTAL PLAN The nine (9) month limitation applies to 1) polishing, 2) the application of fluoride, and 3) the recall itself. The nine (9) month limitation does not apply to scaling; any current scaling limits in dental contracts apply.

List of Eligible Expenses. Medical Travel: When ordered by the attending physician because in his/her their opinion adequate medical treatment is not available within a 100 kilometre radius of the employee’s home campus, the following are included as eligible expenses:  ⮚ Public transportation (e.g. scheduled air, rail, bus, taxi and/or ferry);  ⮚ Automobile use as set out in the policy or collective agreement (as applicable) of employee’s institution Accommodation: Where transportation has been provided as outlined above, accommodation in a commercial facility, Easter Seal House, Xxxxxxx Heather House, Vancouver Lodge, Xxxxxx XxXxxxxx House, or other similar institutions as approved by the administrator, before and after medical treatment. Meals: Where transportation has been provided above, reasonable and customary expenses for meals as set out in the policy or collective agreement (as applicable) of the employee’s institution. Attendant: Where necessary, and at the request of the attending physician, transportation and accommodation of an attendant (e.g. family member or registered nurse) in connection with expenses incurred under items 1 and 2 above. Superior Benefits A superior benefit that existed in an institution's Medical Travel Referral Benefit Plan or Collective agreement that was in place prior to the 1998 Common Agreement continues to apply. Exclusions No benefit shall be payable for:  ⮚ Charges which are considered an insured service of any provincial government plan;  ⮚ Charges which are considered an insured service under the extended health plan, or any other group plan in force at the time;  ⮚ Charges for a surgical procedure or treatment performed primarily for beautification, or charges for hospital confinement for such surgical procedure or treatment;  ⮚ Charges for medical treatment, transport or travel, other than specifically provided under eligible expenses;  ⮚ Charges not included in the list of eligible expenses;  ⮚ Charges for services and supplies which are furnished without the recommendation and approval of a physician acting within the scope of his/her their license;  ⮚ Charges which are not medically necessary to the care and treatment of any existing or suspected injury, disease or pregnancy;  ⮚ Charges which are from an occupational injury or disease covered by any Workers’ Compensation legislation or similar legislation;  ⮚ Charges which would not normally have been incurred but for the presence of this coverage or for which the employee or dependent is not legally allowed to pay;  ⮚ Charges which the administrator is not permitted, by any law to cover;  ⮚ Charges for dental work where a third party is responsible for payments of such charges;  ⮚ Charges for bodily injury resulting directly or indirectly from war or act of war (whether declared or undeclared), insurrection or riot, or hostilities of any kind;  ⮚ Charges for services and supplies resulting from any intentionally self-inflicted wound;  ⮚ Charges for experimental procedures or treatment not approved by the Canadian Medical Association or the appropriate medical speciality society;  ⮚ Charges made by a physician for travel, broken appointments, communication costs, filling in forms, or physician’s supplies. Claims Adjudication To claim benefits, the employee or dependent must:  ⮚ Submit original receipts or photocopies of receipts if accompanied by an explanation of benefits from another carrier, and a claim form;  ⮚ Provide explanation and proof to support the claim including itemized bills and the attending physician’s statement that the referral to the location where treatment was received was medically necessary;  ⮚ Provide explanation and proof to support the claim that an attendant (if any) was necessary and made at the request of an attending physician. APPENDIX G DENTAL PLAN The nine (9) month limitation applies to 1) polishing, 2) the application of fluoride, and 3) the recall itself. The nine (9) month limitation does not apply to scaling; any current scaling limits in dental contracts apply.

