Common use of MAJOR MEDICAL EXPENSE BENEFIT Clause in Contracts

MAJOR MEDICAL EXPENSE BENEFIT. Basic medical benefits are provided for you and your family under your provincial health plan (OHIP). The major medical expense benefit under the Company’s group insurance plan provides benefits for you and your covered dependents for certain expenses not covered by the provincial hospital and medical plans. Expenses allowed under the major medical expense benefit are listed below. Effective January 1, 2009 there is a lifetime maximum of $750,000 for all major medical expenses per person. Benefits are payable only if the services are recommended by a physician and if provincial legislation does not prohibit insurance of any such expense. • drugs and medicines dispensed on the written prescription of a physician. Reimbursement will be based on the cost of the generic equivalent of a prescription drug, if such an equivalent exists. You will receive full reimbursement of a brand name drug only if a generic equivalent does not exist, or if your physician provides specific instructions prohibiting substitution. Effective January 1, 2009 a maximum of $10.00 dispensing fee per prescription will be reimbursed. • private duty nursing by registered graduate nurses who are not ordinarily resident in your home and are not related to you or your dependents • hospital charges for other than room and board not paid by the provincial plan • oxygen and its administration • blood and blood plasma • rental of wheel chair, hospital bed or respirator/ ventilator • splints, trusses, braces, crutches, casts • artificial limbs and eyes provided the loss of the natural limb or eye occurred while insured under this plan • services of duly qualified and licensed physiotherapists other than members of the insured’s family • local ambulance services • emergency transportation by a licensed ground ambulance, including air ambulance, to and from the nearest hospital in which treatment can be provided (subject to one round trip per calendar year). • services of a licensed chiropractor or osteopath when operating in their recognized field of expertise (eligible only after provincial plan maximum has been reached). • services of a licensed Acupuncturist, Podiatrist, Homeopath, Massage Therapist, Naturopath, Psychologist or Speech Therapist. These practitioner services are reimbursable only after any applicable provincial plan maximum has been reached and subject to a total annual maximum benefit of $500 for these services. The following items are covered when prescribed by a physician or optometrist: • frames, lenses and the fitting of any type of prescription glasses (including contact lenses), up to a total payment of $200.00 every twenty-four (24) months for each eligible insured person, and $200.00 every twelve months for dependent children under the age of eighteen (18) years. Effective January 1, 2009 the total payment increases to $250.00 / 24 months per person. • Laser surgery once in a lifetime for employees only with an optometrist’s recommendation. Maximum reimbursement is $1,000. • contact lenses, up to a total payment of $180.00 per person in any two (2) consecutive calendar years, if they are prescribed for severe corneal astigmatism, severe corneal scarring, keratoconus or aphakia, and if visual acuity can only be improved by contact lenses to at least the 20/40 level. You are required to pay the first $10 of expenses incurred in each calendar year. This is known as the “deductible” and is applied to each insured person, employee or dependent, except that the total deductible for all members of your family will not be more than $20 in each calendar year. If expenses which are included in the deductible occur within the last three months of the calendar year the same expenses may be applied against the deductible for the next calendar year. If two or more insured members of your family are injured in a common accident only one deductible will be applied against their resulting combined expenses incurred in any one calendar year. The amount of benefit payable is determined as follows: (a) the charges are totalled for all allowable expenses incurred by the employee or dependent during the calendar year (b) from this total the deductible is subtracted (c) the major medical expense benefit then pays 100% of the remainder The major medical expense benefit does not cover periodic health check-ups and examinations, eye refractions or fitting of glasses, dental services, travel for health, expenses resulting from an act of war, charges for hospital room and board, hospital and medical expenses for services covered by the provincial plan, expenses for injury or illness covered by Worker’s Compensation Act, or any service for which an employee or dependent does not have to pay. If when you retire you are entitled to group life insurance as explained in Section 3, you and your eligible dependents will continue to be insured for major medical expense benefits. You will continue to be required to pay the first $10 of expenses incurred in each calendar year as a “deductible” applied to each insured person with the total deductible for all members of your family not to exceed $20 in each calendar year. You will then be reimbursed for 80% of any eligible expenses incurred after the date of your retirement in excess of the deductible. The maximum total amount payable for expenses incurred after your date of retirement is $20,000 for each individual member of your family. If you terminate service and do not qualify for retired benefits your major medical insurance will be cancelled as of the date on which your service is terminated, except that the following extended benefits are provided: (a) if you are totally disabled when your insurance is cancelled, major medical benefits will be extended for up to one year, provided such expenses are incurred during the continuance of that disability (b) if one of your dependents is in hospital when your insurance is cancelled, benefits will be extended for a maximum of one year provided the dependent remains in the hospital (c) if you or your dependent spouse are pregnant on the date insurance coverage is cancelled, benefits will be payable for treatment as a result of that pregnancy.

