Major Medical Benefits. The City shall provide eligible CSU 52 members, that are participating in the Supplementary Health Care Plan and the Dental Plan, with a Direct Xxxx Card. The Card shall be consistent with that provided to other City of Edmonton employees.
02.01 Eligible Expense % Reimbursement Maximum Benefit DRUGS Charges for drugs, medicines, allergy serums, allergy serum extracts and insulin which are purchased on a written prescription of a physician or dentist and dispensed by a licensed pharmacist, except that proprietary or patent medicines or drugs which can be purchased without a prescription will not be covered. 80% No maximum Smoking cessation products requiring a prescription by law. 80% One treatment plan per lifetime, per covered person. Oral contraceptives 80% $250 per calendar year Drugs for the management of obesity or weight loss, sexual dysfunction, fertility and hair replacement are not eligible for reimbursement. Reimbursement under this article will be made on the following basis: Least cost alternative$5.00 dispensing fee cap Recognized third party drug formulary. New drugs that become available will be reviewed to determine if they will be added to the formulary.
Major Medical Benefits. The City shall provide eligible CSU 52 members, that are participating in the Supplementary Health Care Plan and the Dental Plan, with a Direct Xxxx Card. The Card shall be consistent with that provided to other City of Edmonton employees. Eligible Expense % Reimbursement Maximum Benefit DRUGS Charges for drugs, medicines, allergy serums, allergy serum extracts and insulin which are purchased on a written prescription of a physician or dentist and dispensed by a licensed pharmacist, except that proprietary or patent medicines or drugs which can be purchased without a prescription will not be covered. 80% No maximum Smoking cessation products requiring a prescription by law. 80% One treatment plan per lifetime, per covered person. Oral contraceptives 80% $250 per calendar year Drugs for the management of obesity or weight loss, sexual dysfunction, fertility and hair replacement are not eligible for reimbursement. Reimbursement under this article will be made on the following basis: Least cost alternative $5.00 dispensing fee cap Recognized third party drug formulary. New drugs that become available will The plan will pay in such calendar year in accordance with the following schedule of benefits:
6.02.01 Eligible Expense % Reimbursement Maximum Benefit be reviewed to determine if they will be added to the formulary.
6.02.02 AMBULANCE Charges for professional ambulance services when required due to illness or injury. This includes air transportation where ground transportation is either not available or not medically recommended. Such charges are limited to those incurred within Canada. 80% No maximum
6.02.03 BRACES AND PROSTHETICS The usual and reasonable costs of artificial limbs (excepting myoelectric- controlled prosthesis), artificial eyes, braces which incorporate a rigid support of metal or plastic, trusses, cervical collars, and breast prosthesis as a result of a mastectomy, manufactured according to the specifications on the written order of a physician, and necessary repairs or replacement of such appliances if such repairs or replacement are performed on the written order of a physician. All such appliances must be required to treat an existing medical condition. Repair or replacement of a breast prosthesis shall not require the written order of a physician, however such replacement or repair shall be limited to once in 24 months. 80% $2,000 per calendar year
6.02.04 HOME NURSING Medical care provided, on the written order of a physician, in...
Major Medical Benefits. Including drug and Vision Care. Vision care is limited to four hundred ($400.00) dollars per 24 months. Any portion of this benefit can be used for eye glasses, contact lenses and/or one (1) eye examination per 24 month period.
Major Medical Benefits. A member and his eligible dependents shall be covered for Major Medical Coverage. On a reasonable and customary basis, Major Medical Coverage shall reimburse the member for 90% of the actual charges incurred for all eligible expenses in any calendar year. Subject to an automatic annual reinstatement of up to $1,000.00, the lifetime maximum payment for each covered individual shall not exceed $140,000.00. The Company will continue to address those who reach the Lifetime Maximum on a case-by-case basis.
Major Medical Benefits. The Employer shall pay one hundred percent (100%) of the cost for continuing Major Medical Benefits which are currently in effect for all full-time nurses.
Major Medical Benefits. This Plan will pay eighty percent (80%) of the eligible major medical expenses claimed by a member, unless otherwise specified herein. Eligible expenses are defined in accordance with the following:
6.02.01 Charges for drugs, medicines, allergy serums, allergy serum extracts, asthmatic drugs, and insulin which are purchased on a written prescription of a physician or dentist and dispensed by a licensed pharmacist. Proprietary or patent medicines or drugs which can be purchased without a prescription will not be covered. Reimbursement is based on a recognized third party drug formulary, utilizing lowest–cost alternative drugs. The maximum reimbursement for dispensing fees are as follows: Cost of the Drug Dispensing Fees (excluding Inventory Allowance ) 0 - $74.99 $6.25 (@ 80% - $5.00 reimbursement) $75 - $149 $9.38 (@ 80 % - $7.50 reimbursement) $150 and over $12.50 (@80% - $10.00 reimbursement)
02.01.01 The City will utilize a "pay-direct" method of reimbursement for prescription drugs. Employees that are members of the City's Supplementary Health Care Plan will be provided with a drug card.
6.02.02 For charges of professional ambulance services when required due to illness or injury. This includes air transportation where ground transportation is either not available or not medically recommended. Such charges are limited to those incurred within Canada.