List of Eligible Expenses. Medical Travel: When ordered by the attending physician because in his/her opinion adequate medical treatment is not available within a 100 kilometre radius of the employee’s home campus, the following are included as eligible expenses:  Public transportation (e.g. scheduled air, rail, bus, taxi and/or ferry);  Automobile use as set out in the policy or collective agreement (as applicable) of employee’s institution Accommodation: Where transportation has been provided as outlined above, accommodation in a commercial facility, Easter Seal House, Xxxxxxx Heather House, Vancouver Lodge, Xxxxxx XxXxxxxx House, or other similar institutions as approved by the administrator, before and after medical treatment. Meals: Where transportation has been provided above, reasonable and customary expenses for meals as set out in the policy or collective agreement (as applicable) of the employee’s institution. Attendant: Where necessary, and at the request of the attending physician, transportation and accommodation of an attendant (e.g. family member or registered nurse) in connection with expenses incurred under items 1 and 2 above. Common Agreement Page April to March Superior Benefits A superior benefit that existed in an institution's ’s Medical Travel Referral Benefit Plan or Collective agreement that was in place prior to the 1998 Common Agreement continues to apply. Exclusions No benefit shall be payable for:  Charges which are considered an insured service of any provincial government plan;  Charges which are considered an insured service under the extended health plan, or any other group plan in force at the time;  Charges for a surgical procedure or treatment performed primarily for beautification, or charges for hospital confinement for such surgical procedure or treatment;  Charges for medical treatment, transport or travel, other than specifically provided under eligible expenses;  Charges not included in the list of eligible expenses;  Charges for services and supplies which are furnished without the recommendation and approval of a physician acting within the scope of his/her license;  Charges which are not medically necessary to the care and treatment of any existing or suspected injury, disease or pregnancy;  Charges which are from an occupational injury or disease covered by any Workers’ Compensation legislation or similar legislation;  Charges which would not normally have been incurred but for the presence of this coverage or for which the employee or dependent is not legally allowed to pay;  Charges which the administrator is not permitted, by any law to cover;  Charges for dental work where a third party is responsible for payments of such charges;  Charges for bodily injury resulting directly or indirectly from war or act of war (whether declared or undeclared), insurrection or riot, or hostilities of any kind;  Charges for services and supplies resulting from any intentionally self-inflicted wound;  Charges for experimental procedures or treatment not approved by the Canadian Medical Association or the appropriate medical speciality society;  Charges made by a physician for travel, broken appointments, communication costs, filling in forms, or physician’s supplies. Claims Adjudication To claim benefits, the employee or dependent must:  Submit original receipts or photocopies of receipts if accompanied by an explanation of benefits from another carrier, and a claim form;  Provide explanation and proof to support the claim including itemized bills and the attending physician’s statement that the referral to the location where treatment was received was medically necessary;  Provide explanation and proof to support the claim that an attendant (if any) was necessary and made at the request of an attending physician. Common Agreement Page April to March APPENDIX G DENTAL PLAN The nine (9) month limitation applies to 1) polishing, 2) the application of fluoride, and 3) the recall itself. The nine (9) month limitation does not apply to scaling; any current scaling limits in dental contracts apply.The process for an individual faculty employee to have teeth cleaned more frequently than every nine (9) months as provided by Article is as follows: Faculty employee visits dentist as usual Dentist advises that the faculty employee has gum disease or other dental problem which requires cleaning more frequently than every nine (9) months Dentist fills in the usual claim form, but in addition notes that the faculty employee has gum disease or specifies the other dental problem that requires more frequent cleaning Faculty employee or dentist submits the form to the Insurance Carrier as normal The Insurance Carrier determines if the reasons set out by the dentist fit within the approved reasons under the dental plan for having teeth cleaned more frequently than every nine (9) months The employers’ approval of the more frequent cleaning is not required. Common Agreement Page April to March APPENDIX H DEFERRED SALARY LEAVE APPLICATION, AGREEMENT, AND