Appears in 1 contract

Samples: Collective Bargaining Agreement

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MAJOR MEDICAL EXPENSE BENEFIT. Basic medical benefits are provided for you and your family under your provincial health plan (OHIP). The major medical expense benefit under the Company’s 's group insurance plan provides benefits for you and your covered dependents for certain expenses not covered by the provincial hospital and medical plans. Expenses allowed under the major medical expense benefit are listed below. Effective January 1, 2009 there is a lifetime maximum of $750,000 for all major medical expenses per person. Benefits are payable only if the services are recommended by a physician and if provincial legislation does not prohibit insurance of any such expense. drugs and medicines (except over-the-counter drugs) dispensed on the written prescription of a physician. Reimbursement will be based on the cost of the generic equivalent of a prescription drug, if such an equivalent exists. You will receive full reimbursement of a brand name drug only if a generic equivalent does not exist, or if your physician provides specific instructions prohibiting substitution. Effective January 1, 2009 a maximum of $10.00 dispensing fee per prescription will be reimbursed. • private duty nursing by registered graduate nurses who are not ordinarily resident in your home and are not related to you or your dependents hospital charges for other than room and board not paid by the provincial plan oxygen and its administration blood and blood plasma rental of wheel chair, hospital bed or respirator/ respirator/ventilator splints, trusses, braces, crutches, casts artificial limbs and eyes provided the loss of the natural limb or eye occurred while insured under this plan services of duly qualified and licensed physiotherapists other than members of the insured’s 's family local ambulance services emergency transportation by a licensed ground ambulance, including air ambulance, to and from the nearest hospital in which treatment can be provided (subject to one round trip per calendar year). services of a licensed chiropractor or osteopath when operating in their recognized field of expertise (eligible only after provincial plan maximum has been reached). services of a licensed provided by the following: Acupuncturist, Podiatrist, Homeopath, Massage Therapist, Naturopath, Psychologist or Psychologist, Speech Therapist. These All practitioner services are reimbursable only after any applicable provincial plan maximum has been reached and subject to a total annual maximum benefit of $500 for these such services. The following items are covered when prescribed by a physician or optometrist: • frames, lenses and the fitting of any type of prescription glasses (including contact lenses), when prescribed by a physician or optometrist up to a total payment of $200.00 250.00 every twenty-four (24) months for each eligible insured person, and $200.00 250.00 every twelve months for dependent children under the age of eighteen (18) years. Effective January 1, 2009 the total payment increases to $250.00 / 24 months per person. • Laser surgery once in a lifetime for employees only with an optometrist’s recommendation. Maximum reimbursement is $1,000. • contact lenses, up to a total payment of $180.00 per person in any two (2) consecutive calendar years, if they are prescribed for severe corneal astigmatism, severe corneal scarring, keratoconus or aphakia, and if visual acuity can only be improved by contact lenses to at least the 20/40 level. You are required to pay the first $10 of expenses incurred in each calendar year. This is known as the "deductible" and is applied to each insured person, employee or dependent, except that the total deductible for all members of your family will not be more than $20 in each calendar year. If expenses which are included in the deductible occur within the last three months of the calendar year the same expenses may be applied against the deductible for the next calendar year. If two or more insured members of your family are injured in a common accident only one deductible will be applied against their resulting combined expenses incurred in any one calendar year. The amount of benefit payable is determined as follows: (a) a. the charges are totalled totaled for all allowable expenses incurred by the employee or dependent during the calendar year (b) b. from this total the deductible is subtracted (c) c. the major medical expense benefit then pays 100% of the remainder The major medical expense benefit does not cover periodic health check-ups and examinations, eye refractions or fitting of glasses, dental services, travel for health, expenses resulting from an act of war, charges for hospital room and board, hospital and medical expenses for services covered by the provincial plan, expenses for injury or illness covered by Worker’s Compensation Act, or any service for which an employee or dependent does not have to pay. WHAT HAPPENS WHEN I RETIRE? If when you retire you are entitled to group life insurance as explained in Section 3, you and your eligible dependents will continue to be insured for the major medical expense benefitsexpenses listed above, with the exception of vision care. You will continue to be required to pay the first $10 of expenses incurred in each calendar year as a "deductible" applied to each insured person with the total deductible for all members of your family not to exceed $20 in each calendar year. You will then be reimbursed for 80% of any eligible expenses incurred after the date of your retirement in excess of the deductible. The maximum total amount payable for expenses incurred after your date of retirement is $20,000 for each individual member of your family. If you terminate service and do not qualify for retired benefits your major medical insurance will be cancelled as of the date on which your service is terminated, except that the following extended benefits are provided: (a) if you are totally disabled when your insurance is cancelled, major medical benefits will be extended for up to one year, provided such expenses are incurred during the continuance of that disability (b) if one of your dependents is in hospital when your insurance is cancelled, benefits will be extended for a maximum of one year provided the dependent remains in the hospital (c) if you or your dependent spouse are pregnant on the date insurance coverage is cancelled, benefits will be payable for treatment as a result of that pregnancy.