6.02.03 The Plan shall pay a maximum of two thousand dollars ($2,000.00) per calendar year for the usual and reasonable costs of artificial limbs (excepting myo-electric controlled prosthesis), artificial eyes, braces which incorporate a rigid support of metal or plastic, trusses, cervical collars and breast prosthesis resulting from a mastectomy, manufactured according to the specifications on the written order of a physician and necessary repairs or replacement of such appliances if such repairs or replacement are performed on the written order of a physician. All such appliances must be required to treat an existing medical condition. Repair or replacement of a breast prosthesis shall not require a written order of a physician, however, such replacement or repair shall be limited to once in each twenty-four (24) month period.
6.02.04 The Plan shall pay a maximum total of two thousand dollars ($2,000.00) per calendar year, for medical care, on the written order of a physician, in the member's home, to a member or a member's dependent, by a practical or
6.02.05 The Plan shall pay a maximum of one thousand...
Major Medical Benefits. Established major medical plan coverage that in addition to the above coverage for semi private room and board, provides a broad level of medical coverage intended to complement provincial hospital and medical plan benefits by reimbursing a broader range of expenses that exceed the provincial plan reimbursement limit to include:
a) Hospital charges for outpatient services
b) Emergency ambulance service
c) Nursing care in a licensed nursing home for convalescent or chronic care up to $20.00 per day
d) Physiotherapy - $600.00 per year
e) Diagnostic procedures, radiology, blood transfusions and oxygen
Major Medical Benefits. The City shall provide eligible CSU 52 members, that are participating in the Supplementary Health Care Plan and the Dental Plan, with a Direct Xxxx Card. The Card shall be consistent with that provided to other City of Edmonton employees. Eligible Expense % Reimbursement Maximum Benefit Drugs Charges for drugs, medicines, allergy serums, allergy serum extracts and insulin which are purchased on a written prescription of a physician or dentist and dispensed by a licensed pharmacist, except that proprietary or patent medicines or drugs which can be purchased without a prescription will not be covered. 80% No maximum Smoking cessation products requiring a prescription by law. 80% One treatment plan per lifetime, per covered person. Oral contraceptives 80% $250 per calendar year Drugs for the management of obesity or weight loss, sexual dysfunction, fertility and hair replacement are not eligible for reimbursement. Reimbursement under this article will be made on the following basis: ▪ Least cost alternative The plan will pay in such calendar year in accordance with the following schedule of benefits:
6.02.01 ▪ $5.00 dispensing fee cap ▪ Recognized third party drug formulary. New drugs that become available will be reviewed to determine if they will be added to the formulary.
6.02.02 Ambulance Charges for professional ambulance services when required due to illness or injury. This includes air transportation where ground transportation is either not available or not medically recommended. Such charges are limited to those incurred within Canada. 80% No maximum
6.02.03 BRACES AND PROSTHETICS The usual and reasonable costs of artificial limbs (excepting myoelectric-controlled prosthesis), artificial eyes, braces which incorporate a rigid support of metal or plastic, trusses, cervical collars, and breast prosthesis as a result of a mastectomy, manufactured according to the specifications on the written order of a physician, and necessary repairs or replacement of such appliances if such repairs or replacement are performed on the written order of a physician. All such appliances must be required to treat an existing medical condition. Repair or replacement of a breast prosthesis shall not require the written order of a physician, however such replacement or repair shall be limited to once in 24 months. 80% $2,000 per calendar year
6.02.04 HOME NURSING Medical care provided, on the written order of a physician, in the member's home, to a member or a member's de...
Major Medical Benefits. Individual Calendar Year Deductible $200 2016 and thereafter Family Calendar Year Deductible $400 The City reserves the right to unilaterally change health insurance plans and make adjustments to coverages of the health insurance plan. The City will consult with the Union before making significant changes to the plan. Any changes to the plan will be uniform among City employees. Nothing in this Section shall prohibit the City from offering additional health care plans that may have a higher deductible. Generic co-pay (except injected drugs) $ 5.00 Brand co-pay (except injected drugs) $20.00 Injected drugs co-pay $40.00 Any employee that presently has family coverage, and whose spouse has family coverage shall be entitled to a yearly payment of $400 in December, provided that said employee provides evidence of family coverage by their spouse.
Major Medical Benefits. A member and their eligible dependents shall be covered for Major Medical Coverage. On a reasonable and customary basis, Major Medical Coverage shall reimburse the member for 90% of the actual charges incurred for all eligible expenses in any calendar year. Subject to an automatic annual reinstatement of up to $1,000.00, the lifetime maximum payment for each covered individual shall not exceed $160,000.00. The Company will continue to address those who reach the Lifetime Maximum on a case-by-case basis. The cost of obtaining requested medical documentation to satisfy the need for prescription drugs will be reimbursed by the Company.
a. ELIGIBLE EXPENSES SHALL INCLUDE:
1) services and supplies furnished by the hospital for medical care therein, and
2) room and board charges in a licensed nursing home or clinic, and
3) emergency local ambulance service, and
4) professional services of any duly licensed physician, surgeon or psychiatrist, and
5) dental treatment for an accidental injury to natural teeth, and
6) after the annual OHIP maximum payment has expired, up to $30.00. per visit and a maximum of 25 visits per year (effective August 1, 2018) for paramedical services rendered by a duly licensed chiropractor, an osteopath, or podiatrist or naturopath, and
7) charges for the services of a trained, duly licensed nurse, other than a close relative or other person normally resident in your home, when ordered by the attending physician, and
8) speech therapy by a qualified speech therapist, other than a close relative, to restore speech loss or correct an impairment, due to: i) a congenital defect for which corrective surgery has been performed, or