APPROVAL FORM I have read and I understand the terms and conditions of Article of the Common Agreement the provisions of the [institution name] Deferred Salary Leave Plan, between the union and the employer governing the Deferred Salary Leave Plan. I agree to participate in the Plan subject to its rules and on the following specific conditions: Enrolment Date: My enrolment in the Plan shall become effective Year of Leave: I propose to commence my leave upon the approval of the employer, for a period of months (up to one year). Funding of the Leave: To accomplish the funding of the leave I hereby authorize the following amounts be withheld from my current compensation effective the date of my enrolment in the Plan: First Year YO Second Year Third Year YO Fourth Year YO Number of additional year Percentage per additional year The participant may, by written notice to the employer prior to the anniversary date in any year, alter the percentage amounts for that and any subsequent year subject to the provisions [institution name] of the Deferred Salary Leave Plan Memorandum. Signature of Applicant Date The employer hereby approves the above noted employees participation in the Deferred Salary Leave Plan Signature of Employer Date Common Agreement Page April to March APPENDIX I FAMILY MEMBERS FOR THE PURPOSE OF ARTICLE COMPASSIONATE CARE LEAVE The following “family members” are persons identified through their relationship to the employee. e Spouse (includes heterosexual, common-law, and same-sex relationships) e Children e Children’s spouses Step-children e Step-children-in-law e Siblings e In-law siblings e Parents e Step-parents e Parents-in-law e Grandparents e Grandchildren e e Guardians e Step-siblings e e Current or former xxxxxx-parents e Current or former xxxxxx children e Current or former wards e Current or former guardians e Spouse of sibling or step-sibling Spouse of child or step-child e Spouse of a grandparent e Spouse of a grandchild e Spouse of an aunt or uncle e Spouse of a niece or nephew e Spouse of a current or former xxxxxx child e Spouse of a current or former guardian e Spouse of an employee’s current or former xxxxxx parent Spouse of an employee’s current or former xxxx e Spouse of a person who is living with the employee as a member of the employee’s family The following “family members” are persons identified through their relationship to the employee’s spouse Xxxxxx’s parents or step-parents Xxxxxx’s siblings or step-siblings Xxxxxx’s children Xxxxxx’s grandparents Xxxxxx’s grandchildren Xxxxxx’s aunts or uncles Common Agreement Page April to March Xxxxxx’s nieces or nephews Spouse’s current or former xxxxxx parents Spouse’s current or former wards The following “family members” are deemed family members Any other person in the same household who is dependent upon the employee Any person who lives with the employee as a member of the employee’s family Whether or not related to an employee by blood, adoption, marriage or common-law partnership, an individual with a serious medical condition who considers the employee to be, or whom the employee considers to be, like a close relative Common Agreement to March LETTER OF UNDERSTANDING JOINT ADMINISTRATION DISPUTE RESOLUTION COMMITTEE OPERATIONAL REVIEW The Joint Administration Dispute Resolution Committee will review its own procedures and protocols to ensure operational efficiency and effectiveness. This will be completed by a date determined by Common Agreement Page April to March

List of Eligible Expenses. Medical Travel: When ordered by the attending physician because in his/her their opinion adequate medical treatment is not available within a 100 100-kilometre radius of the employee’s home campus, the following are included as eligible expenses:  ⮚ Public transportation (e.g. scheduled air, rail, bus, taxi and/or ferry);  ⮚ Automobile use as set out in the policy or collective agreement (as applicable) of employee’s institution Accommodation: Where transportation has been provided as outlined above, accommodation in a commercial facility, Easter Seal House, Xxxxxxx House, Vancouver Lodge, Xxxxxx XxXxxxxx House, or other similar institutions as approved by the administrator, before and after medical treatment. Meals: Where transportation has been provided above, reasonable and customary expenses for meals as set out in the policy or collective agreement (as applicable) of the employee’s institution. Attendant: Where necessary, and at the request of the attending physician, transportation and accommodation of an attendant (e.g. family member or registered nurse) in connection with expenses incurred under items 1 and 2 above. Superior Benefits A superior benefit that existed in an institution's Medical Travel Referral Benefit Plan or Collective agreement that was in place prior to the 1998 Common Agreement continues to apply. Exclusions No benefit shall be payable for:  ⮚ Charges which are considered an insured service of any provincial government plan;  ⮚ Charges which