Appears in 1 contract

Samples: Collective Agreement

MAJOR MEDICAL EXPENSE BENEFIT. Basic medical benefits are provided for you and your family under your provincial health plan (OHIP). The major medical expense benefit under the Company’s 's group insurance plan provides benefits for you and your covered dependents for certain expenses not covered by the provincial hospital and medical plans. Expenses allowed under the major medical expense benefit are listed below. Effective January 1, 2009 there is a lifetime maximum of $750,000 for all major medical expenses per person. Benefits are payable only if the services are recommended by a physician and if provincial legislation does not prohibit insurance of any such expense. • drugs Drugs and medicines dispensed on the written prescription of a physician. Reimbursement will be based on the cost of the generic equivalent of a prescription drug, if such an equivalent exists. You will receive full reimbursement of a brand name drug only if a generic equivalent does not exist, or if your physician provides specific instructions prohibiting substitution. Effective January 1, 2009 a maximum of $10.00 dispensing fee per prescription will be reimbursed. Effective January 1, 2018 a maximum of $8.00 dispensing fee per prescription will be reimbursed. • private duty nursing by registered graduate nurses who are not ordinarily resident in your home and are not related to you or your dependents • hospital charges for other than room and board not paid by the provincial plan • oxygen and its administration • blood and blood plasma • rental of wheel chair, hospital bed or respirator/ ventilator • splints, trusses, braces, crutches, casts • artificial limbs and eyes provided the loss of the natural limb or eye occurred while insured under this plan • services of duly qualified and licensed physiotherapists other than members of the insured’s 's family • local ambulance services • emergency transportation by a licensed ground ambulance, including air ambulance, to and from the nearest hospital in which treatment can be provided (subject to one round trip per calendar year). • services of a licensed chiropractor or osteopath when operating in their recognized field of expertise (eligible only after provincial plan maximum has been reached). • services of a licensed Acupuncturist, Podiatrist, Homeopath, Massage Therapist, Naturopath, Psychologist or Speech Therapist. These practitioner services are reimbursable only after any applicable provincial plan maximum has been reached and subject to a total annual maximum benefit of $500 for these services. The following items are covered when prescribed by a physician or optometrist: • frames, lenses and the fitting of any type of prescription glasses (including contact lenses), up to a total payment of $200.00 every twenty-four (24) months for each eligible insured person, and $200.00 every twelve months for dependent children under the age of eighteen (18) years. Effective January 1, 2009 the total payment increases to $250.00 / 24 months per person. • Laser surgery once in a lifetime for employees only with an optometrist’s recommendation. Maximum reimbursement is $1,000. • contact lenses, up to a total payment of $180.00 per person in any two (2) consecutive calendar years, if they are prescribed for severe corneal astigmatism, severe corneal scarring, keratoconus or aphakia, and if visual acuity can only be improved by contact lenses to at least the 20/40 level. You are required to pay the first $10 of expenses incurred in each calendar year. This is known as the "deductible" and is applied to each insured person, employee or dependent, except that the total deductible for all members of your family will not be more than $20 in each calendar year. If expenses which are included in the deductible occur within the last three months of the calendar year the same expenses may be applied against the deductible for the next calendar year. If two or more insured members of your family are injured in a common accident only one deductible will be applied against their resulting combined expenses incurred in any one calendar year. The deductible will be eliminated as of January 1, 2018 The amount of benefit payable is determined as follows: (a) the charges are totalled for all allowable expenses incurred by the employee or dependent during the calendar year (b) from this total the deductible is subtracted (c) the major medical expense benefit then pays 100% of the remainder remainder. Effective on January 1, 2018 reimbursement is at 90% and on January 1, 2020 at 80%. The major medical expense benefit does not cover periodic health check-ups and examinations, eye refractions or fitting of glasses, dental services, travel for health, expenses resulting from an act of war, charges for hospital room and board, hospital and medical expenses for services covered by the provincial plan, expenses for injury or illness covered by Worker’s 's Compensation Act, or any service for which an employee or dependent does not have to pay. If when you retire (and subject to the limitations set out below) you are entitled to group life insurance as explained in Section 3, you and your eligible dependents will continue to be insured for major medical expense benefits. You will continue to be required to pay the first $10 of expenses incurred in each calendar year as a "deductible" applied to each insured person with the total deductible for all members of your family not to exceed $20 in each calendar year. New employees hired after July 18, 2015 will not be eligible for post-retirement benefits. Employees who elect to retired after January 1, 2018 will cease to be eligible for post- retirement benefits coverage after reaching 65 years of age. Coverage for eligible dependents will also cease upon the employee reaching 65 years of age. If an employee dies prior to reaching age 65, coverage for surviving dependents will be extended until the date of the deceased employee’s 65th birthday. You will then be reimbursed for 80% of any eligible expenses incurred after the date of your retirement in excess of the deductible. The maximum total amount payable for expenses incurred after your date of retirement is $20,000 for each individual member of your family. If you terminate service and do not qualify for retired benefits your major medical insurance will be cancelled as of the date on which your service is terminated, except that the following extended benefits are provided: (a) if you are totally disabled when your insurance is cancelled, major medical benefits will be extended for up to one year, provided such expenses are incurred during the continuance of that disability (b) if one of your dependents is in hospital when your insurance is cancelled, benefits will be extended for a maximum of one year provided the dependent remains in the hospital (c) if you or your dependent spouse are pregnant on the date insurance coverage is cancelled, benefits will be payable for treatment as a result of that pregnancy.

