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 dollars ($1,000.00) per calendar year for the services of a clinical psychologist engaged in the treatment of a mental or emotional illness of a member or their dependents. Submitted expenses shall be eighty percent (80%) paid for by the Plan. 6.02.06 The Plan shall pay a maximum of $2,500.00 per calendar year for the usual and reasonable costs for the purchase or rental of: 6.02.06.01 Respiratory equipment, including oxygen – CPAP machines are reimbursed at 80% and limited to the purchase of one machine in a 5-year period; 6.02.06.02 Inhalation devices for the delivery of inhaled asthmatic medication on the written order of a physician; 6.02.06.03 Machines for use by diabetics, on the written order of a physician, to monitor glucose reimbursed at eighty percent (80%) and limited to one such machine in each five (5) year period; 6.02.06.04 Air cleaning devices, ionizing machines, vaporizers and humidifiers are excluded. 6.02.07 i Usual and reasonable charges for colostomy, ileostomy, urostomy and adult ncontinence supplies upon written order of a physician.
Appears in 1 contract
Samples: Collective Agreement
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 dollars ($1,000.00) per calendar year for the services of a clinical psychologist engaged in the treatment of a mental or emotional illness of a member or their dependents. Submitted expenses shall be eighty percent (80%) paid for by the Plan.
6.02.06 The Plan shall pay a maximum of $2,500.00 per calendar year for the usual and reasonable costs for the purchase or rental of:
6.02.06.01 Respiratory equipment, including oxygen – CPAP machines are reimbursed at 80% and limited to the purchase of one machine in a 5-year period;
6.02.06.02 Inhalation devices for the delivery of inhaled asthmatic medication on the written order of a physician;
6.02.06.03 Machines for use by diabetics, on the written order of a physician, to monitor glucose reimbursed at eighty percent (80%) and limited to one such machine in each five (5) year period;
6.02.06.04 Air cleaning devices, ionizing machines, vaporizers and humidifiers are excluded.
6.02.07 i Usual and reasonable charges for colostomy, ileostomy, urostomy and adult ncontinence incontinence supplies upon written order of a physician.
6.02.08 The Plan shall pay a maximum of one thousand dollars ($1,000.00) per calendar year for services rendered by a qualified physiotherapist.
6.02.09 The Plan shall pay a maximum of $2,000.00 per calendar year for services rendered by a licensed chiropractor. Submitted eligible expenses shall be eighty percent (80%) paid for by the Plan.
6.02.10 The Plan shall pay a maximum of five hundred dollars ($500.00) per calendar year for services rendered by a licensed podiatrist. The Plan shall not pay for such services until the allowable limits under the Alberta Health Care Plan have been reached. A letter from Alberta Health Care stating the date the maximum was attained shall be submitted with the claim.
6.02.11 The Plan shall pay a maximum of five hundred dollars ($500.00) per calendar year for acupuncture services, provided it is administered as a pain reliever or anaesthetic. Submitted eligible expenses shall be eighty percent (80%) paid for by the Plan.
6.02.12 The Plan shall pay a maximum of $2,500.00 in any five (5) consecutive calendar year period for the purchase and repair of hearing aids as prescribed by a physician. Maintenance, batteries and recharging devices are excluded. Submitted eligible expenses shall be eighty percent (80%) paid for by the Plan.
6.02.13 The Plan shall pay a maximum of $80.00 per covered person in any two consecutive calendar year periods for eye examinations administered by an optometrist or ophthalmologist. Reimbursement shall be based only on amounts not paid by Alberta Health Care.
6.02.14 The Plan shall pay a maximum of $5,000.00 per year for insulin pumps and supplies (excluding transmitters and sensors). Submitted eligible expenses shall be 80% paid for by the Plan. 6.
Appears in 1 contract
Samples: Collective Agreement
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 6.02.01.01 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 dollars ($1,000.00) per calendar year for the services of a clinical psychologist engaged in the treatment of a mental or emotional illness of a member or their his/her dependents. Submitted expenses shall be eighty percent (80%) paid for by the Plan.
6.02.06 The Plan shall pay a maximum of $2,500.00 per calendar year for the usual and reasonable costs for the purchase or rental of:
6.02.06.01 Respiratory equipment, including oxygen – CPAP machines are reimbursed at 80% and limited to the purchase of one machine in a 5-year period;
6.02.06.02 Inhalation devices for the delivery of inhaled asthmatic medication on the written order of a physician;
6.02.06.03 Machines for use by diabetics, on the written order of a physician, to monitor glucose reimbursed at eighty percent (80%) and limited to one such machine in each five (5) year period;
6.02.06.04 Air cleaning devices, ionizing machines, vaporizers and humidifiers are excluded.
6.02.07 i Usual and reasonable charges for colostomy, ileostomy, urostomy and adult ncontinence supplies upon written order of a physician.
Appears in 1 contract
Samples: Collective Agreement
Major Medical Benefits. This Plan will pay eighty percent (80%) of the eligible major medical expenses claimed by a member, 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 that are purchased on a written prescription prescriptions of a physician or dentist and dispensed by a licensed pharmacist. Proprietary or patent medicines or drugs which that 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 6.02.01.01 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 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 ($2,000.002,000) 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 dollars ($1,000.00) per calendar year for the services of a clinical psychologist engaged in the treatment of a mental or emotional illness of a member or their dependents. Submitted expenses shall be eighty percent (80%) paid for by the Plan.
6.02.06 The Plan shall pay a maximum of $2,500.00 per calendar year for the usual and reasonable costs for the purchase or rental of:
6.02.06.01 Respiratory equipment, including oxygen – CPAP machines are reimbursed at 80% and limited to the purchase of one machine in a 5-year period;
6.02.06.02 Inhalation devices for the delivery of inhaled asthmatic medication on the written order of a physician;
6.02.06.03 Machines for use by diabetics, on the written order of a physician, to monitor glucose reimbursed at eighty percent (80%) and limited to one such machine in each five (5) year period;
6.02.06.04 Air cleaning devices, ionizing machines, vaporizers and humidifiers are excluded.
6.02.07 i Usual and reasonable charges for colostomy, ileostomy, urostomy and adult ncontinence supplies upon written order of a physician.four
Appears in 1 contract
Samples: Collective Agreement