are considered an insured service under the extended health plan, or any other group plan in force at the time;  ⮚ Charges for a surgical procedure or treatment performed primarily for beautification, or charges for hospital confinement for such surgical procedure or treatment;  ⮚ Charges for medical treatment, transport or travel, other than specifically provided under eligible expenses;  ⮚ Charges not included in the list of eligible expenses;  ⮚ Charges for services and supplies which are furnished without the recommendation and approval of a physician acting within the scope of his/her their license;  ⮚ Charges which are not medically necessary to the care and treatment of any existing or suspected injury, disease or pregnancy;  ⮚ Charges which are from an occupational injury or disease covered by any Workers’ Compensation legislation or similar legislation;  ⮚ Charges which would not normally have been incurred but for the presence of this coverage or for which the employee or dependent is not legally allowed to pay;  ⮚ Charges which the administrator is not permitted, by any law to cover;  ⮚ Charges for dental work where a third party is responsible for payments of such charges;  ⮚ Charges for bodily injury resulting directly or indirectly from war or act of war (whether declared or undeclared), insurrection or riot, or hostilities of any kind;  ⮚ Charges for services and supplies resulting from any intentionally self-inflicted wound;  ⮚ Charges for experimental procedures or treatment not approved by the Canadian Medical Association or the appropriate medical speciality society;  ⮚ Charges made by a physician for travel, broken appointments, communication costs, filling in forms, or physician’s supplies. Claims Adjudication To claim benefits, the employee or dependent must:  ⮚ Submit original receipts or photocopies of receipts if accompanied by an explanation of benefits from another carrier, and a claim form;  ⮚ Provide explanation and proof to support the claim including itemized bills and the attending physician’s statement that the referral to the location where treatment was received was medically necessary;  ⮚ Provide explanation and proof to support the claim that an attendant (if any) was necessary and made at the request of an attending physician. APPENDIX G DENTAL PLAN The nine (9) month limitation applies to 1) polishing, 2) the application of fluoride, and 3) the recall itself. The nine (9) month limitation does not apply to scaling; any current scaling limits in dental contracts apply.. The process for an individual faculty employee to have their teeth cleaned more frequently than every nine

List of Eligible Expenses. Medical Travel: When ordered by the attending physician because in his/her their opinion adequate medical treatment is not available within a 100 kilometre radius of the employee’s home campus, the following are included as eligible expenses:  ⮚ Public transportation (e.g. scheduled air, rail, bus, taxi and/or ferry);  ⮚ Automobile use as set out in the policy or collective agreement (as applicable) of employee’s institution Accommodation: Where transportation has been provided as outlined above, accommodation in a commercial facility, Easter Seal House, Xxxxxxx Heather House, Vancouver Lodge, Xxxxxx XxXxxxxx House, or other similar institutions as approved by the administrator, before and after medical treatment. Meals: Where transportation has been provided above, reasonable and customary expenses for meals as set out in the policy or collective agreement (as applicable) of the employee’s institution. Attendant: Where necessary, and at the request of the attending physician, transportation and accommodation of an attendant (e.g. family member or registered nurse) in connection with expenses incurred under items 1 and 2 above. Superior Benefits A superior benefit that existed in an institution's Medical Travel Referral Benefit Plan or Collective agreement that was in place prior to the 1998 Common Agreement continues to apply. Exclusions No benefit shall be payable for:  ⮚ Charges which are considered an insured service of any provincial government plan;  ⮚ Charges which are considered an insured service under the extended health plan, or any other group plan in force at the time;  ⮚ Charges for a surgical procedure or treatment performed primarily for beautification, or charges for hospital confinement for such surgical procedure or treatment;  ⮚ Charges for medical treatment, transport or travel, other than specifically provided under eligible expenses;  ⮚ Charges not included in the list of eligible expenses;  ⮚ Charges for services and supplies which are furnished without the recommendation and approval of a physician acting within the scope of his/her their license;  ⮚ Charges which are not medically necessary to the care and treatment of any existing or suspected injury, disease or pregnancy;  ⮚ Charges which are from an occupational injury or disease covered by any Workers’ Compensation legislation or similar