Appears in 1 contract

Samples: Collective Agreement

MAJOR MEDICAL EXPENSE BENEFIT. Basic medical benefits are provided for you and your family under your provincial health plan (OHIP). The major medical expense benefit under the Company’s 's group insurance plan provides benefits for you and your covered dependents for certain expenses not covered by the provincial hospital and medical plans. Expenses allowed under the major medical expense benefit are listed below. Effective January 1, 2009 there is a lifetime maximum of $750,000 for all major medical expenses per person. Benefits are payable only if the services are recommended by a physician and if provincial legislation does not prohibit insurance of any such expense. π drugs and medicines (except over-the-counter drugs) dispensed on the written prescription of a physician. Reimbursement will be based on the cost of the generic equivalent of a prescription drug, if such an equivalent exists. You will receive full reimbursement of a brand name drug only if a generic equivalent does not exist, or if your physician provides specific instructions prohibiting substitution. Effective January 1, 2009 a maximum of $10.00 dispensing fee per prescription will be reimbursed. • π private duty nursing by registered graduate nurses who are not ordinarily resident in your home and are not related to you or your dependents π hospital charges for other than room and board not paid by the provincial plan π oxygen and its administration π blood and blood plasma π rental of wheel chair, hospital bed or respirator/ respirator/ventilator π splints, trusses, braces, crutches, casts π artificial limbs and eyes provided the loss of the natural limb or eye occurred while insured under this plan π services of duly qualified and licensed physiotherapists other than members of the insured’s 's family π local ambulance services π emergency transportation by a licensed ground ambulance, including air ambulance, to and from the nearest hospital in which treatment can be provided (subject to one round trip per calendar year). π services of a licensed chiropractor or osteopath when operating in their recognized field of expertise (eligible only after provincial plan maximum has been reached). π services of a licensed provided by the following: Acupuncturist, Podiatrist, Homeopath, Massage Therapist, Naturopath, Psychologist or Psychologist, Speech Therapist. These All practitioner services are reimbursable only after any applicable provincial plan maximum has been reached and subject to a total annual maximum benefit of $500 for these such services. The following items are covered when prescribed by a physician or optometrist: • π frames, lenses and the fitting of any type of prescription glasses (including contact lenses), when prescribed by a physician or optometrist up to a total payment of $200.00 250.00 every twenty-four (24) months for each eligible insured person, and $200.00 250.00 every twelve months for dependent children under the age of eighteen (18) years. Effective January 1, 2009 the total payment increases to $250.00 / 24 months per person. • π Laser surgery once in a lifetime for employees only with an optometrist’s recommendation. Maximum reimbursement is $1,000. • contact lensesπ As of January 1, up to a total payment 2018, eye exam reimbursement will be made every twenty four (24) months at 70% of $180.00 per person in any two (2) consecutive calendar years, if they are prescribed for severe corneal astigmatism, severe corneal scarring, keratoconus or aphakia, and if visual acuity can only be improved by contact lenses to at least the 20/40 levelreceipted costs. You are required to pay the first $10 of expenses incurred in each calendar year. This is known as the "deductible" and is applied to each insured person, employee or dependent, except that the total deductible for all members of your family will not be more than $20 in each calendar year. If expenses which are included in the deductible occur within the last three months of the calendar year the same expenses may be applied against the deductible for the next calendar year. If two or more insured members of your family are injured in a common accident only one deductible will be applied against their resulting combined expenses incurred in any one calendar year. The amount of benefit payable is determined as follows: (a) a. the charges are totalled totaled for all allowable expenses incurred by the employee or dependent during the calendar year (b) b. from this total the deductible is subtracted (c) c. the major medical expense benefit then pays 100% of the remainder The remainder. As of January 1, 2018, the major medical expense benefit does not cover periodic health check-ups pays at 90% of the remainder and examinationsas of January 1, eye refractions or fitting of glasses2020, dental services, travel for health, expenses resulting from an act of war, charges for hospital room and board, hospital and medical expenses for services covered by the provincial plan, expenses for injury or illness covered by Worker’s Compensation Act, or any service for which an employee or dependent does not have to pay. If when you retire you are entitled to group life insurance as explained in Section 3, you and your eligible dependents will continue to be insured for major medical expense benefits. You will continue to be required to pay the first $10 of expenses incurred in each calendar year as a “deductible” applied to each insured person with the total deductible for all members of your family not to exceed $20 in each calendar year. You will then be reimbursed for benefit pays at 80% of any eligible expenses incurred after the date of your retirement in excess of the deductible. The maximum total amount payable for expenses incurred after your date of retirement is $20,000 for each individual member of your family. If you terminate service and do not qualify for retired benefits your major medical insurance will be cancelled as of the date on which your service is terminated, except that the following extended benefits are provided:remainder WHAT HAPPENS WHEN I RETIRE? (a) a. if you are totally disabled when your insurance is cancelled, major medical benefits will be extended for up to one year, provided such expenses are incurred during the continuance of that disability (b) b. if one of your dependents is in hospital when your insurance is cancelled, benefits will be extended for a maximum of one year provided the dependent remains in the hospital (c) c. if you or your a dependent spouse are wife is pregnant on the date her insurance coverage is cancelled, benefits will be payable for treatment as a result of that pregnancy.

Appears in 1 contract

Samples: Collective Agreement

MAJOR MEDICAL EXPENSE BENEFIT. Basic medical benefits are provided for you and your family under your provincial health plan (OHIP). The major medical expense benefit under the Company’s 's group insurance plan provides benefits for you and your covered dependents for certain expenses not covered by the provincial hospital and medical plans. Expenses allowed under the major medical expense benefit are listed below. Effective January 1, 2009 there is a lifetime maximum of $750,000 for all major medical expenses per person. Benefits are payable only if the services are recommended by a physician and if provincial legislation does not prohibit insurance of any such expense. π drugs and medicines (except over-the-counter drugs) dispensed on the written prescription of a physician. Reimbursement will be based on the cost of the generic equivalent of a prescription drug, if such an equivalent exists. You will receive full reimbursement of a brand name drug only if a generic equivalent does not exist, or if your physician provides specific instructions prohibiting substitution. Effective January 1, 2009 a maximum of $10.00 dispensing fee per prescription will be reimbursed. • π private duty nursing by registered graduate nurses who are not ordinarily resident in your home and are not related to you or your dependents π hospital charges for other than room and board not paid by the provincial plan π oxygen and its administration π blood and blood plasma π rental of wheel chair, hospital bed or respirator/ respirator/ventilator π splints, trusses, braces, crutches, casts π artificial limbs and eyes provided the loss of the natural limb or eye occurred while insured under this plan π services of duly qualified and licensed physiotherapists other than members of the insured’s 's family π local ambulance services π emergency transportation by a licensed ground ambulance, including air ambulance, to and from the nearest hospital in which treatment can be provided (subject to one round trip per calendar year). π services of a licensed chiropractor or osteopath when operating in their recognized field of expertise (eligible only after provincial plan maximum has been reached). π services of a licensed provided by the following: Acupuncturist, Podiatrist, Homeopath, Massage Therapist, Naturopath, Psychologist or Psychologist, Speech Therapist. These All practitioner services are reimbursable only after any applicable provincial plan maximum has been reached and subject to a total annual maximum benefit of $500 for these such services. The following items are covered when prescribed by a physician or optometrist: • π frames, lenses and the fitting of any type of prescription glasses (including contact lenses), when prescribed by a physician or optometrist up to a total payment of $200.00 250.00 every twenty-four (24) months for each eligible insured person, and $200.00 250.00 every twelve months for dependent children under the age of eighteen (18) years. Effective January 1, 2009 the total payment increases to $250.00 / 24 months per person. • π Laser surgery once in a lifetime for employees only with an optometrist’s recommendation. Maximum reimbursement is $1,000. • contact lensesπ As of January 1, up to a total payment 2018, eye exam reimbursement will be made every twenty four (24) months at 70% of $180.00 per person in any two (2) consecutive calendar years, if they are prescribed for severe corneal astigmatism, severe corneal scarring, keratoconus or aphakia, and if visual acuity can only be improved by contact lenses to at least the 20/40 levelreceipted costs. You are required to pay the first $10 of expenses incurred in each calendar year. This is known as the "deductible" and is applied to each insured person, employee or dependent, except that the total deductible for all members of your family will not be more than $20 in each calendar year. If expenses which are included in the deductible occur within the last three months of the calendar year the same expenses may be applied against the deductible for the next calendar year. If two or more insured members of your family are injured in a common accident only one deductible will be applied against their resulting combined expenses incurred in any one calendar year. The amount of benefit payable is determined as follows: (a) a. the charges are totalled totaled for all allowable expenses incurred by the employee or dependent during the calendar year (b) b. from this total the deductible is subtracted (c) c. the major medical expense benefit then pays 100% of the remainder The remainder. As of January 1, 2018, the major medical expense benefit does not cover periodic health check-ups pays at 90% of the remainder and examinationsas of January 1, eye refractions or fitting of glasses2020, dental services, travel for health, expenses resulting from an act of war, charges for hospital room and board, hospital and medical expenses for services covered by the provincial plan, expenses for injury or illness covered by Worker’s Compensation Act, or any service for which an employee or dependent does not have to pay. If when you retire you are entitled to group life insurance as explained in Section 3, you and your eligible dependents will continue to be insured for major medical expense benefits. You will continue to be required to pay the first $10 of expenses incurred in each calendar year as a “deductible” applied to each insured person with the total deductible for all members of your family not to exceed $20 in each calendar year. You will then be reimbursed for benefit pays at 80% of any eligible expenses incurred after the date of your retirement in excess of the deductible. The maximum total amount payable for expenses incurred after your date of retirement is $20,000 for each individual member of your family. If you terminate service and do not qualify for retired benefits your major medical insurance will be cancelled as of the date on which your service is terminated, except that the following extended benefits are provided:remainder WHAT HAPPENS WHEN I RETIRE? (a) a. if you are totally disabled when your insurance is cancelled, major medical benefits will be extended for up to one year, provided such expenses are incurred during the continuance of that disabilitythe (b) b. if one of your dependents is in hospital when your insurance is cancelled, benefits will be extended for a maximum of one year provided the dependent remains in the hospital (c) c. if you or your a dependent spouse are wife is pregnant on the date her insurance coverage is cancelled, benefits will be payable for treatment as a result of that pregnancy.