legislation;  ⮚ Charges which would not normally have been incurred but for the presence of this coverage or for which the employee or dependent is not legally allowed to pay;  ⮚ Charges which the administrator is not permitted, by any law to cover;  ⮚ Charges for dental work where a third party is responsible for payments of such charges;  ⮚ Charges for bodily injury resulting directly or indirectly from war or act of war (whether declared or undeclared), insurrection or riot, or hostilities of any kind;  ⮚ Charges for services and supplies resulting from any intentionally self-inflicted wound;  ⮚ Charges for experimental procedures or treatment not approved by the Canadian Medical Association or the appropriate medical speciality society;  ⮚ Charges made by a physician for travel, broken appointments, communication costs, filling in forms, or physician’s supplies. Claims Adjudication To claim benefits, the employee or dependent must:  ⮚ Submit original receipts or photocopies of receipts if accompanied by an explanation of benefits from another carrier, and a claim form;  ⮚ Provide explanation and proof to support the claim including itemized bills and the attending physician’s statement that the referral to the location where treatment was received was medically necessary;  ⮚ Provide explanation and proof to support the claim that an attendant (if any) was necessary and made at the request of an attending physician. APPENDIX G DENTAL PLAN The nine (9) month limitation applies to 1) polishing, 2) the application of fluoride, and 3) the recall itself. The nine (9) month limitation does not apply to scaling; any current scaling limits in dental contracts apply.. The process for an individual faculty employee to have their teeth cleaned more frequently than every nine

List of Eligible Expenses. Medical Travel: When ordered by the attending physician because in his/her their opinion adequate medical treatment is not available within a 100 kilometre radius of the employee’s home campus, the following are included as eligible expenses:  Public transportation (e.g. scheduled air, rail, bus, taxi and/or ferry);  Automobile use as set out in the policy or collective agreement (as applicable) of employee’s institution Accommodation: Where transportation has been provided as outlined above, accommodation in a commercial facility, Easter Seal House, Xxxxxxx House, Vancouver Lodge, Xxxxxx XxXxxxxx House, or other similar institutions as approved by the administrator, before and after medical treatment. Meals: Where transportation has been provided above, reasonable and customary expenses for meals as set out in the policy or collective agreement (as applicable) of the employee’s institution. Attendant: Where necessary, and at the request of the attending physician, transportation and accommodation of an attendant (e.g. family member or registered nurse) in connection with expenses incurred under items 1 and 2 above. Superior Benefits A superior benefit that existed in an institution's Medical Travel Referral Benefit Plan or Collective agreement that was in place prior to the 1998 Common Agreement continues to apply. Exclusions No benefit shall be payable for:  Charges which are considered an insured service of any provincial government plan;  Charges which are considered an insured service under the extended health plan, or any other group plan in force at the time;  Charges for a surgical procedure or treatment performed primarily for beautification, or charges for hospital confinement for such surgical procedure or treatment;  Charges for medical treatment, transport or travel, other than specifically provided under eligible expenses;  Charges not included in the list of eligible expenses;  Charges for services and supplies which are furnished without the recommendation and approval of a physician acting within the scope of his/her their license;  Charges which are not medically necessary to the care and treatment of any existing or suspected injury, disease or pregnancy;  Charges which are from an occupational injury or disease covered by any Workers’ Compensation legislation or similar legislation;  Charges which would not normally have been incurred but for the presence of this coverage or for which the employee or dependent is not legally allowed to pay;  Charges which the administrator is not permitted, by any law to cover;  Charges for dental work where a third party is responsible for payments of such charges;  Charges for bodily injury resulting directly or indirectly from war or act of war (whether declared or undeclared), insurrection or riot, or hostilities of any kind;  Charges for services and supplies resulting from any intentionally self-inflicted wound;  Charges for experimental procedures or treatment not approved by the Canadian Medical Association or the appropriate medical speciality society;  Charges made by a physician for travel, broken appointments, communication costs, filling in forms, or physician’s supplies. Claims Adjudication To claim benefits, the employee or dependent must:  Submit original receipts or photocopies of receipts if accompanied by an explanation of benefits from another carrier, and a claim form;  Provide explanation and proof to support the claim including itemized bills and the attending physician’s statement that the referral to the location where treatment was received was medically necessary;  Provide explanation and proof to support the claim that an attendant (if any) was necessary and made at the request of an attending physician. APPENDIX G DENTAL PLAN The nine (9) month limitation applies to 1) polishing, 2) the application of fluoride, and 3) the recall itself. The nine (9) month limitation does not apply to scaling; any current scaling limits in dental contracts apply.. The process for an individual faculty employee to have their teeth cleaned more frequently than every nine

List of Eligible Expenses. Medical Travel: When ordered by the attending physician because in his/her opinion adequate medical treatment is not available within a 100 kilometre radius of the employee’s home campus, the following are included as eligible expenses:  ⮚ Public transportation (e.g. scheduled air, rail, bus, taxi and/or ferry);  ⮚ Automobile use as set out in the policy or collective agreement (as applicable) of employee’s institution Accommodation: Where transportation has been provided as outlined above, accommodation in a commercial facility, Easter Seal House, Xxxxxxx Heather House, Vancouver Lodge, Xxxxxx XxXxxxxx House, or other similar institutions as approved by the administrator, before and after medical treatment. Meals: Where transportation has been provided above, reasonable and customary expenses for meals as set out in the policy or collective agreement (as applicable) of the employee’s institution. Attendant: Where necessary, and at the request of the attending physician, transportation and accommodation of an attendant (e.g. family member or registered nurse) in connection with expenses incurred under items 1 and 2 above. Superior Benefits A superior benefit that existed in an institution's Medical Travel Referral Benefit Plan or Collective agreement that was in place prior to the 1998 Common Agreement continues to apply. Exclusions No benefit shall be payable for:  ⮚ Charges which are considered an insured service of any provincial government plan;  ⮚ Charges which are considered an insured service under the extended health plan, or any other group plan in force at the time;  ⮚ Charges for a surgical procedure or treatment performed primarily for beautification, or charges for hospital confinement for such surgical procedure or treatment;  ⮚ Charges for medical treatment, transport or travel, other than specifically provided under eligible expenses;  ⮚ Charges not included in the list of eligible expenses;  ⮚ Charges for services and supplies which are furnished without the recommendation and approval of a physician acting within the scope of his/her license;  ⮚ Charges which are not medically necessary to the care and treatment of any existing or suspected injury, disease or pregnancy;  ⮚ Charges which are from an occupational injury or disease covered by any Workers’ Compensation legislation or similar legislation;  ⮚ Charges which would not normally have been incurred but for the presence of this coverage or for which the employee or dependent is not legally allowed to pay;  ⮚ Charges which the administrator is not permitted, by any law to cover;  ⮚ Charges for dental work where a third party is responsible for payments of such charges;  ⮚ Charges for bodily injury resulting directly or indirectly from war or act of war (whether declared or undeclared), insurrection or riot, or hostilities of any kind;  ⮚ Charges for services and supplies resulting from any intentionally self-inflicted wound;  ⮚ Charges for experimental procedures or treatment not approved by the Canadian Medical Association or the appropriate medical speciality society;  ⮚ Charges made by a physician for travel, broken appointments, communication costs, filling in forms, or physician’s supplies. Claims Adjudication To claim benefits, the employee or dependent must:  ⮚ Submit original receipts or photocopies of receipts if accompanied by an explanation of benefits from another carrier, and a claim form;  ⮚ Provide explanation and proof to support the claim including itemized bills and the attending physician’s statement that the referral to the location where treatment was received was medically necessary;  ⮚ Provide explanation and proof to support the claim that an attendant (if any) was necessary and made at the request of an attending physician. Note, 2012-2014 Common Agreement Appendix G, Dental Plan Will need to be renumbered Tentatively Agreed APPENDIX G DENTAL PLAN The nine (9) month limitation applies to 1) polishing, 2) the application of fluoride, and 3) the recall itself. The nine (9) month limitation does not apply to scaling; any current scaling limits in dental contracts apply.