Appears in 1 contract

Samples: Collective Agreement

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MAJOR MEDICAL EXPENSE BENEFIT. Basic medical benefits are provided for you and your family under your provincial health plan (OHIP). The major medical expense benefit under the Company’s 's group insurance plan provides benefits for you and your covered dependents for certain expenses not covered by the provincial hospital and medical plans. Expenses allowed under the major medical expense benefit are listed below. Effective January 1, 2009 there is a lifetime maximum of $750,000 for all major medical expenses per person. Benefits are payable only if the services are recommended by a physician and if provincial legislation does not prohibit insurance of any such expense. • drugs Drugs and medicines dispensed on the written prescription of a physician. Reimbursement will be based on the cost of the generic equivalent of a prescription drug, if such an equivalent exists. You will receive full reimbursement of a brand name drug only if a generic equivalent does not exist, or if your physician provides specific instructions prohibiting substitution. Effective January 1, 2009 a maximum of $10.00 dispensing fee per prescription will be reimbursed. Effective January 1, 2018 a maximum of $8.00 dispensing fee per prescription will be reimbursed. • private duty nursing by registered graduate nurses who are not ordinarily resident in your home and are not related to you or your dependents • hospital charges for other than room and board not paid by the provincial plan • oxygen and its administration • blood and blood plasma • rental of wheel chairwheelchair, hospital bed or respirator/ respirator/ventilator • splints, trusses, braces, crutches, casts • artificial limbs and eyes provided the loss of the natural limb or eye occurred while insured under this plan • services of duly qualified and licensed physiotherapists other than members of the insured’s 's family • local ambulance services • emergency transportation by a licensed ground ambulance, including air ambulance, to and from the nearest hospital in which treatment can be provided (subject to one round trip per calendar year). • services of a licensed chiropractor or osteopath when operating in their recognized field of expertise (eligible only after provincial plan maximum has been reached). • services of a licensed Acupuncturist, Podiatrist, Homeopath, Massage Therapist, Naturopath, Psychologist or Speech Therapist. These practitioner services are reimbursable only after any applicable provincial plan maximum has been reached and subject to a total annual maximum benefit of $500 for these services. • Services of a licensed Psychology, Psychotherapist, Social Worker, Marriage and Family Therapist, or Clinical Counsellor to a total annual maximum of $750 for these services. • Wigs limited to 1 per lifetime • Gender affirmation procedures covered up to $15,000 per lifetime. Insurer standard provisions will apply. • Viscosupplementation • Hearing Aids - $500 every 3 calendar years • Out of country emergency medical travel coverage. Insurer standard provisions will apply. The following items are covered when prescribed by a physician or optometrist: • frames, lenses and the fitting of any type of prescription glasses (including contact lenses), up to a total payment of $200.00 every twenty-four (24) months for each eligible insured person, and $200.00 every twelve months for dependent children under the age of eighteen (18) years. Effective January 1, 2009 the total payment increases to $250.00 250 / 24 months per person. Effective January 1, 2023 the total payment increases to $300 / 24 months per person (children every 12 months). • Eye examinations limited to 1 exam every 24 months per person, and every 12 months per child. • Laser surgery once in a lifetime for employees only with an optometrist’s recommendation. Maximum reimbursement is $1,000. • contact lenses, up to a total payment of $180.00 per person in any two (2) consecutive calendar years, if they are prescribed for severe corneal astigmatism, severe corneal scarring, keratoconus or aphakia, and if visual acuity can only be improved by contact lenses to at least the 20/40 level. You are required to pay the first $10 of expenses incurred in each calendar year. This is known as the "deductible" and is applied to each insured person, employee or dependent, except that the total deductible for all members of your family will not be more than $20 in each calendar year. If expenses which are included in the deductible occur within the last three months of the calendar year the same expenses may be applied against the deductible for the next calendar year. If two or more insured members of your family are injured in a common accident only one deductible will be applied against their resulting combined expenses incurred in any one calendar year. The deductible will be eliminated as of January 1, 2018 The amount of benefit payable is determined as follows: (a) the charges are totalled for all allowable expenses incurred by the employee or dependent during the calendar year (b) from this total the deductible is subtracted (c) the major medical expense benefit then pays 100% of the remainder remainder. Effective on January 1, 2018 reimbursement is at 90% and on January 1, 2020 at 80%. The major medical expense benefit does not cover periodic health check-ups and examinations, eye refractions or fitting of glasses, dental services, travel for health, expenses resulting from an act of war, charges for hospital room and board, hospital and medical expenses for services covered by the provincial plan, expenses for injury or illness covered by Worker’s 's Compensation Act, or any service for which an employee or dependent does not have to pay. If when you retire (and subject to the limitations set out below) you are entitled to group life insurance as explained in Section 3, you and your eligible dependents will continue to be insured for major medical expense benefits. You will continue to be required to pay the first $10 of expenses incurred in each calendar year as a "deductible" applied to each insured person with the total deductible for all members of your family not to exceed $20 in each calendar year. New employees hired after July 18, 2015, will not be eligible for post-retirement benefits. Employees who elect to retired after January 1, 2018, will cease to be eligible for post- retirement benefits coverage after reaching 65 years of age. Coverage for eligible dependents will also cease upon the employee reaching 65 years of age. If an employee dies prior to reaching age 65, coverage for surviving dependents will be extended until the date of the deceased employee’s 65th birthday. You will then be reimbursed for 80% of any eligible expenses incurred after the date of your retirement in excess of the deductible. The maximum total amount payable for expenses incurred after your date of retirement is $20,000 for each individual member of your family. If you terminate service and do not qualify for retired benefits your major medical insurance will be cancelled as of the date on which your service is terminated, except that the following extended benefits are provided: (ad) if you are totally disabled when your insurance is cancelled, major medical benefits will be extended for up to one year, provided such expenses are incurred during the continuance of that disability (be) if one of your dependents is in hospital when your insurance is cancelled, benefits will be extended for a maximum of one year provided the dependent remains in the hospital (cf) if you or your dependent spouse are pregnant on the date insurance coverage is cancelled, benefits will be payable for treatment as a result of that pregnancy.