List of Eligible Expenses. Medical Travel: When ordered by the attending physician because in his/her opinion adequate medical treatment is not available within a 100 kilometre radius of the employee’s home campus, the following are included as eligible expenses:  Ø Public transportation (e.g. scheduled air, rail, bus, taxi and/or ferry);  Ø Automobile use as set out in the policy or collective agreement (as applicable) of employee’s institution Accommodation: Where transportation has been provided as outlined above, accommodation in a commercial facility, Easter Seal House, Xxxxxxx House, Vancouver Lodge, Xxxxxx XxXxxxxx House, or other similar institutions as approved by the administrator, before and after medical treatment. Meals: Where transportation has been provided above, reasonable and customary expenses for meals as set out in the policy or collective agreement (as applicable) of the employee’s institution. Attendant: Where necessary, and at the request of the attending physician, transportation and accommodation of an attendant (e.g. family member or registered nurse) in connection with expenses incurred under items 1 and 2 above. Superior Benefits A superior benefit that existed in an institution's Medical Travel Referral Benefit Plan or Collective agreement that was in place prior to the 1998 Common Agreement continues to apply. Exclusions No benefit shall be payable for:  Ø Charges which are considered an insured service of any provincial government plan;  Ø Charges which are considered an insured service under the extended health plan, or any other group plan in force at the time;  Ø Charges for a surgical procedure or treatment performed primarily for beautification, or charges for hospital confinement for such surgical procedure or treatment;  Ø Charges for medical treatment, transport or travel, other than specifically provided under eligible expenses;  Ø Charges not included in the list of eligible expenses;  Ø Charges for services and supplies which are furnished without the recommendation and approval of a physician acting within the scope of his/her license;  Ø Charges which are not medically necessary to the care and treatment of any existing or suspected injury, disease or pregnancy;  Ø Charges which are from an occupational injury or disease covered by any Workers’ Compensation legislation or similar legislation;  Ø Charges which would not normally have been incurred but for the presence of this coverage or for which the employee or dependent is not legally allowed to pay;  Ø Charges which the administrator is not permitted, by any law to cover;  Ø Charges for dental work where a third party is responsible for payments of such charges;  Ø Charges for bodily injury resulting directly or indirectly from war or act of war (whether declared or undeclared), insurrection or riot, or hostilities of any kind;  Ø Charges for services and supplies resulting from any intentionally self-inflicted wound;  Ø Charges for experimental procedures or treatment not approved by the Canadian Medical Association or the appropriate medical speciality society;  Ø Charges made by a physician for travel, broken appointments, communication costs, filling in forms, or physician’s supplies. Claims Adjudication To claim benefits, the employee or dependent must:  Ø Submit original receipts or photocopies of receipts if accompanied by an explanation of benefits from another carrier, and a claim form;  Ø Provide explanation and proof to support the claim including itemized bills and the attending physician’s statement that the referral to the location where treatment was received was medically necessary;  Ø Provide explanation and proof to support the claim that an attendant (if any) was necessary and made at the request of an attending physician. APPENDIX G DENTAL PLAN The nine (9) month limitation applies to 1) polishing, 2) the application of fluoride, and 3) the recall itself. The nine (9) month limitation does not apply to scaling; any current scaling limits in dental contracts apply.. The process for an individual faculty employee to have his/her teeth cleaned more frequently than every nine (9) months as provided by Article 9.2.1 (d) is as follows: Ø Faculty employee visits dentist as usual Ø Dentist advises that the faculty employee has gum disease or other dental problem which requires cleaning more frequently than every nine (9) months Ø Dentist fills in the usual claim form, but in addition notes that the faculty employee has gum disease or specifies the other dental problem that requires more frequent cleaning Ø Faculty employee or dentist submits the form to the Insurance Carrier as normal Ø The Insurance Carrier determines if the reasons set out by the dentist fit within the approved reasons under the dental plan for having teeth cleaned more frequently than every nine(9) months The employers’ approval of the more frequent cleaning is not required. APPENDIX H