Appears in 1 contract

Samples: Collective Agreement

MAJOR MEDICAL EXPENSE BENEFIT. Basic medical benefits are provided for you and your family under your provincial health plan (OHIP). The major medical expense benefit under the Company’s 's group insurance plan provides benefits for you and your covered dependents for certain expenses not covered by the provincial hospital and medical plans. Expenses allowed under the major medical expense benefit are listed below. Effective January 1, 2009 there There is a lifetime maximum of $750,000 for all major medical expenses per personexpense benefits for active seniority employees. Benefits are payable only if the services are recommended by a physician and if provincial legislation does not prohibit insurance of any such expense. • drugs and medicines dispensed on the written prescription of a physician. Reimbursement will be based on the cost of the generic equivalent of a prescription drug, if such an equivalent exists. You will receive full reimbursement of a brand name drug only if a generic equivalent does not exist, or if your physician provides specific instructions prohibiting substitution. Effective January 1, 2009 a A maximum of $10.00 dispensing fee per prescription will be reimbursedreimbursed for dispensing fees. • private duty nursing by registered graduate nurses who are not ordinarily resident in your home and are not related to you or your dependents • hospital charges for other than room and board not paid by the provincial plan • oxygen and its administration • blood and blood plasma • rental of wheel chair, hospital bed or respirator/ ventilator • splints, trusses, braces, crutches, casts • artificial limbs and eyes provided the loss of the natural limb or eye occurred while insured under this plan • services of duly qualified and licensed physiotherapists other than members of the insured’s 's family • local ambulance services • emergency transportation by a licensed ground ambulance, including air ambulance, to and from the nearest hospital in which treatment can be provided (subject to one round trip per calendar year). • services of a licensed chiropractor or osteopath when operating in their recognized field of expertise (eligible only after provincial plan maximum has been reached). • services of a licensed Acupuncturist, Podiatrist, Homeopath, Massage Therapist, Naturopath, Psychologist or Speech Therapist. These practitioner services are reimbursable only after any applicable provincial plan maximum has been reached and subject to a total annual maximum benefit of $500 for these services. The following items are covered when prescribed by a physician or optometrist: • frames, lenses and the fitting of any type of prescription glasses (including contact lenses), up to a total payment of $200.00 every twenty-four (24) months for each eligible insured person, and $200.00 every twelve months for dependent children under the age of eighteen (18) years. Effective January 1, 2009 the total payment increases to $250.00 / 24 months per person. • Laser surgery once in a lifetime for employees only with an optometrist’s recommendation. Maximum reimbursement is $1,000. • contact lenses, up to a total payment of $180.00 per person in any two (2) consecutive calendar years, if they are prescribed for severe corneal astigmatism, severe corneal scarring, keratoconus or aphakia, and if visual acuity can only be improved by contact lenses to at least the 20/40 level. You are required to pay the first $10 of expenses incurred in each calendar year. This is known as the "deductible" and is applied to each insured person, employee or dependent, except that the total deductible for all members of your family will not be more than $20 in each calendar year. If expenses which are included in the deductible occur within the last three months of the calendar year the same expenses may be applied against the deductible for the next calendar year. If two or more insured members of your family are injured in a common accident only one deductible will be applied against their resulting combined expenses incurred in any one calendar year. The amount of benefit payable is determined as follows: (a) the charges are totalled for all allowable expenses incurred by the employee or dependent during the calendar year (b) from this total the deductible is subtracted (c) the major medical expense benefit then pays 100% of the remainder The major medical expense benefit does not cover periodic health check-ups and examinations, eye refractions or fitting of glasses, dental services, travel for health, expenses resulting from an act of war, charges for hospital room and board, hospital and medical expenses for services covered by the provincial plan, expenses for injury or illness covered by Worker’s 's Compensation Act, or any service for which an employee or dependent does not have to pay. If when you retire you are entitled to group life insurance as explained in Section 3, you and your eligible dependents will continue to be insured for major medical expense benefits. You will continue to be required to pay the first $10 of expenses incurred in each calendar year as a "deductible" applied to each insured person with the total deductible for all members of your family not to exceed $20 in each calendar year. You will then be reimbursed for 80% of any eligible expenses incurred after the date of your retirement in excess of the deductible. The maximum total amount payable for expenses incurred after your date of retirement is $20,000 for each individual member of your family. If you terminate service and do not qualify for retired benefits your major medical insurance will be cancelled as of the date on which your service is terminated, except that the following extended benefits are provided: (a) if you are totally disabled when your insurance is cancelled, major medical benefits will be extended for up to one year, provided such expenses are incurred during the continuance of that disability (b) if one of your dependents is in hospital when your insurance is cancelled, benefits will be extended for a maximum of one year provided the dependent remains in the hospital (c) if you or your dependent spouse are pregnant on the date insurance coverage is cancelled, benefits will be payable for treatment as a result of that pregnancy.

Appears in 1 contract

Samples: Collective Agreement

MAJOR MEDICAL EXPENSE BENEFIT. Basic medical benefits are provided for you and your family under your provincial health plan (OHIP). The major medical expense benefit under the Company’s 's group insurance plan provides benefits for you and your covered dependents for certain expenses not covered by the provincial hospital and medical plans. Expenses allowed under the major medical expense benefit are listed below. Effective January 1, 2009 there is a lifetime maximum of $750,000 for all major medical expenses per person. Benefits are payable only if the services are recommended by a physician and if provincial legislation does not prohibit insurance of any such expense. • drugs and medicines dispensed on the written prescription of a physician. Reimbursement will be based on the cost of the generic equivalent of a prescription drug, if such an equivalent exists. You will receive full reimbursement of a brand name drug only if a generic equivalent does not exist, or if your physician provides specific instructions prohibiting substitution. Effective January 1, 2009 a maximum of $10.00 dispensing fee per prescription will be reimbursed. • π private duty nursing by registered graduate nurses who are not ordinarily resident in your home and are not related to you or your dependents π hospital charges for other than room and board not paid by the provincial plan π oxygen and its administration π blood and blood plasma π rental of wheel chair, hospital bed or respirator/ respirator/ventilator π splints, trusses, braces, crutches, casts π artificial limbs and eyes provided the loss of the natural limb or eye occurred while insured under this plan π services of duly qualified and licensed physiotherapists other than members of the insured’s 's family π local ambulance services π emergency transportation by a licensed ground ambulance, including air ambulance, to and from the nearest hospital in which treatment can be provided (subject to one round trip per calendar year). π services of a licensed chiropractor or osteopath when operating in their recognized field of expertise (eligible only after provincial plan maximum has been reached). π services of a licensed provided by the following: Acupuncturist, Podiatrist, Homeopath, Massage Therapist, Naturopath, Psychologist or Psychologist, Speech Therapist. These All practitioner services are reimbursable only after any applicable provincial plan maximum has been reached and subject to a total annual maximum benefit of $500 for these such services. The following items are covered when prescribed by a physician or optometrist: • π frames, lenses and the fitting of any type of prescription glasses (including contact lenses), when prescribed by a physician or optometrist up to a total payment of $200.00 250.00 every twenty-four (24) months for each eligible insured person, and $200.00 250.00 every twelve months for dependent children under the age of eighteen (18) years. Effective January 1, 2009 the total payment increases to $250.00 / 24 months per person. • π Laser surgery once in a lifetime for employees only with an optometrist’s recommendation. Maximum reimbursement is $1,000. • contact lensesπ As of January 1, up to a total payment 2018, eye exam reimbursement will be made every twenty four (24) months at 70% of $180.00 per person in any two (2) consecutive calendar years, if they are prescribed for severe corneal astigmatism, severe corneal scarring, keratoconus or aphakia, and if visual acuity can only be improved by contact lenses to at least the 20/40 levelreceipted costs. You are required to pay the first $10 of expenses incurred in each calendar year. This is known as the "deductible" and is applied to each insured person, employee or dependent, except that the total deductible for all members of your family will not be more than $20 in each calendar year. If expenses which are included in the deductible occur within the last three months of the calendar year the same expenses may be applied against the deductible for the next calendar year. If two or more insured members of your family are injured in a common accident only one deductible will be applied against their resulting combined expenses incurred in any one calendar year. The amount of benefit payable is determined as follows: (a) the charges are totalled for all allowable expenses incurred by the employee or dependent during the calendar year (b) from this total the deductible is subtracted (c) the major medical expense benefit then pays 100% of the remainder The major medical expense benefit does not cover periodic health check-ups and examinations, eye refractions or fitting of glasses, dental services, travel for health, expenses resulting from an act of war, charges for hospital room and board, hospital and medical expenses for services covered by the provincial plan, expenses for injury or illness covered by Worker’s Compensation Act, or any service for which an employee or dependent does not have to pay. If when you retire you are entitled to group life insurance as explained in Section 3, you and your eligible dependents will continue to be insured for major medical expense benefits. You will continue to be required to pay the first $10 of expenses incurred in each calendar year as a “deductible” applied to each insured person with the total deductible for all members of your family not to exceed $20 in each calendar year. You will then be reimbursed for 80% of any eligible expenses incurred after the date of your retirement in excess of the deductible. The maximum total amount payable for expenses incurred after your date of retirement is $20,000 for each individual member of your family. If you terminate service and do not qualify for retired benefits your major medical insurance will be cancelled as of the date on which your service is terminated, except that the following extended benefits are provided: (a) if you are totally disabled when your insurance is cancelled, major medical benefits will be extended for up to one year, provided such expenses are incurred during the continuance of that disability (b) if one of your dependents is in hospital when your insurance is cancelled, benefits will be extended for a maximum of one year provided the dependent remains in the hospital (c) if you or your dependent spouse are pregnant on the date insurance coverage is cancelled, benefits will be payable for treatment as a result of that pregnancy.

Appears in 1 contract

Samples: Collective Agreement

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